[Question #891] HPV/Genital Warts

53 months ago
I know we can't formally make request for who responds, but if possible if Dr. Handsfield could comment that would be most appreciated as he answered a somewhat similar question on Medhelp sometime ago. So several months ago I was reckless with my sexual activities and didn't wear a condom during multiple occasions. I have had a full panel STD test and everything came back negative which came as a huge relief. However, I had a several small skin tag looking bumps at the base of my penis, and another one that slightly bigger on my shaft. Knowing that all the other major culprits had negative results, I made the assumption of genital warts. I made an apt with a GP to confirm my assumption and he said I was fine. He gave me some cream to use on the bumps(used for jock rash and other things), but didn't see cause for concern. His inspection was brief at best and seemed to discount my concerns saying their not red, raised, fluid filled etc... more of the herpes systems.

So I didn't think much of it for 2 months until I recently started seeing someone 2 weeks ago. While grooming/inspecting the area it seems the area may have gotten worse, with slightly larger and maybe more raised bumps. Last night we had sexual interactions in the form of her rubbing my penis and I rubbed/fingered her vagina. We also did grind but this was with clothing on, so I'm not overly concerned about that. I am concerned that I may have passed genital warts onto her by the touching/rubbing assuming I have genital warts. Do you think I have cause for concern here?  At this point I am fairly certain I have something and genital warts seems to make the most sense based on my past. I want to engage in sexual activities with her, but also don't want to give her HPV. I know that most virus clear within 1-2 years, but does this included cases with genital warts? I couldn't find any clear cut information on that. The last time Ive been with someone was 7-8 months ago, so if it was HPV I was hoping it would have clear by now. Should I get a second opinion? Or could this potentially be something else and I have nothing to worry about. Thanks.

Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

As you know, you cannot request response from one or the other of us so you are stuck with me. 

You raise a number of questions and may be unclear on some of the scientific facts regarding HPV infection. I'll try to address them below. The first question is whether or not you have genital warts.  You do not mention when you noted these bumps following the sexual contacts that you describe above.  Further, it sounds as though you may have two different processes- one which you describe as "small skin tag looking bumps at the base of my penis" and a second solitary process that is somewhere on the shaft itself.  (It would be unusual for genital warts to appear in tow different places with different appearances or to appear in less than 2-3 months following sexual contact). There are a number of cutaneous condition which can cause genital lesions including actual skin tags, molluscum contagiousum and other processes.  Thus, for this reason, I would endorse your decision to have someone else take a look- perhaps a dermatologist or STD specialist if you have access would be best.

Second, the fact is that you have had at least one other sexual partner and perhaps your newer partner has as well. If so, my suggestion would be to assume that one or both of you have HPV infection, whether you know it or not and to not worry about it.  Since at least 85-90% of sexually active persons have or have had HPV, far wiser to assume that you do than to worry about whether you might have it on not.  If you make this assumption, then the next issue is what to do with/about your HPV infection and most experts would say: 1. as long as men have suspicious lesions evaluated and women follow reproductive health recommendations ( for PAP smears, etc.) to prevent the RARE consequences of HPV so that they can be treated, unless there are cosmetic concerns, there is little to worry about.  Treatment can be worse than allowing HPV infections to resolve on their own as most do. and 2. If visible warts become a concern, have them treated with the easiest, least expensive treatment available.  Further, if you really believe that neither you nor your partner have HPV and perhaps even if you do, the widely available HPV vaccine almost completely eliminates the risk of genital cancers and dramatically reduces risk for further infection.

Finally, there is no data to suggest that hand to genital contact or rubbing ("grinding", even with wet clothes), leads to transmission of HPV.

Yes, the data on clearance does include genital warts.

I hope this information is helpful to you.  A second opinion will be helpful. In the interim, please try your best not to worry. EWH

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52 months ago
Dr. Hook,

Thank you for the information, it proved helpful. Based on your endorsement I had another Dr take a look today. Based on his inspection he couldn't fully confirm nor deny it was in fact warts(minus taking a skin sample which we both agreed against). He stated in some instances its easy to make that determination based on the size, shape, etc, but in my case they are small and could be just a general skin lesion or something similar.
1)He provided me with a scrip for Condylox and said the only way to know for sure is apply the gel and see if it clears if I choose to use it. Would you support this rationale?
2) If so, I know reoccurrence is possible, but how often? I read that the presence of warts increases the chance of transmission?

Based on reading some of your other post regarding HPV it seems like its not really an issue, even when warts are involved, is this the case? My main concern is giving my new partner warts in the event she hasn't been vaccinated which I think would cause some stress on the relationship.
3) Based on my understanding of HPV, just because I have warts wouldn't mean she would get them? And I've seen varying degree of transmission data floating around from 20%-80% based on 6 months of sex. For all we know she might already have HPV, but I know she's "claims" shes only been with 2 people. I would obviously love to become romantically involved with her, but am having a hard time getting my mind around the possibility of transmitting warts.
Thanks, 

Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago

As I mentioned above, in all likelihood your partner either has been vaccinated or is already infected, whether she knows it or not.   Transmission estimates are difficult to calculate.  There are of course no guarantees but the odds of you infecting your partner are small. AT the same time, your concerns are laudable and one approach would be to discuss your concerns with you partner. This could clear the air and when people are able to do this, it tends to strengthen relationships.   EWH

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52 months ago
Dr. Hook,

I agree that at this point she had probably been vaccinated or already has HPV. My concern would be to giving her the strand of HPV that could potentially cause genital warts. As I mentioned in my previous post:

1)The Dr provided me a scrip for Condylox and said the only way to know for sure is apply the gel and see if it clears if I choose to use it. Would you support this rationale?? If I can reduce the rate of transmission even if she has some type of HPV I would have greater peace of mind and I have read the presence of warts can increase transmission? Thus by removing the potential wart I reduce transmission chances?

2) Also, I would like some reassurance/peace of mind on my comment "Based on reading some of your other post regarding HPV it seems like its not really an issue, even when warts are involved, is this the case? I apologize if this is repetitive but getting expert confirmation on this topic would help me.

3) You mentioned that even if you have HPV you can still receive the vaccine to reduce risk of further infection? I'm 28 and too old based on my research, but shes only 25 so she could still receive it?

4) Lastly, assuming I choose to treat the wart and it goes away or stay the course, would you recommend sexual activity as usual or should I refrain from such activity.

Thank you,
Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago
1.  Condolox is non-specific treatment. And we do not recommend treatment "just in case".   This is often misleading and just confuses things.  As I have said above, I would urge you to move on without concern.  You are more worried about this than you should be.  If you are serious about this relationship, then discuss your concerns with her.  This would be a sign of caring and respect.

2.  Virtually all sexually active persons have or have had HPV and the infection should not be a cause for anxiety or concern.    Rather steps should be taken to prevent the RARE consequences/complications of infection.  These are regular check ups and testing (such as PAP smears for women) and for men, having a professional look at lesions.  If the professional is u sure as is your case, better to simply have the professional follow over time.

3.  You both can receive the vaccine.  She is of an age when insurance often will pay for it, you are not and would probably need to pay for it yourself.  The reason for the age cut off has to do with the fact that most people have HPV if they get older and so from an insurance company perspective it makes little sense to pay for it. On the other hand for you and possibly your partner ( if she has not already received the vaccine) vaccination would greatly reduce the risk of new infections.

4.  I see no reason for refraining from sexual activity.

I hope these comments are helpful.  EWH
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