[Question #8445] Persistent Genital Warts Question
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44 months ago
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I'm 48 & have had persistent warts since 2013. A biopsy a couple years ago said 6 & 11, & my ex wife says I gave her 16 & 18 (I'm inclined to believe her considering hers & my past). I know HPV has a greater chance to persist the older you are. What does the research say about my likely future? I just had one burnt off on Monday. I have fairly severe General Anxiety Disorder, & I attribute it's persistence to how that compromises my immune system as I'm otherwise quite healthy. My new partner & I always use condoms, but I can't finish with them so I'm losing steam. She got all 3 G-9 shots when I told her about my lot in life, but it's not my decision to drop the condoms given I'm still having active warts. G-9 is very effective, but is it effective against protecting against unprotected sex even if I have an active wart present? Is it just as effective if it's anal as opposed to vaginal? What about oral? What does the research say about my future. Everybody always talks about the year or maybe two HPV troubles you before it clears, and some also talk about how unpredictable it can be, too, but no one really discusses all the statistical outlier scenarios HPV can present. I just want to have sex without a condom someday without having a panic attack about HPV while doing so and without infecting someone to do so. Is there anything you can tell me other than, "we all get it?" Thanks
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Edward W. Hook M.D.
44 months ago
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Welcome to our forum. Thanks for your question. I’ll do my best to address your questions but As you point out outliers are those individuals who do not follow the generalizations regarding these very common infections.
Your visible warts, including the one that was recently treated, are most likely type 6 or 11, HPV types which are included in the Gardisil-9 HPV vaccine. Further and equally important HPV six and 11 infections virtually never progress to cause cancer. Finally, the fact that your partner has been fully vaccinated makes her risk of infection, even if exposed to untreated (active) infections very, very low. Furthermore, should she become infected, particularly given her vaccination status, the likelihood that an infection that she required would persist or progress is very very low. Given these facts, providing there are no other STI’s present, I see a little of reason to avoid unprotected sexual intercourse going forward. Obviously that is her choice but the odds that she would get infected and suffer complications of those infections is close to zero.
Data on HPV transmission during rectal and oral intercourse is still emerging. The rectum seems to be nearly as susceptible as the vagina to acquisition of HPV. On the other hand, for reasons that are unclear, acquisition of oral HPV infection is far less common following exposure then acquisition of infection at genital or anal sites.
In my opinion, particularly with a vaccinated partner, the risk of transmitting HPV (which you are actively seeking treatment for) through unprotected intercourse is low and should not require condom protection. Of course, the ultimate decision regarding this relates to your level of concern and your partner’s level of comfort. Considering the information I have provided above however, I would not be overly concerned regarding unprotected intercourse. I hope this perspective is helpful. As you point out there are no absolutes. EWH
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44 months ago
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Thanks for your reply. That's encouraging news about how effective Gardisil 9 is. I know the research landscape on this is stark at best, but do you have any gut feelings on whether I'll have persistent warts for the rest of or most of my life? I am pretty convinced that my persistence is related to my pretty severe general anxiety and how that relates to my immune system so perhaps as my life settles down and I'm able to meditate and breath to reduce my anxiety the outbreaks will go away. I know that's probably not anything you can really speak to, but one never knows.
I have some HPV questions, too. I've had warts twice. The first time was a textbook case of a year of outbreaks and then gone. This recurring infection I got three or more years later and has a different morphology and number of warts per outbreak so I'm sure it's a different strain (yes, a biopsy says it's 6 or 11). The first outbreak was pretty localized to a certain area, and the second to another area. I was told the virus doesn't always stay where it penetrated the skin and can even show up on the anus even if you've never had anal sex or much anal play to speak of. Is this true? Also, theoretically, if I had a crystal showing me that in three months I was going to have a wart as such and such spot, if I treated that exact spot with, say, liquid nitrogen, would that future wart never occur now or would it? Theoretically, if I could dip my whole penis in liquid nitrogen without deleterious effects, would the virus still be there? Is there any cream I could apply regularly that would prevent outbreaks to some degree or completely? These are just things I must about.
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Edward W. Hook M.D.
44 months ago
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The research landscape on the efficacy of HPV vaccines is anything but Stark. They are benefits are incontrovertible Anuel proven by an enormous number of research studies. They are highly protective.
I cannot comment on the likelihood that your words will persist for the rest of your life but this would be unusual. Most warts go away on their own and you have actively undertaken seeking treatment which further assures that you will rid yourself of warts with treatment.
A previous wart infection provides less protection from future infections than the vaccines. Your two episodes of warts may have been caused by HPV six, HPV 11, or both types at different times.
Other than for you to seek vaccination with the HPV vaccine, there are no proven mechanisms for avoidance of warts other than correct and consistent condom use and condoms are not perfect. In general, my advice would be given your concerns, if you have not had the HPV vaccine you should seek it.
I hope these replies and perspectives are helpful to you. EWH
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44 months ago
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Thank you. My last question is about who should actually get the Gardasil 9 vaccine. I've read in the past that it works best for people who have not been sexually active or, more specifically, people who haven't yet contracted any strains. Should older people who have had many partners still get vaccinated? Does getting vaccinated do anything regarding strains someone had already contracted and previously cleared? What about in my case where outbreaks are persistent? Thanks again.
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Edward W. Hook M.D.
44 months ago
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Recommendations for who should receive the HPV vaccine have evolved since it was introduced. While the vaccine certainly works best and offers greatest protection for persons who receive it before they initiate sexual activity, even for people who have had HPV infections in the past, it is unlikely that they have been infected with all nine strains contained in the vaccine and thus the vaccine offers some protection. In addition, Limited, evolving data suggest that the vaccine may somewhat enhance resolution of infection in people who are already infected. The HPV vaccine is now approved for use in men and women up to age 45. Hope this helps. EWH ---