[Question #7569] Genital Warts and HIV

3 months ago
Thanks again for allowing me on this forum as it is a valuable resource.  I know I ask a lot but my doctors give me conflicting answers at time and I come here for expertise and the voice of reason.

2 weeks ago, and a month after I had unprotected vaginal sex with a female friend (see question 7502), I went to the dermatologist to get a skin tag removed and he noticed, what he thought, was a couple tiny genital warts on the base of my penis where it attaches to my body. He froze them and gave me Imiquimod 5% to take.  This time my pubic area was shaved and he said they were new.  He asked if I was tested for HIV.   I told him I was tested negative about 3 days after I had unprotected vaginal sex with that female friend.  I went on HIV-PEP 65 hours after the encounter.  (See question 7502 again)

In the fall, the same dermatologist removed a previous skin tag and I was not shaven and he didn't seem to notice anything.  The warts may have been there but I didn't notice them because of the pubic hair.  Meanwhile my PCP did not think they were genital warts.

1) Why would my dermatologist ask if I was tested for HIV?  Would genital warts appear a month after possible HIV infection?

2) In a previous answer it was mentioned it's rare to get genital warts after age 40.  This has me concerned, if I beat the odds and got genital warts, maybe I got HIV as well? (I also have HSV-2 for 3 years and take Valtrex and have had no outbreaks for a year.)

3) both DRs say it's impossible to know who I got the warts from.  One thought it wasn't a new infection. Could they turn up after a month from a partner?  Thanks again!

Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago
Welcome back to perform. Concerns about HPV infections are challenging to answer and different perspectives from different healthcare providers are common. This is, in part, due to the fact that our understanding of these very common infections is still evolving. When most healthcare providers, even dermatologists,inspect patientsIt is not the least it uncommon to miss small genital warts. Most physicians do not worry about these infections because they are so very common and of so little consequence.  In answer to your specific questions:

1.  You were seeing the dermatologist for a possible STI. It is good practice for clinicians to inquire about the presence of other possible STI’s at the time of evaluation. Your dermatologist was doing her/his job properly by asking about your HIV status.  It would be most unusual for you to develop new visible genital warts just a month after an exposure. Typically visible general warts are not detectable until approximately three months following acquisition of infection.

2.  With all due respect, the lesions that were noted may or may not have been genital warts and the duration of their presence is difficult to know. They may have been missed in the past. After reading your 20 questions posted here over the past year, it appears that you have had multiple sexual partners over the past year. We’re you to acquire a new general wart it would not be something to worry about or a sign of something more serious.

3.  I believe this question has already been ask and answer. There is no way to know whether the bumps you noted were warts or not, much less where they were acquired from or how long they have been present.

I hope this information is helpful. If there are further questions please feel free to use Europe to follow up questions for clarification. EWH


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3 months ago
Thank you very much Doctor.  From November 2019 to January 2021 I have had sexual intercourse with three women.   The middle woman was a 9 month long monogamous relationship.  The recent one where I went on PEP was because I had unprotected sex with a friend of mine.   Something I rarely do.  They all know I have well controlled HSV-2.  I was just freaked because the thought of possibly having genital warts in addition to HSV-2 and then a fear of possibly acquiring HIV as well.  

1)But having genital warts is not a sign of HIV infection?

2) I have noticed some doctors say PEP won't interfere with an HIV test a month after the encounter and a week after finishing PEP.  Others say it will.  Any idea why that is?
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago
1. Correct, having or acquiring genital warts is by no means a sign of HIV infection.
2.  Doctors who stated taking PEP will not interfere with testing for HIV, either while the PEP is being taken, or in the first 4–6 weeks following completion of PEP are incorrect. The medications used for PEP are the same medicines used to treat HIV. Thus such medicines could suppress the detection of HIV while they were being taken and it could take several weeks for a test to become positive.  The only exception from the statement that I made above is that if a person taking PEP had acquired the infection and developed symptoms due to their infection, the test would then be positive. When symptoms of recently acquired HIV are present, tests are always positive.

EWH 
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3 months ago
Just one more follow up to the above (and question 7502), I never thought about Syphilis, Hep B and C risks.  I just got tested for everything today and I am nervous waiting for my results.

Considering I have HSV-2 and possibly genital warts, assuming I had genital warts at the time of the unprotected sex act with my female friend (see question 7502).  Is contracting Hepatitis B or C a big concern?  I had no open lesions on my penis at that time and maybe a genital wart or two.  

I have not been vaccinated against Hep B.
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago
You discussed other STIs I your exchange with Dr. Handsfield (7502) and we’re tested for the most common ones after the encounter at a time when you results were reliable.  Your risk for Syphilis was negligible as the disease is very rare in women .  I would not worry further about these STIs.  

As for hepatitis B, I’m surprised you haven’t been vaccinated.  As a general health measure you should be.  That said, your risk for hepatitis B from the encounter you’ve described is low and your risk for hepatitis C which is almost never transmitted through heterosexual encounters approaches zero(hepatitis C is occasionally transmitted in persons engaged in receptive rectal intercourse with infected partners.

I anticipate that your tests from today will be negative.  When they are I encourage you to move forward without concern and to consider vaccination for hepatitis B.  This concludes this thread. EWH 
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3 months ago
Thanks Doctor, so you think the risk of a Hep B exposure would be low in this case even though I have HSV-2 (no open lesions) and unprotected vaginal sex with my friend?  I'm guessing a risk to a man to Hep B is also lower than that of a woman because of insertion?
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago
Repetitive and in excess of the three responses called for in response to each client’s questions.  This response will be brief.

Your genital herpes does not meaningfully increase your risk for acquisition of hepatitis B in the unlikely circumstance that you were exposed.  Once again, please don’t overthink things and please don’t worry.  The thread is now complete.  Take care. EWH 
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