[Question #7484] Wart Treatment and Recurrence

5 months ago
Hi Drs,

I have been reading through the other questions on this site and it has been very helpful. A while back I discovered warts and went to a dermatologist for treatment. They used cryotherapy and most of the original spots are now clear after a session or 2 and have been for about 6 weeks or so now. Admittedly this problem has caused me some anxiety and a I went in a few more times for newly discovered spots. Those times the dermatologist wasn't sure they were warts but treated them anyways to be safe and for the past 3 weeks I have had no new spots to treat.

I had a few questions.

1) I'm a bit confused on how cryotherapy works.  I know it is a destructive process, but is it also attempting to trigger the body's immune response as well by damaging the tissue in the area?

2) I know based on other questions that if a wart does not recur in 3-6 month it is unlikely to. How soon after treatment would I expect to start seeing recurrences if they were to happen? Does the likelihood of recurrence decline with each week/month? The waiting game is not fun

3) I have inspected the area a number of times in the last few weeks, at this point I'm fairly certain that I would have noticed any warts present. My last exposure would have been sometime in the first few months of this year. Given that, am I likely to still see new warts develop in new areas or should my focus be more on looking for recurrences in treated areas?

4) Typically when warts do recur, how many recurrences are the norm? I've seen some info that says if warts recur they normally do so only once more, is that accurate?

I think I have gotten a little too caught up in what if's and frequency of abnormal cases. Would you say the most likely outcome is that the warts do not recur and I can move on with my life in a few months?

Thank you

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Welcome. Thanks for your confidence in our services, and for reading questions similar to your own. I happened to log in a few minutes after you posted -- most users shouldn't expect nearly real-time replies!

Your questions are common ones among people with genital warts. The subject is pretty complex, and I'm going to suggest you read up for more detail. Two excellent resourxes are the US Centers for Disease Control and Prevention (CDC) www.cdc.gov/std; and the sponsor of this forum, the American Sexual Health Association (www.ashasexualhealth.org; follow the links for STIs then HPV). (If you search the ASHA site, you should be able to find a pair of video interviews I did about genital HPV. It was several years ago, but I think most of my comments are standing the test of time.) I'll also say that genital warts are more common than you might suspect. Probably a quarter of the population is diangosed with genital (or anal) warts at least once in their lives -- maybe more.

1) Cryotherapy is purely destructive. In theory, the inflammation that accompanies any healing wound or tissue could contribute, but probably not much.

2) The first sentence answers the question in the second sentence. Probably the likelihood of reactivation does decline with each month without a recurrence.

3,4) Perhaps surprisingly, there are no good data on this. For accurate data, one would need to get a large number of persons (hundreds?) with GWs to agree to return to a particular doctor or clinic periodically for years, both for any observed recurrences and perhaps yearly for professional exam -- for several years. As you can imagine, such research would be logistically difficult and expensive. And most experts would agree it wouldn't be worth it, since warts are generally considered an unpleasant inconvenience but not an especially important health problem (despite the anxiety experienced by many afffected persons). So all we can rely on is persons who come for care of warts that they believe are recurrences -- a highly biased sample. My personal impression is that most persons have no recurrent warts at all; but at least several percent have reactivation that sometimes occurs years later; and a few have multiple recurrences.

And for those reasons, your closing sentence (before Thank you) is exactly right: Probably you have done more internet reading than necessary and most likely you are done with genital warts forever. 

Final advice:  If you're under age 26, get vaccinated to prevent future infection with most cancer-causing and wat-causing HPV types. For what it's worth, it's possible it would also reduce the risk of reactivation of your recent infection. When the vaccine was first developed, it was believed to have no effect on current or previous HPV infections, but more recent research indicates there may some benefit along these lines.

I hope this information is helpful. Thanks for the advance thanks. Let me know if anything isn't clear.

5 months ago
Thanks for your response, all of this information is very helpful.

In that case, since my warts were removed with cryotherapy would I not have any immunity to this strand on HPV in the future?

To clarify your response to question 2) does that mean that if a wart is going to recur after treatment I likely wont see it start to do so until at least 3 months or more after treatment or can it start to appear earlier than that?

If a wart is recurring, is it likely to start as a very small bump and grow, or reappear at a similar size/shape as the original?

I am 30, I know insurance likely wont cover it, but is there still benefit to me getting the vaccine?

I will definitely try to stop internet searching following our conversation. I know its not uncommon for warts to reaper after treatment, but that does not sound like it happens to the majority of people and I need to keep that in mind.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Treatment of warts is not what makes people immune. Even without treatment, your immune system would have cleared this infection, and it will prevent (or at least reduce the risk) of infection with the same type of HPV in the future.

New versus recurrent warts is partly semantic, just how words are defined. New warts that appear soon after treatment are not considered recurrent; instead, they are newly developing warts that were brewing before treatment was given. Once ~3 months go by, probably most newly appearing warts are reactivation of the original infection. In other woreds, you might have new warts appear within 3 months, but most likely this isn't a true recurrence.

Any genital warts can vary widely in size. All are slow growing. However, I strongly recommend against compulsive self examination to detect warts. 

In general, new HPV infections are uncommon after age 30; and most people your age have already been infected with many or most of the 9 HPV types prevented by the vaccine, in which case immunization isn't helpful. On the other hand, the HPV vaccine is approved up to age 45, and your health insurance may or may not cover it. This is something you can discuss with your doctor. But if somehow I were in your situation, probably I would not seek immunization.
4 months ago
Thanks, a couple final questions. I had a follow up with the dermatologist the other day. My usual one was out, so I saw a new one. The dermatologist ended up performing Cryotherapy on a few small locations, they said they were not convinced any of the spots sprayed were actually warts but opted to spray them just to be safe. How do you think I sure approach this? Should I reset my 3-6 month timer?

Understood that compulsive self examination is not recommended. How would you recommend I monitor for new or recurrent warts? (Ie. how close should I look and how often? )

Lastly my girlfriend is aware of my warts diagnosis and is comfortable continuing to have sex (She knows shes already be exposed and was vaccinated as a kid). Any precautions we should take? Would having sex potentially lead to increased chance of recurrences or me spreading the infection to other parts of my skin?

I know this is my last follow up, so thank you for your time and I wish you a happy and healthy New Year!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
I'm sorry, but there simply are no data to answer you rfirs tquestion with any precision. That's partly why such a wide range is shown for time to consider warts cleared, e.g. 3-6 months, or maybe up to a year by some experts). The longer  you go without a recurrence, the mroe likely the infection is gone; there is no sharp cut-off point.

Anything you don't notice in routine day to day superficial contact with your genital area (when showering, using the toilet, etc) probably doesn't matter. If you just can't stand being that imprecise, I would suggest maybe a closer inspectio once a month, but no more ofteh than that.

It sounds like your partner has a level-headed, practical uncerstanding. That she doesn't seem to care much is  a good sign. Netiher should you. Most genital warts should be viewed as a slightly unpleasant inconvenience, nothing more.

Having sex won't spread warts around. You need take no precautions at all. Genital warts rarely appear at distant body sites. When they show up nearby (e.g. anal area, scrotum, a new spot on the penis) it's more likely the infection was there all along, not spread there by sex, washing, or other kinds of manipulation.

Thanks for the thanks. Happy new year yourself (expeciing to to be a far better one!).