[Question #934] HPV - Recurrence

98 months ago

Doctors,

I was diagnosed with genital warts in 2012. I had a few recurrences but the warts eventually cleared within the 2 year timeframe. Then to my knowledge, I had not had any recurrences since (I'm guessing I had been clear for the past two years or so). Just recently, I had found a very small bump near the base of my shaft so I decided to get it checked out by my dermatologist. At the time, he wasn't sure it was a wart (he thought it could've been a hair follicle gland that just didn't have any hair). For peace of mind, I requested that he biopsy and test it.

He said that his pathologists confirmed that it was in fact a wart. They tried to test it and determine which strain of hpv it was, however, he said the tests couldn't pick up anything which he was guessing was because it was so small. He made it sound as though the pathologists determined it was a wart solely based off appearance under the microscope.

Here are my questions:

1. Is there a chance the pathologist is incorrect in the diagnosis since it was based off of appearance under a microscope and not actual tests?

2. I have been dating my girlfriend for a few months and we had been using condoms until very recently where we started having unprotected sex the last couple weeks. She had the gardasill shots roughly 5 years ago. What are the odds of her being infected at this point? Am I any less contagious because the tests couldn't pick up the hpv strain in the tests?

3. What sexual precautions would you recommend moving forward? Or would you not recommend sex right now? (For what it's worth, the previous girl I dated through all of my wart outbreaks also had the gardasil shots and to my knowledge she did not ever have any visible outbreaks)

4. Since this has come back years later, does this mean anything for future recurrences? Everything that I had read/been told led me to believe that they were likely gone forever after such a long time without an outbreak. Does this mean I will be more likely to have future recurrences?

Also, my immune system is not compromised in anyway. I'm a healthy 29 year old. My biggest vice is drinking socially on the weekends.

H. Hunter Handsfield, MD

98 months ago

Welcome to the forum. Thanks for your question. Sorry you're having this experience. However, it really should not be very worrisome; this is an inconvenience, not an important health threat either for your or your partner. To your questions:

1) Micrroscopy is definitive. I can't say error never occur, but almost certainly it's a wart. However, it is possible that some warts are "burned out": the immune system is keeping cellular proliferation and HPV in check. That could explain why HPV testing was negative. If so, it also implies low potential for transmission. That said, we're in a data free zone here: I'm not aware of any research on these topics. I'm just drawing logical conclusions.

2) Probably there is little risk for your partner. Most important, Gardasil is an extremely effective vaccine, with 100% protection against the two HPV types (HPV6 and 11) that cause 90% of genital warts. While I can't guarantee your wart is due to HPV6 or 11, probably it is (90%). And if not, the chance your partner would develop visible warts, even if infected with such an HPV type, is low. And as implied above, I do agree it is likely you are less infectious given the negative HPV analysis.

3) I recommend no precautions against HPV. Even your condom use until now probably hasn't helped much. (It's always a good idea for new couples to use condoms initially, e.g. until mutual monogamy is assured. But it's mostly to protect against STDs other than HPV. Condoms are only ~90% protective against HPV for each exposure; with multiple episodes of intercourse, condoms make little if any difference in HPV risk. So you can safely assume your partner has been repeatedly exposed to your presumptive HPV infection. Everyone gets genital HPV -- it's an unavoidable, expected consequence of human sexuality, regardless of the best precautions.

4) I doubt this has any implications for future recurrences of your genital warts. That said, this also is an area that to my knowledge has not been studied: I am unaware of research on the frequency of future recurrence after an initial one has happened. But I have rarely if ever seen patients who continued to have repeatedly recurrent warts as the years went by.

I'm glad to hear you maintain your health. But the "strength" of the immune system doesn't appear to have any effect on recurrent or persistent HPV. Overt, serious immune deficiencies (AIDS, cancer chemotherapy, etc) increase the risk of persistent or recurrent HPV. But everyday insults on the immune system (colds, other illnesses, drugs, alcohol, poor nutrition, etc) aren't known to have any effect. (Oops, one exception to that statement: tobacco. Smokers have slightly higher HPV persistence or recurrence rates, and higher risk of HPV progression to cancer, than nonsmokers.)

The bottom line, put in personal terms: If I were your situation, I would continue unprotected sex with my partner, while both of us remained on the alert for development of visible warts. But I doubt that will happen. Your partner should also follow standard pap smear recommendations -- but so should all women, and this situation doesn't increase her risk of an HPV related pap smear someday. (But her previous Gardasil markedly reduces that chance.)

I hope this has been helpful. Sorry that some of the answers aren't as clear as you might like, due to absence of definitive data. But I am very confident, as implied above, that this situation doesn't imply any serious health risk for either of you.

Best wishes-- HHH, MD

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