Hi,

Two quick, clear questions (that probably do not have quick, clear answers).

1. The "80% of sexually active adults will acquire some form of genital HPV in their lifetime" statistics is helpful and reassuring. But is there any data on how prevalent the wart-causing strains of HPV (6 and 11, and others?) are? If a person has GW, do they necessarily need to feel like part of a very small unlucky group, or are HPV 6- and -11 some of the most common strains transmitted? I ask because of the fact that even though only 1-4% have visible warts at any given time, many people are asymptomatic carriers and just never know it.

2. I read somewhere that new research suggests that infecting someone with HPV-6 or -11 will almost definitely give them visible warts. Is this true? The wisdom from before was always that MOST people who are exposed to these low risk strains never show any symptoms. Any references on this? Because I'd like to know, if a person has a warty strain and is in a transmitting state, and exposes a partner (who has never before been exposed to HPV 6 or 11), will that person have a very low chance of developing visible symptoms, or is the chance quite high? What's the word on this from all the new research?

HPV prevalence data is kind of tricky, because it's a snapshot at the given moment. Most people in any study like this who had HPV at some point probably cleared it, and thus would not count in the "positive" group.

In one study - Dunne, Unger, et al. - that looked at HPV genotype prevalence among women, HPV-6 was found in only 1.3% of the subjects. HPV-11 showed up in a paltry 0.1% of participants. These HPV types are responsible for about 90% of genital warts. Of course, many more of these women probably had one or both of these HPV types in their past, but the infections are no longer detectable.

With men, research in the HIM Study by Giuliano et al. found HPV 6 in about 6.5% of men.

As for symptomatic cases, it's true that the majority probably would have some type of skin lesion if examined closely enough. Keep in mind, though, that HPV lesions (even external genital warts) can be very, very tiny, hard to detect, and tend to clear spontaneously without treatment. So while the % of those with low-risk HPV who technically have some type of lesion is probably high, the number of cases where the warts are readily visible or of any clinical relevance is relatively low.

Best,
Fredo

_________________
ASHA Moderator

Thanks for that. So basically what you're saying is that the 80% figure shouldn't really make anyone with EGW feel better, right? Because in that case, "Genital Warts", i.e. HPV-6/11, is still a fairly uncommon virus -- which is probably why all the stigma is attached to it.

I really thought the prevailing viewpoint was that many people exposed to HPV-6/11 were asymptomatic. Then again I did read somewhere that "new evidence" suggests that nearly everyone with HPV-6/11 expresses some symptoms. It's all very confusing and depressing.

Most of the "feel good" information about the prevalence of HPV does not therefore apply, and the notion that future partners have very likely already been exposed to the low risk strains (and have cleared it) is probably morally bankrupt in light of what you're saying.

Maybe you can help me with some of my anxieties:

For the record, I don't know if I have HPV. In January I found something that freaked me out -- I could barely eat or sleep for days, until I returned from the holidays and could drop in at my local STI clinic. Once there I got an intern who was useless, saying it was a "tricky" diagnosis, and then proceeded to point out 3 or 4 other lesions in the pubic area (some of which were clearly moles or ingrown hairs). He called in an "expert", during which I sweated bullets.

When the expert arrived, he examined it and said "I don't see any warts." But there was a tiny lesion that we had identified that we then "lost" and spent minutes searching for again. The expert grew impatient and was ready to leave. Finally we found it, and I pointed to it, he looked, and then said "I don't see any warts" again.

When I returned home, I froze it off with a home freezing kit just to get it off my mind, but I never thought about HPV again until 2 days ago. In the interim, it turned out that I got molluscum ... starting below my navel.

I've been battling molluscum for almost 4 months now and the damn thing is persistent. I have had serious anxiety and depression surrounding this "trivial" STI.

And then amidst all that, I found something that might have been a wart. I was so terrified and decided then and there to get rid of it myself, because I could not possibly handle a positive diagnosis at this stage, 4 months into molluscum-related depression.

So I froze it (I've been using an upside down can of dust-off sprayed into a bottlecap, and the resultant liquid applied with a q-tip, on my molluscum sometimes). Naturally, in my state of panic I over-froze it. The lesion turned a bright red, almost cherry red, unlike any wart I've ever frozen on my neck. I told myself it probably wasn't a wart, it was a skin tag or any other benign skin lesion, but I kept staring at it and theorizing.

I didn't want to go in to check, and felt like a murderer covering up the scene of the crime. The next day the area got swollen due to the over-freezing, and I starting pulling on it with tweezers, and surprisingly the tissue just came off (with most of the underlying skin that was inflamed). I then noticed a tiny other blemish of similar sort, but softer, and was out of freezing fluid so I actually pulled it up with tweezers and made a tiny incision with a razor blade that was sterilized. Of course I have all the tools -- alcohol, povidone iodine, tea tree oil, tweezers, razor, so forth.

Basically now I have removed all evidence of those lesions, but I find myself uncomfortable not knowing. My rationale was this: if it was HPV but was to be an isolated minor episode, with no more warts to follow, then I'd rather not know. I want to be one of the masses of people who are asymptomatic or just never realize it until they clear it. I don't want to face it. Maybe if I hadn't been struggling with the loneliness and depression of molluscum, I'd be more adult about it. But I just can't now.

And I figure if it was really HPV I'm likely to get more, and then it'll be unavoidable. But maybe I'll get lucky. And in the meantime I'd like to hope that it was not a wart that I froze. But I'm gathering all the info on HPV just so I feel less horrible about it, and maybe will be able to better deal with it if it comes up.

It doesn't seem like HPV is that much worse than molluscum, but it IS stigmatized. I hope it doesn't come to me knowing for sure.

For the record: the growths were almost like a "ridge" with one major bump and two tiny minor bumps. Not as soft and floppy as a skin tag, almost like a harder skin tag that looked a bit like a mountain range in profile. No wart I've ever had looked anything like it -- I've had flat, rough warts on hands and feet, and I've had the "horny", filiform warts on my neck that sort of look like multiple stalks with a rough surface when you touch the tips. It definitely wasn't molluscum.

What do genital warts typically look like? Multiple stalks, or roundish bumps with rough cauliflower texture? Or can they look like anything?

Sorry for the disjointedness of this reply. I didn't mean to spill so much in this one post, but it's late and I guess I have a lot on my mind.

continued...

But maybe I'll get lucky. And in the meantime I'd like to hope that it was not a wart that I froze. But I'm gathering all the info on HPV just so I feel less horrible about it, and maybe will be able to better deal with it if it comes up.

It doesn't seem like HPV is that much worse than molluscum, but it IS stigmatized. I hope it doesn't come to me knowing for sure.

For the record: the growths were almost like a "ridge" with one major bump and two tiny minor bumps. Not as soft and floppy as a skin tag, almost like a harder skin tag that looked a bit like a mountain range in profile. No wart I've ever had looked anything like it -- I've had flat, rough warts on hands and feet, and I've had the "horny", filiform warts on my neck that sort of look like multiple stalks with a rough surface when you touch the tips. It definitely wasn't molluscum.

What do genital warts typically look like? Multiple stalks, or roundish bumps with rough cauliflower texture? Or can they look like anything?

Are there differential diagnoses? I am assuming there are other sorts of lesions that are not molluscum or warts.

Sorry for the disjointedness of this reply. I didn't mean to spill so much in this one post, but it's late and I guess I have a lot on my mind.

Hey there,

I didn't realize what an ordeal this has been for you! Sorry it's been so difficult.



Let's clear this up if we can. Remember I said that the studies that look at HPV genotype prevalence are a "snapshot" in time. Heck, there may be NO subjects in a study that have this or that HPV type detected. It doesn't mean they haven't had it in the past, though. People can clear an HPV infection but still likely retain an immune response to the type they had. When this happens, they will test "negative" in these studies, thus rendering the results artificially low within the context of whether or not someone has EVER had the virus. The studies only look at whether on not they have the virus NOW. Make sense?

Part II below!

Fredo

_________________
ASHA Moderator

I can quote this one in my sleep! "Rough or smooth, single or multiple. Warts may be raised or flat, and sometime have a cauliflower texture or appearance. Warts are usually the color of the surrounding skin, but can be darker or lighter."



ASHA consults with a number of smart folks in this area, and one of our buddies is an expert specifically in the area of genital warts. He says a visual inspection by a health care professional is accurate "95% of the time." In cases where there is real doubt, a biopsy can be done. Molluscum contagiosum virus (MCV) is most often diagnosed based on the characteristic appearance of the lesion. MCV may also be diagnosed by collecting a specimen from the lesion, placing it onto a slide and staining with a Gram stain which shows changes in infected cells. Diagnosis may be made by collecting a specimen from the lesion and viewing it under an electron microscope.

MCV Lesion Treatment

* Most symptoms are self-resolving, but generally lesions are removed. Removal of lesions reduces autoinoculation and transmission to others.
* Lesions can be removed surgically and/or treated with a chemical agent such as podophyllin, cantharidin, phenol, silver nitrate, trichloracetic acid or iodine.
* Cryotherapy is an alternative method of removal.
* Lesions may recur, but it is not clear whether this is due to reinfection, exacerbation of subclinical infection, or reactivation of latent infection.

I should mention this: Don't self-treat suspected warts! Let the pros have a crack at it, pal. Much safer for your skin.

Best to you,
Fredo

_________________
ASHA Moderator

Quick question: what is molluscum, exactly?

From what i've understood of it, it is really contagious.
Clear things up?
Thanks

_________________
"Courage is not the absence of fear yet, it is the presence of fear but the will to go on."