[Question #980] Further follow up to question number 880.

50 months ago
Hope I am not being a nuisance here but hope one of the experts can answer a few further questions to those i asked Dr Hook a month ago. I appreciate the work you both do and your expertise. 
1. How often are other lesions mistaken for warts? As said,those i saw were 2 little pimples very close together which i would probably have missed had i not been looking closely. Frozen off. I forgot to say there was also what looked like a tiny flap of skin in the area between my testicle and my leg which was also frozen off about a week later. On all occasions,the nurses said because they went white they were warts. I believed Dr hooks assessment that this is not an indicator. 
2. My lady and i have not had sex since July last year,so 12  months ago.  We have never used condoms and are considering doing so without when we do get together in this way. She knows about the wart,or warts. I appreciate this will be our decision alone but as a rough guide is there any timeline we could do this? Does viral load decrease over time? Does age have any bearing on clearance? I am 67 and so is she.  Also,could chafing have caused skin lesions? In all cases,there had been some chafing before the lesions showed up. 
3.  In my first question,which Dr Handsfield answered,I explained my only infidelity was a stupid one where i touched another woman then masturbated with the same hand. This person has no symptons according to her as i have asked.  The clinic said it was more likely an old infection which baffles me as apart from this my lady has been my only partner in around 20 years. 
My main problem is I don't want her to get warts as mine have been very minor. But the ones i have seen pictures of,particularly females,have been horrific.
Thanks Doctors,I appreciate this is not straightforward but any observations will be appreciated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Welcome back to the forum. Dr. Hook and I take questions more or less randomly and I'll be answering this one. However, several people have selected username "john" and I have not been able to review your previous discussion -- so the current replies respond strictly to the questions you have asked this time. Directly to them:

1) The reliability of diagnosing warts is generally pretty good, but it depends a lot on the experience and training of the clinician. I will say that the nurse you saw seems to not be highly expert. Whitening of tissues with acid (vinegar etc) is very unreliable in distinguishing warts. Some warts don't turn white, and some white things are not warts. We never use that method in my STD clinic. Small "pimples" are not likely to be warts; and if something looks like a skin tag, usually that's what it is. And genital warts don't generally occur in the location you describe.

2) I hope you and your partner have not been avoiding sex for a whole year because of concern about HPV and warts. We're talking about a minor inconvenience, not a serious health issue. Had you been my patient, I would have told you to never stop having sex together.

3) It is usually impossible to know with certainty when and from whom genital warts or other HPV infections were acquired. And some genital HPV provlems appear in people who seem to be at zero risk. The explanation isn't really known. But since warts are just an inconvenience, I really don't see that it matters.

As for your comment about some warts getting large and otherwise more seriously troublesome, that sort of problem is always easily avoided by prompt treatment. The horrible photos you can find online mostly are in people who ignored them for many months or even several years before being professionally evaluated; or, in come cases, people with advance immune deficiencies that foster rapid growth of warts (AIDS, advanced cancer, potent chemotherapy, etc). The "horrific" warts you have seen are always easily avoidable.

Please let me know if anything isn't clear--  HHH, MD

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50 months ago
Thanks for your quick reply Doctor.  For various reasons,we have not had sex for almost exactly a year,though when we have got together,we have petted etc. One reason is I have had surgery on my leg but that is recovering. Must admit,though,I have had fear of transmission. 
Basically the timeline is this:   
1. I saw a wart on the shaft of my penis in December 2014. Frozen off one month later in January 2015. In the interim I have seen spots etc which I have had checks at the clinic,maybe 3 or 4 times and they have said on inspection not warts. Seen nothing till the end of May this year 2016.
2. Last week in may saw these minute pimples,barely above the skin. Were both frozen off. As said a while later in fold between my testicle and leg a soft thing that I could move but was maybe a millimetre long was frozen off. None of these they seemed to be sure about. Dr Hook said it seemed a long time between. As I have b never known anybody else with warts I have nothing to compare it with.  But if indeed these WERE warts it would appear they had showed up around 18 months after the first one. 
I have looked on your old medhelp forum and in general it appears if no warts after between 3 and 6 months likelihood is that it is not transmissible. I know you both say there are no absolutes in science so I am certainly not banking on this.  Has this changed? Sorry once again for my persistence but thanks once again Dr. I appreciate what yourself and Dr Hook do.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
If the newer spots on your penis didn't look the same as the previous warts, then probably they weren't warts. And as I said, warts never look at all like pimples.

Our previous advice on MedHelp about HPV transmissibility after apparent resolution of warts has not changed.

Thanks for the thanks about our services.

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50 months ago
Thanks Dr Handsfield. I believe I can post one more time so hope you don't mind another couple of questions. First,neither of the things I saw later were like the original wart,and nowhere near the same location. So Im assuming THEY were not actually warts. Ive thought about waiting another few months before we have sex . By the time we get together it will be three months.  If you were in my position,would that be an acceptable time?
Also,in your experience,and this has always baffled me,does the presence of warts increase risk of transmission?  If Im not allowed another post please ignore me and once again thanks for your advice and service.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Your assumption almost certainly is correct. Warts usually look like warts, and recurrent warts usually look pretty much the same as the original ones. In other words, the change in appearance is against the possibility of new warts.

If I were in our situation, I would never have stopped having sex with my wife -- for sure if she and had been sexually active all along, in which case it could be assume she was already infected with my wart-causing HPV. Even if there had been a new partnership that might have explained your warts, you could havfe safely started having sex with your partner soon after the original treatment. In my opinion, it is wrong for you to still be avoiding having sex with her the next 3 months.

Most experts assume that active, visible warts is associated with a higher viral load (more virus on the surface) than asymptomatic wart virus infections. If so, transmissibility might be higher during visible warts than with asymptomatic infections. However, there are no data on this; there has never been studies on it, and never will be. Not an important enough issue to warrant the expense of such research. In the absence of data, you'll find highly variable opinions on it, from both experts and non-experts. This is why you can't find consistent answers (or any answers at all) by online searching.

That indeed completes the two follow-ups included with each thread, and so ends this one. Best wishes.

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