[Question #8940] Regarding Past Recurring Genital Warts

37 months ago

Doctors,

First, thank you for this service. I was diagnosed with genital warts at the beginning of 2018 (approximately) and have browsed this forum many times to help educate myself and ease my intense anxiety and panic over the diagnoses. Apologies in advance for the long description of my situation and follow-up questions.

I am 31 years old and had genital warts which recurred several times between 2018 and 2020. During this time, I once insisted I receive a biopsy on what my dermatologist deemed likely a “dead wart” (no active infection) due to my confusion as to why this kept happening, and concern that perhaps I was being misdiagnosed or over-treated. The biopsy came back as negative for low-risk types 6 and 11 (and high-risk 16,18, 31/33 and 51).

Up to the end of 2019 I had only been treated via electrolysis or cryotherapy. I then began to see a new dermatologist in 2020 who treated my last recurrence via cryotherapy, and I then requested to be prescribed Aldara. At this time I also began receiving the Gardasil vaccine, particularly due to the anecdotal evidence that it may help prevent further recurrence of past infections (I received all three shots on the recommended schedule). This treatment seemed to be effective, but I requested and received a second round of the Aldara due to my frustration with the infection despite no evidence of lesions. I have not had a recurrence in now over 2 years (I have seen the dermatologist a hand full of times to confirm this, including a few days ago).

I have now just begun dating again and am extremely anxious about all topics related to transmission risk and disclosure. Here are my questions:

-I understand that after 3-6 months without additional lesions, the chance of recurrence is extremely low, and disclosure is not necessary from a medical perspective (please correct me if I misinterpreted). Given I did have recurrences though, does this mean I have an increased chance of additional recurrences as compared to someone who only received treatment once?

-Is there any specific statistical evidence regarding length of time without new lesions and chance of recurrence related to specific periods of time. E.g., I have not had lesions in 2 years, is there a statistic I could note to future partners about chance of infecting them?

-Should I be concerned that the warts were due to a strain outside of 6 and 11 given the “dead wart” was negative for these strains? (which would therefore make a vaccinated partner still in danger of transmission).

-Do you have any particular advice on what should be noted to future partners when describing my situation and any risk I pose to their health?

Thank you again.

Edward W. Hook M.D.

37 months ago

Welcome to our forum and thanks for your confidence in our work. Thanks as well for having looked at other threads on the forum to expand your own knowledge regarding HPV and other STIs. I’ll be happy to comment.

I applaud your concern regarding the potential for transmitting HPV to others and your efforts to address your own HPV infections through interactions with dermatologists and receipt of the HPV vaccine. That said, I cannot help but feel that your level of concern is out of proportion to the risk and importance of HPV to your future sexual relationships. As you know from reading other threads on this site, virtually all unvaccinated sexually active adults will have multiple HPV infections over the course of their lives and in the vast majority of these individuals, the infections will have a little meaningful long-term health consequences. In the few in whom HPV may persist and begin to progress towards precancerous lesions, regular sexual health checks reliably minimize the risk for invasive cancer. Further, for those who choose to receive it, HPV vaccination further minimizes the likelihood of infection with the most common HPV types and thus of progression to pre-cancerous lesions. In addition, as you mentioned above, in persons who already have HPV infection, anecdotal evidence suggests that vaccination may improve response rates to therapy and reduce the likelihood of recurrence.

The fact that despite careful observation on your part and multiple confirmatory visits to dermatologist you have not had a recurrence of your genital warts in over two years is good news and makes it unlikely that you will suffer further recurrences. There are no reliable data to describe the proportion of persons in your situation who will experience recurrent warts however, there is consensus amongst experts that the longer the time period without a recurrence, the less likely future recurrences are to occur.

My advice as you move forward with future relationships is that you have no need or reason to disclose your past, previously treated words. In discussions with future partners, exchange of information regarding the HPV vaccination status by both partners is often helpful in strengthening communication within the relationship. If you choose to mention your previous general warts and their successful treatment that is certainly fine. Let me make sure you however that you are previous HPV infections in no way represents a threat to their health.

Finally, regarding the “dead wart” which you had biopsied, I wonder what the biopsy did show. Was there any evidence of HPV infection? If not what you had biopsied may have been a scar or other benign general lesion.

I hope these perspectives are helpful to you. I worry that you are more concerned about your previous genital warts than you really need to be. Take care. EWH

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37 months ago

A sincere thank you for your response and advice, Dr. Hook. I will take this to heart going forward.

The language on the addendum of the report is as follows: "In-situ hybridization is negative for both high and low risk types of HPV. The assay tests for high risk types 16, 18, 31/33, and 51, and low risk types 6 and 11. Although findings are negative, they do not unequivocally exclude condyloma acuminatum (either and old lesion or a rarer HPV type)." The test occurred June 2019.

Edward W. Hook M.D.

37 months ago

Thank you for the additional information. The addendum indicates quite clearly that the lesion which was biopsied did not have active HPV in it. I would consider that good news and believe that it reinforces the messages in my original reply. EWH---