I hope you are doing well.

I've been 5 months wart free. I used Aldara which worked from the first time using it(in the morning one of the warts was gone/smaller)

I want to ask some questions because there are things that I'm still confused about.

1. Could the fact that Aldara worked so incredibly fast be a good sign that my immune system was already fighting the virus?

2.Is it true that the more time you go without warts the less chances you have of a recurrence?

3. I keep hearing mixed things. Some say that your body eliminates the virus completely,others say that your body just controls the virus. Which one is more right?I feel like if HPV was really for life there will be much more ppl with warts or abnormal paps since this is a virus that almost everyone will have.

4.I'm getting really sick of the hair and it's so hard to trim down there. Could I use an electric razor? Someone recommended me Philips Satinshave Advanced wet n dry. I bought it but I'm scared to use it. It looks like the blades have this mesh cover but I can't tell if it's still able to cause micro cuts or not. What do you think about using an electric razor?And what do you think about using a hair removal cream?I keep looking it up but there's no info about this.

5.Could I still receive oral with no protection?

Looking forward to your answer

I'm glad to hear your recent warts are gone; at 5+ months without a recurrence, probably you'll have no recurrences. But if that happens, don't panic: I hope you view genital warts (correctly) as an unpleasantness but not an important health risk. And if you haven't yet been vaccinated against HPV, I would also encourage you to do so. Not only will you be protected against the HPV types most likely to cause cervical and other cancers, but it might reduce the likelihood of recurrence of your warts. (Initial vaccine research indicated no benefit against existing infection. However, more recent research suggests there likely is reduced frequency of reactivation of the virus.)

To your questions:

1) I'm glad the imiquimod (Aldara) worked promrly and effectively, but I don't think it says much about your immune system.

2)  True statement:  Not well proved by reesearch, but most STD experts have observed that most persistent or recurrent genital warts show up in the first few months, and that hte longer one goes after ~6 months, the less the chance of recurrence. That said, warts (or other HPV infections) can reactivate even years later, so there are no guarantees.

3) Good question and indeed there is a lot of confusion. What is clear is that HPV DNA often persists in infected tissues, and some experts believe this is the norm -- that DNA is never entirely gone. But persistent DNA isn't the same as active infection, which usually is entirely suppressed by the immune system and not likely to reactivate, and not transmissible to partners. Some experts base their opinions on DNA and say HPV always persists; others focus on active virus and point out that infection is gone. It certainly is true that almost everyone gets HPV at least once, usually several times; getting and having HPV should be considered a normal, expected, unavoidable aspect of human sexuality. That's why immunization is so important, prevening infection with the 9 HPV types that together cause 90% of genital warts and 90% of genital and throat cancers. Its also why all women need to follow pap smear guidelines -- not only those at higher STD risk.

4) I have no advice at all about genital area shaving, and no clue whether electric or blade razors are best, or the pros and cons of dipliatory (hair removal) creams. This is a cosmetics issue, not a medical one; at least I am unaware of any reports of different medical consequences of different shaving methods. Sorry. (FYI, I've been in the STD business for nearly 50 years. The first 30 years in a busy STD clinic, I maybe saw 10 patients (among thousands) who had shaved their pubic areas. The last 20 years it has become increasingly common, and these days almost all are shaved. It has been quite a cultural change. However, it seems to make little or no difference in STD risk or complications -- except that pubic lice (crabs), once common, now are rare.)

5) Genital warts can infect the oral area, but rarely cause warts or disease. I see no reason you cannot now safely participate in any and all sexual practices that are  pleasurable for you and your partners, including oral sex.

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

HHH, MD

I know that razors cause micro cuts so I don’t know if that would apply to a hair removal cream,but I think it’s not worth it to risk it for now.

I would like to ask you 2 more questions.

1. Why do some people get symptoms but others not even tho they have the same strain?

2. Let’s say that someone hpv spread all over their vulva and with time the immune system gets rid of some of it. Could the vaccine potentially protect the skin that doesn’t have the virus anymore from a reinfection?Or if I have HPV on my genitals but I never had it in my mouth would the vaccine protect me against my mouth getting it too?

I hope it makes sense,I don’t know how to explain ahah

Thank you so much once more. I was feeling down because of it today because I feeldirty ever since I got it and  getting answers from an expert really helped me

2) As your question implies, it is probable that HPV involvement is patchy. However, this is never been studied. Self transfer of infection to new body sites is called autoinoculation and is uncommon; the immune system mostly prevents it. It’s logical to suppose vaccination might further reduce the chance, but no data are available.

I'm not sure I understand your second question. With both low and high risk types, the immune system clears most infections to the point they cannot be transmitted. The longer it is, the lower the chance of reactivation.