[Question #6271] Genital Wart biopsy and HPV concerns moving forward

17 months ago

I’m a 60 year old heterosexual man in a monogamous relationship for 42 years. Both my wife and I had very limited sexual experience before marriage - each of us had hand sex with a couple of people and I received oral sex from 1 person. We have had regular intercourse over the 42 years and engaged in oral sex with each other but never any type of anal sex or touching. Both of us have been completely faithful. I noticed a few bumps near my anus so I went to a proctologist. He doubted genital warts but took 3 biopsies to be sure and they came back positive for condyloma  Based on posts in this forum can you clarify the following: 1) We are perplexed since it seems impossible based on our history? 2) the perianal location of the warts does not necessarily mean thats the location I would have contracted the virus? 3) The doctor prescribed Aldara 5% for 8 weeks which I’m unsure if I should start or wait and see since it can irritate the skin and I have sensitive skin 4) either of us could have been the 1st to contract the virus and give it to the other and it could have laid dormant for many many years. Since my wife has no genital warts maybe her immune system killed it but mine obviously has not? 5) I’m unclear if any precautions need to be taken with our sex life such as using condoms or abstinence. 6) We babysit our grandchildren, all under 4 years old, so we need to change diapers and bathe them and when we see them they all want to kiss us. Can you provide any information about precautions for our sex life moving forward and our interaction with our grandkids.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thanks for your question.

Situations like yours are fairly common -- i.e. appearance of new genital area or anal warts in people at no risk for recent HPV infection or other STDs. Throughout modern medical history until 20-30 years ago, when sexual transmission of HPV became better understood, the issue of sexual acquistion or transmission never came up. In a way, that's still the proper way to think of this. STD experts, dermatologists, and other experts have always been aware that some HPV infections recur months or years after initially acquired. Recent research suggests it occurs more often than once thought, perhaps because the immune system naturally becomes less effective with aging. As you already seem to understand, there is no reason to suspect you or your wife have acquired a new HPV infection in recent years.

To your specific questions:

1) It's not impossible at all that you and/or your wife acquired genital HPV. It's common even in people with "very limited" sexual experiences before monogamy. Oral sex is a possible source, and maybe hand-genital contact on rare occasions. But there have always been a small percentage of people with genital area HPV without known source of sexual acquisition. The explanation is unknown.

2) Anal and perineal warts are not rare in people who have never had direct anal sexual exposures. The exact mechanism isn't known, but it probably has to do with both migration of the virus along the skin, i.e. from the genitals; or auto-inoculation, i.e. contacting the anus with one's fingers after contacting the genital area. We don't really know, and it's always impossible to know with certainty in any particular case.

3) There are several treatment; imiquimod (Aldara) is one of them. I suggest you follow your doctor's advice. Or ask for alternatives, such as laser cautery or freezing. (Since you have seen a proctologist, probably he performed anoscopy or proctoscopy to look inside and make sure there are no internal warts. These are not easily treated with Aldara.) Discuss all this with the proctologist.

4,5) Almost certainly this is exactly what is going on:  You, your wife, or both have had longstanding genital area HPV without symptoms, which now has reactivated in you alone. Your wife should be on the lookout for genital area bumps and see her gynecologist if anything shows up. But if she remains without symptoms, nothing need be done. People are immune or highly resistant to new infection with the HPV type(s) they already have had. For that reason, there probably is little or no risk of you (re)infecting your wife on account of your current problem. In any case, there is no point in using condoms or stopping sex at this point. Your current infection probably was active and transmissible for months (even maybe years?) before you noticed the warts. Altering your sexual practices now would be like closing the barn door long after the horse is galloping over distant hills.

6) HPV is never transmitted by nonsexual personal contact, and kids (or adults) never become infected. Use common sense hygiene (e.g. hand washing after toilet), otherwise no worries and no precautions of any kind are necessary.

I'm sorry there are no good answers to your firsr two questions, but I hope this information is helpful and reassuring. Let me know if anything isn't clear.

HHH, MD
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17 months ago
Thanks for the quick response - so very helpful! #3 - Yes the proctologist also used an anoscope and there were no internal warts. The proctologist prescribed the Aldera because his preferred treatment is for it to be used over the entire perianal region rather than just on the warts themselves, thats what caused my concern over my sensitive skin issues because I used it on a precancerous growth on my thigh a few years ago - I'll discuss with him before filling the prescription #4/5 - does not altering our sex life include the period of time between now and the completion of the Aldera (and hopefully the disappearance of the GW)?  Is this a situation where after the GW are gone we should check ourselves regularly but its not something to dwell on moving forward,  just to be aware?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Inflammation from Aldara usually isn't any big deal, and it seems the proctologist has a lot of experience with it. I would follow his advice.

As I said above, I see no reason to not continue sex with your wife, especially since your anus and perineum probably won't be involved (and contact with these areas can easily be avoided). After the warts are gone, don't go looking for recurrences. Anxious persons who closely examine their skin usually find irregularies, bumps, or variations in skin texture or tone that are entirely normal and don't matter. If your warts persist or recur, you'll know it without looking closely (as probably happened with your current warts). Don't go looking for trouble!

Finally, don't get overly freaked out over all this. Nobody wants genital or anal area warts, but it's really not a big deal. Warts are an inconvenience, rarely an important health threat.
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17 months ago
Sounds like a plan - thanks again!