[Question #7845] HPV Question
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51 months ago
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Hello,
I'm a 40 year old male. Diagnosed with HPV in 2020. Had 3 warts initially all on my foreskin top and bottom of shaft and they all looked different. I had the warts treated with Cryo and Aldara and they went away in 2-3 months. Had a recurrence on the perimeter of the treated area (8 warts) thenwas wart free for about 6 months on the dot. Recently I was prescribed a corticosteroid to treat Strep B and a bacteria called Klebsiella oxytoca. Im 4 days in applying the cream twice a day and taking 1 oral antibioitc daily. I think there are now warts forming UNDER my foreskin where I applied the cream. I had read topical steroids can cause HPV to reactivate, but 2 doctors said that was not the case. So here I am to ask the experts. If these are warts (they also look different from previous warts)are they being caused by the steroid? I was also vaccinated for covid 3 weeks ago and have my second shot scheduled in 2 days could that be the source of the warts? Should I stop applying the topical? As I mentioned, I am 40. Most of what Ive read says "young" people can clear the virus. Does that fact that I was infected at 40 mean I wont clear or eradicate the virus? I smoke cigarettes' and marijuana daily as well. The timing of the cream and these lesions has crushed me. Am I wrong in making this correlation? I definitely didnt see these until I started the cream. But could that be coincidence and really related to my age, cigarettes, marijuana? Covid shot? The irritation from the bacterial infection needs to be treated and I dont know what to do. I am devastated and feel hopeless that I will find a partner since I am a walking GW infection risk . Im sorry my question isn't the most concise, but hope you can make sense of it. Thank you so much for this service.
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Edward W. Hook M.D.
51 months ago
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Welcome to our forum and thanks for your confidence in our service. I’ll do my best to answer your questions. At the same time, I would also urge you to read other threads present on the forum regarding the topics of genital warts and HPV infections. We purposefully leave these threads on the site in order to provide additional information to our clients. Many people find reading them helpful.
HPV infections are very common amongst sexually active persons. We estimate that well over 80% of sexually active persons will acquire HPV at some point in their lives and that most of these infections will reflect infection with more than one HPV type. A portion of HPV infections manifest themselves as genital warts which, while a visible manifestation of HPV, are merely a nuisance and do not lead to serious health consequences. Treatment of general warts is to achieve a cosmetic goal is these infections have few health consequences. The fact that you have had genital warts should in no way compromise your ability to date. This topic is addressed on multiple occasions in the forum.
Persons with diminished immune function 10 to have prolonged infections with HPV, a slightly increased risk of progression, and call me their infections may be more challenging to treat. I am not aware of any credible data to suggest that treatment With topical steroids changes the natural history of HPV infections. I presume that your topical steroid treatment will be relatively brief (a week or two) and would not worry that it is putting you at increased risk for recurrence of your warts. Similarly, there are no data to suggest that smoking tobacco or cannabis diminishes immune function or represents a risk factor for acquisition or recurrence of genital wart infections. Call there is no medical or scientific reason to suspect that your receipt of the Covid vaccine is any way related to the lesion see you have seen on your penis.
You were age is not a concern and should not diminish your ability to deal with your warts. Regarding the lesions that you have noticed under your foreskin, they may or may not represent warts. When examined closely, irregularities, cysts, and other “bumps” are regularly and typically present on the penis. This is particularly true at the head and corona of the penis. The best way to determine what the lesions on your penis are used to have a experienced clinician take a look and make an assessment. I would not assume necessarily that they are warts.
I hope the information I have provided yourself. If there further questions or anything is unclear please feel free to use your update to follow up questions for clarification. EWH
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51 months ago
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Thank you for the prompt reply... I did read through the forum, but there are only so many questions you can go through. With regard to your response and the responses that I have read on the forum. I see statements like "unlikely to infect partner after 6 months" Those statements are then qualified by saying they are "not science based" but "common sense" opinions of STD experts. These statements don't seem to make sense coming from doctors and scientists (no offense). If not proven by science, then are only anecdotal right? How long are patients being followed up with? How do you know they haven't infected a partner? What percentage of people go over a year without recurrence? Just trying to understand how in the absence of scientific evidence you could feel comfortable telling people they can move ahead and not disclose to partners after a year. In my particular answer you say that in people with weal immune systems GW can be "prolonged" vs "forever". Does that mean that even with a weak immune system the GW will eventually stop recurring even if prolonged to a certain time? I've also read on the site that HPV DNA can reactive after time if the immune system is weakened. I have an unrelated condition where I have surgery to remove cysts every few years. If I do make it to 6 months a year or three years without a recurrence and then have surgery, how "likely" is that HPV DNA will reactivate and cause warts/make me infectious? If I get cancer does that mean the HPV will definitely reactive during chemo? Also, I did see my derm (actually a PA) about my possible recurrence and he said based on my history of HPV it "could" be a wart but he wasn't sure (even using a dermoscope). It's essentially a small white circular flat lesion that looks almost like a maceration like the white skin hover a wound you'd have on your finger, its located a few inches from my glans only visible when I pull my skin back. He is of the opinion that GW will return within months to years for life. Is he wrong? Why is this opinion so common among doctors? This have given me cognitive dissonance as I think about whether to disclose to a new partner and the risk of infecting them.
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Edward W. Hook M.D.
51 months ago
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I am sorry you found information I provided in my comments unsatisfactory. Scientific knowledge is continually evolving I had previously held “facts” are continuously needing to be revised or qualified. That is the nature of the discipline. The information presented on this forum reflects the cover for decades of sexual health/STI focused research and patient care that each of us has accrued over the course of our careers, as well as information gleaned from discussions with other experts and continuing review of the scientific literature. Unfortunately that does not provide all the answers. Further, given the infinite person to person variability in exposures, immune responses, and numerous other variables, the information provided represents statistical analysis for which there are virtually always exceptions. We do our best to provide science-based answers in the context of the questions as we receive them. I’m sorry you find that unsatisfactory.
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Our recommendations regarding disclosure to sexual partners is based on scientific observation and years of experience. Warts that have not recurred after six months rarely do so. On the other hand, as recently as a few years ago it was believed that when warts have resolved the virus and it’s genetic material had likewise resolved. More recent data accrued using improved scientific techniques now indicate that residual HPV nucleic acid‘s may remain at the site of infection in at least a proportion (less than 50%) of persons in whom HPV infections have clinically resolved. This provides the theoretical possibility of recurrence. On the other hand, our statements, based on the clinical experience of ourselves and other experts, is that this rarely occurs. That’s those are the facts. As a result, based on the fact that HPV infections are so prevalent in unvaccinated persons, that less than 1% of persons with HPV infection suffer serious complications, the fact that recurrences are quite rare, and observations as to how frequently HPV exposed persons overreact to the information that they have been exposed. we do not feel strongly about disclosure for those who are uneasy about it. That said, disclosure is always the preferred course of action.
Surgical procedures are unlikely to read to recurrence of HPV including genital warts.
I disagree with the dermatology physicians assistant you spoke with. Dermatologist tend to see a subset of persons who have particularly troublesome infections. Based on my own clinical experience, I am confident that the risk of recurrence of warts and HPV infections which are no longer detectable more than six months following resolution, whether that be due to treatment or immune response, is very low.
In closing this reply, I will add that you may want to consider getting the HPV vaccine. The vaccine is now approved for persons of your age and recent data show that vaccination not only dramatically reduces and almost eliminates risk for acquisition of HPV due to vaccine HPV types but may also Help to control existing infections. EWH
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51 months ago
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Dear Dr. Hook,
I did not mean to imply that I was unsatisfied, and I apologize if it came across that way. I just try to be cognizant of my own confirmation bias when reading this forum. I was more so looking for you to expound on some of the statements. You have done that and I appreciate it! If I could please ask for further elaboration on some of the comments you've made to my question...
In response to my question regarding age you replied stating my age should not diminish my ability to deal with my warts, which I agree as they have been gone over a year in one of the locations. More specifically, I was wondering whether my age would affect my ability to eradicate the virus or keep it in check forever?
In response to recurrence you mention that warts gone for> 6 months rarely return which as mentioned I've read on the site before. Is that specific to the individual wart that was treated and/or disappeared without treatment, or do you mean warts in general (no recurrence including new warts in new places)
In terms of treating vs not treating warts. In your experience does treating the wart have any affect on recurrence? I understand that removal of warts alleviate the cosmetic concerns in patients, but is there any impact on training the immune system to identify the virus? Does viral load diminish after treatment? If so, does have the ability to increase?
One last question if I may that I forgot to ask initially. Does the clinical appearance of the warts (size, qty, appearance) provide any indication to the level of infection and chance of recurrence?
Thank you again for your always thoughtful answers.