[Question #7131] Recommended treatment of HR-HPV if finances aren't a consideration

8 months ago

I’ve never had an abnormal Pap and had regularly requested HPV testing (always negative, including during my last serious relationship).  I got out of a long-term, monogamous relationship in early 2019 and dated someone for a few months in late 2019-- becoming physical in October.  Recently, I was diagnosed with 11 HR-HPV strains.  I’m in shock; I’m mad— at the guy I dated and myself; and, I want to make a plan and move forward.  

I realize HPV can lie dormant, but I have an autoimmune disease & take Xeljanz— my immune system isn’t the greatest.  It’s hard to imagine that my body would have kept this under wraps long.  Is is pretty safe to say that, between my past negative tests and this that I definitely got it from this guy in late 2019?

I’ve read a lot about Dr. Arani at https://drarani.com/ and his BCR microsurgery treatment.   I realize that even with the warts gone, the virus remains, but does ridding your body of the warts give your body a break/boost in any way to aid in the fight the disease, or is wart removal 100% about aesthetics and physical/psychological comfort?

What about CO2 lasers and/or AHCC?  If money were not a big consideration, but saving time and stress were, what would you recommend for treatment(s)?

Beyond all of that, I do have one big worry— auto-inoculation.  I know I cannot shave in affected areas.  But what about showering/cleansing, drying off, putting on lotion, etc?  I feel like I'm getting warts germs on everything!

Finally, should I mainly see a GYN or dermatologist for this?

Thank you so much for your time. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
8 months ago
Welcome to the forum. Thanks for your confidence in our services.

I'm sorry to hear of your HPV infection and understand how stressful this can be. It is also quite atypical to be infected simultaneously with 11 different HPV types. And are you sure all of them are classified as high risk? That sounds implausible; I'm not sure that many high risk (cancer causing) types exist. It is interesting to speculate wiether being on tofacitinib (Xeljanz) is having an effect. Most similar drugs (e.g. Humira and others) are not known to affect HPV acquistion or activation, and I would not expect tofacitinib to do this. On the other hand, there hasn't really been any signficant research on how these drugs might affect HPV.

I'll add what I think you already know, that it's usually not possible to know with certainty when and from whom any particular HPV infection was acquired. Chronic carriage, reactivation of previously suppressed infection, and uncertainties about past sex partners' other partnerships all muddy the waters. I have no judgment about when and from whom you were infected. (But I don't think you expected me to solve that part of the mystery.)

I've never heard of Dr. Arani and have n familiarity with whatever sort of treatment he offers for HPV. However, I am very skeptical. I am unaware of any method to eradicate or otherwise alter the natural course of asymptomatic HPV infection. To my knowledge, the only option is to treat abnormal tissues when and if they appear (as detected by colposcopy etc). This approach is nearly 100% effective in preventing invasive cancer, but does not necessarily eliminate HPV. The body's immune response is the ultimate (and perhaps only) effective factor.

Auto-inoculation of HPV to other body areas is uncommon. ome experts believe it never occurs, but others believe that some oral HPV infections are so acquired. But oral HPV rarely causes visible abnormaltieis or disease, and should not be a serious concern. Warts elsewhere on the body are never, in my experience, the result of auto-inoculation from genital infection. How you shower, bathe, etc probably carries no risk of auto-inoculation. I'm not sure shaving is a problem at all -- I would avoid shaving an area with apparent warts, but otherwise wouldn't worry about it. (And from what you have said, it seems you have no warts, and perhaps no reason to assume your HPV infection(s) affect any other sites than your cervix and perhaps vaginal/labial area. The pubic area usually isn't involved.

We STD specialists rarely treat patients for HPV other than visible warts; we refer such patients to dermatologists and/or experienced gynecologists. Therefore, I have no experience with or advice about CO2 laser, AHCC, or other procedures. And as just implied, both dermatologists and gynecologists may be highly experienced. 

Finally, you might consider also consulting with an immunologist or other expert in immunosuppressive drugs -- about whether your drug treatment might in fact be influencing all this, including the possiblity of perhaps stopping the tofacitinib for a while, depending on the requirements for the problem it is treating. (For example, if you have psoriatic or rheumatoid arthritis, low-dose methotrexate might be another option. in this area, I speak from intimate family experience.)

Sorry I can't solve all these issues, but I hope these comments are a little bit helpful. Let me know if anything isn't clear.