[Question #7494] Genital Warts/HPV

3 months ago
Hello Dr. Handsfield,

I had genital warts in February 2020 and my doctor used cryotherapy on the 4 warts and then prescribed imiquimod cream which I used 2 weeks later for 8 weeks after my skin healed.

1- I spotted a new Wart yesterday (December 2020) after not spotting anything since March 2020.  Does this mean my Immune system is weak and not fighting well enough?  Is there anything proven in terms of what foods to eat to strengthen the immune system's fight?

2- My dermatologist asks me to completely shave my pubic hair prior to seeing him so we can identify all the warts prior to a cryotherarpy session.  I am afraid that shaving will irritate/spread the warts.  Is it OK to do more than a scissors trim like use a depilatory cream?  I will need to get that new wart treated...should I use immoquid again after cryotherapy?

3- Finally, I saw you mention (Dr. Handsfield) in a recent post that recent data may show that the vaccines could potentially help fight off the virus.   I am now 35....can I benefit from this scenario? 

Thanks for your help,

Regards,

MM
3 months ago
Just wanted to add (incase its relevant) that I am a male and have had zero sexual activity from March (beginning of treatment) until Today.

Thx
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome to the forum. Thanks for your confidence in our services. Directly to your questions.

1. There is no reason to suppose any sort of immune system problem. Recurrent warts are not usually the result of immune impairment; they occur randomly and unpredictably in entirely healthy people, so no worries about your immune system. And your apparent new wart may not count as a recurrence anyway, just continued development of warts from the same HPV infection diagnosed 10 months ago. It takes up to a year, sometimes even longer, for warts to appear after acquring HPV. So this probably does not imply you're at continuing risk for reactivation and reappearance of warts. 

2. It is commonly believed that shaving can spread warts locally, but no data exist. On one hand, it makes sense. OTOH, warts are like icebergs:  you can assume broader areas of your genital area skin already have HPV, with potential for warts to appear regardless of shaving. But if you want to be extra safe, one option is to use a beard trimmer set to short stubble (1-2 mm), which would allow good skin visibility without actually shaving the skin. Most dermatologists have extensive experience managing patients with genital warts, and I suggest you follow his or her advice, including what treatment to use this time around. (There are no data that support one treatment over another for recurrent warts.)

3. To repeat what I said recently -- probably the disucssion you read -- it was originally beleived that although the HPV vaccine is exceedingly effective (nearly 100%) in preventing new HPV infections with the 9 types covered by the vaccine, it has no effect on existing infection. More recent research suggests immunization may have benefit in wpeeding healing or reducing the likelihood of reactivation of existing infections. However, I stress may:  more research is needed to know with certainty. At this time, I do not recommend immunization for this purpose -- and as noted above, it's not certain your current wart counts as reactivation. But if you continue to have a problem with wart recurrence in the future, maybe vaccination would be worth a try. For sure it wouldn't be harmful in anyway, except maybe to your wallet if not covered by your medical insurance.

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

HHH, MD


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3 months ago
Thank you for the responses Dr. Handsfield, just to clarify that I understood correctly:

1- Based on our discussion, If I wait to cross the 1 year mark and see no re-occurance for 6 months thereafter (so 1.5 years after the first wart appeared) can I have sex without a condom or am i still a risk to infect my partner?  (I am planning to get married soon to my gf and she is still a virgin).  My least preferred option to avoid scaring her off would be to tell her to get vaccinated....a quick google search and results about cancer might cause her to walk....but if it is the only way I will have have to do it.

2- Clear, so this means that I currently have HPV virus all over my pubic area (and it is contagious) even without the presence of the warts.  Is this correct?

Thanks for your help.

Regards,

MM


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
1) Condoms do not prevent HPV transmission -- or only moderately. After a year with no recurrence, it is unlikely that you will still have active infection and thus unlikely to transmit to a sex partner, with or without consistent condom use. However, some HPV infections persist indefinitely -- or at least HPV DNA persists at infected sites -- and can reactivate and be transmitted to partners. That is, you'll never be at zero risk of transmitting to partners. But 90+% of all people get genital HPV anyway, so sex with you will not increase anyone's risk of HPV any higher than it would be otherwise. And many will have already been ifnected with types to which they are newly exposed -- and thus iummne to new infection with thoe types. Rather than concentrating either on condoms or on the time since your warts clear up, it's best to discuss your past ifnection with future partners, then the two of you can decide together what sort of precautions you might want to take. But for the most part, that probably will included going ahead with sex without worry. Coindoms always are wise for a new partner until the relationship matures -- but not primarily because of HPV. Also, you should be vaccinated against HPV, to prevent infection with other HPV types most likely to cause warts or cancer.

2) You don't necessarily have HPV "all over [your] pubic area" -- more likely limited to penile skin. But it might be more widespread; there's just no way to know. But for the reasons above, it usually doesn't matter.

Do your best to understand the nost basic truths about HPV:  Everybody gets it; most infections lead to no important health problem; and most clear up over time. Getting and having genital HPV is a normal, expected part of being sexual. Get vaccinated to prevent most potentially serious outcomes, then more or less forget about it.

OK?
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