[Question #7412] HPV Warts Probability

5 months ago

Hi, I am a 22 year old male, in February of this year I had protected sex with a sex worker. During the encounter she had me take off the condom and was masturbating herself and then used the same hand to masturbate me. I couldn’t see but I suspect she had genital warts present as she went from directly touching herself to masturbating me. I wasn’t vaccinated for HPV before the encounter but I am now.

I am 9 months out and I’ve tested negative for all STD’s with no symptoms of HPV or warts. However, I believe I may have been infected with HPV and it’s laying latent. My concern is she infected me with a strain/type of genital (low risk) HPV that could present itself sooner or later and will be a lifelong recurring problem. I can’t seem to find much info on these types of genital warts as the main ones I see talked about are types 6 and 11.

What is the likelihood of transmission to someone who masturbated themselves touching their warts to then directly touching me?

What is the likelihood of developing warts in the future being 9 months out?

Are there other low risk type genital warts worse than types 6 and 11?

Is lifelong recurring warts dependent on the individual and their immune system or the type of HPV they get?

Is the incubation period for genital warts dependent on the person or the type of HPV they have?

Does the longer the incubation period mean your more likely to develop recurring warts?

If you get a certain strain/type are you guaranteed to develop warts?

H. Hunter Handsfield, MD

5 months ago

Welcome to the forum. I'm happy to help allay your concerns.

I'll start by some general comments. You seem to be overly concerned about HPV in general and genital warts in particular. My main bottom line message is that since you've been vaccinated, you can pretty much disregard HPV in the future -- not because you won't catch types not covered by the vaccine (you will), but it usually won't much matter when you do.

Getting and having HPV is a natural and expected consequence of having sex; worrying about it is something like worrying about the staph and strep you carry on your skin and in most body openings, and the E coli and other bacteria that reside in your colon. All can sometimes cause serious infections, but for the most part tney are normal and harmless. By being vaccinated, you have done what you can to markedly lower the risk of serious HPV consequences (warts, cancer) and the chance of transmitting infection to a sex partner. Beyond that I recommend no precautions at all against HPV. You can assume any and all sex partners you have in your life have had HPV, and up to half have transmissible infection at any point in time. Condoms don't help much: they reduce the risk for any one encounter by perhaps 70%, but over time consistent condom users get HPV just as frequently as non-users. (I'm not saying don't use condoms. You need them to protect against other STDs, but they aren't very important for HPV.) And HPV is so common in everyone that active infection is no more frequent in sex workers than anyone else.

To your specific questions:

1) HPV is rarely if ever transmitted by hand-genital contact, even when genital fluids are used for lubrication. You were at greater risk of HPV from the condom-protected vaginal sex than the hand-genital contact.

2) The chance of warts (or any other HPV infection) from any single exposure is very low. And most warts show up before 9 months, so you're probably home free.

3) About 10% of genital warts are caused by several HPV types other than 6 and 11. There are over 120 different HPV types, but the large majority are harmless. By covering the 9 most important types, the vaccine reduces the risk of both warts and cancer by about 90%.

4) Development of recurrent warts -- or of recurrent silent infection, e.g. repeat pap smear abnormalities in women -- seems to be just a matter of bad luck. Particular strains usually are not responsible, and there are no known immune system differences in people with and without recurrent HPV. Maybe future research will learn more.

5) Incubation period of warts also isn't known to be affected by these things.

6) I am aware of no data to suggest that longer incubation period carries a larger chance of prolonged or recurrent warts, pap smear abnormalities, or risk of cancer caused by HPV.

7) No HPV infection is "guaranteed" to cause warts, but HPV 6 and 11 come close: Some data suggest that up to 80-90% of people infected with these types develop visible warts. That's one reasoon why, after 9 months, you can be pretty sure you aren't going to ever have warts related to the sexual exposure you had last February.

All of which supports my "bottom line" statement above. I'm glad you were vaccinated. Now you can stop worrying about HPV.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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5 months ago

Hi, thanks for the response. Unfortunately I noticed something growing on my scrotum yesterday and went to the doctor today and he told me it is a genital wart. It is very tiny and not in a clearly visible spot which is why I never noticed it previously. He referred me to a dermatologist to get it treated.

With this new news that confirms I have genital wart HPV I have some new follow up questions:

What is the most effective treatment for eliminating a tiny genital wart?

What is the likelihood of a recurrence wart after treatment?

What percent of people that get genital warts have recurrences?

Is there a certain amount of time after getting the wart removed if you don’t get a recurrence you can be sure your body has cleared it and you won’t get a recurrence?

If I contracted high risk strains as well, what is the likelihood of these developing into cancer in the future?

Are there certain high risk strains that guarantee developing cancer in the future if contracted?

H. Hunter Handsfield, MD

5 months ago

I think it's likely that when the dermatologist examines you, s/he will confirm your scrotal bump is not a wart. There are planty of other causes of genital area skin bumps; most intiial genital warts are multiple, not single; and the scrotum is an unlikely site for initial warts to appear. Usually they involve sites that receive significant friction during sex (the virus must be massged into the skin for infection to take hold); if you were to develop wartrs from the exposure described, I would expect them at the base of your penis, above the extent of condom coverage. Whatever else, do not attempt to treat the bump before you see the dermatologist, and keep you hands away from it -- for sure don't examine it, rub it, squeeze it to get a better look, etc. These are excellent ways to alter the appearance enough to seriously interfere with accurate diagnosis.

Several treatments are recommended and effective. For a single small wart, if that's what it is, I would expect the dermatologist to freeze or cauterize it, although treatment with podofilox, imiquimod or sinecatechins also are options. (You can google them for more information.)

Recurrences are fairly common, but probably no more than 10-15% of cases.

There is no conclusive time, since HPV DNA may persist indefinitely. But transmission to partners probably is rare after several weeks or a few months.

In males, under 1 in a thousand infections with high-risk (cancer causing) HPV types progress to actual cancer.

Threads are closed after two follow-up comments and replies, or after 4 weeks, whichever comes first. You have one coming. I suggest you hold off until you've seen the dermatologist, then please return and let me know the outcome. I'll have no futher comments until then.

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5 months ago

Hi, I have seen the dermatologist and they confirmed it was a wart on my scrotum and removed it. I had previously been so focused on my encounter with the sex worker I never even considered two others I’ve had in the past several months. The first one was around the end of May I had unprotected sex with a random female I didn’t know. I had also performed oral on her vagina and anus. The second encounter happened mid June and was with a random male I did not know. This was my first time with another male. I was the bottom for the encounter, but there was no penetration, just naked humping in which he rubbed his unprotected penis all over my butt and anus for an extended period of time, as well as licking my anus. I have several new follow-up questions:

How risky was the unprotected encounter with the man for acquiring HPV with no penetration?

Is an anal PAP smear a good idea, what would it tell me?

If I were to develop warts from the encounter with the man, when and where would I expect them to show up?

How likely is it to develop warts inside of my anus from this encounter?

Should I see a proctologist to have the inside of my anus examined?

How likely is it to develop oral warts from the encounter I had with the woman?

Why would I develop a small wart on my scrotum from these encounters and who would have most likely given it to me?

Should I be concerned about any high risk HPV with these encounters?

Do you have any other suggestions or info to give me to help me move forward?

H. Hunter Handsfield, MD

5 months ago

It's still a bit atypical to have a single wart of the scrotum. But your revised sexual history is crucial; one or the other of the contacts you now describe probably was the source. You'll never know for sure: it is rarely possible to know when and from whom any particular HPV infection was acquired -- and it really doesn't matter. But the unprotected sex with your female partner in May was the more likely source.

You didn't have anal penetration and are at low risk for any HPV. You are at little or no risk of intra-rectal HPV or warts and I would not recommend anal paps based on your sexual history or examination by a proctologist. As I said earlier, warts usually appear at sites of direct contact, with friction, although your scrotum is an apparent exception. Oral warts are rare.

Multiple HPV infections are common. Having acquired warts, you could well now be carrying a high-risk HPV infection as well. However, probably not, given your few encounters. But even with the highest risk types, the large majority of inection do not lead to cancer.

"Do you have any other suggestions or info to give me to help me move forward?". Yes. First, get into a condom habit: from alll you say, you're on a path toward serious outcomes, especially HIV. Second, stop worrying about HPV, among the least serious STIs. Everyone gets HPV and the large majority have no important health outcomes from them. Howeve,r you should be vaccinated against HPV, which will protect you from the 9 HPV types most likely to cause signficant health outcomes.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the disucussion has been helpful. Best wisehs and stay safe.

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