Hi everyone, 33-year-old male here diagnosed with genital warts on Friday. Needless to say, it was a demoralizing shock. I had gone to the dermatologist for a yearly mole check and wanted him, basically as an afterthought, to examine 4-5 small skin-colored bumps that had appeared about two months ago at the base of my penis and on my pubic bone area. I thought they were skin tags or some normal age-related skin changes that I figured he would say were nothing to worry about. But apparently, they’re genital warts. He “cryo’ed” them and scheduled a follow-up appointment six weeks from now.

I’ve been freaking out about this since my visit to the doctor and reading up on HPV as much as possible. This site is a godsend, and Fredo, you seem to be a veritable saint. I’ve got a ton of questions I’m hoping people can help me with. Here are a bunch:

- Is it worth getting a biopsy done on one of the warts to know for sure that I have low-risk HPV? The dermatologist made his diagnosis within seconds of examining me “down there.” Is there a chance it could be something else? This dermatologist seems pretty experienced and has probably seen genital warts numerous times over the course of his career, but you never know. Based on what I’ve read on these boards, there’s no approved HPV test for men. It seems the only opportunity for men to get “tested” for low-risk HPV is when there is an outbreak of lesions, one of which can be removed and sent to a lab. I figure I might as well take the opportunity now, while the growths are still there.

- Is there any kind of referral network for doctors that specialize in STIs or even HPV specifically? Again, my dermatologist is experienced, but if possible I’d rather go to someone who deals with this on a regular basis and at least get a second opinion. (I live in Washington, D.C., if anyone has any specific suggestions.) My dermatologist made a fairly cursory examination before going ahead with the cryotherapy; I’m not even sure he hit all possible warts.

- With cryotherapy, are warts supposed to be destroyed/removed instantly? My warts are still there. They look a bit more like pimples now. Am I supposed to rub them off now or leave them alone? I didn’t think to ask my dermatologist, as everything happened quickly and I’d assumed the warts would be removed, like removing a mole.

- Does a follow-up exam in six weeks make sense? From what I’ve read here, it seems like people meet with their doctor much more often than that during treatment.

- Is there any basis to assume that, if a recurrence happens, the warts in a new outbreak would be of the same general size and number? As I mentioned, what I have now is fairly limited—nothing like what I see in photos online. Along the same lines, does having larger warts or more numerous warts mean that the HPV infection is more extensive? In other words, is it possible to have a “minor case” versus a “major case” of HPV infection?

- Can I be reasonably certain about who I may have contracted the virus from? The last time I had sex was in September 2008, and around May of 2009 I began noticing the warts. Before September 2008, I’d been having sex with one girlfriend (who I have no reason to think was not faithful to me) from the fall of 2006 to December 2007. In the spring of 2006, I had sex a couple of times with one girl, and in the summer of 2005, sex once with another girl. (I wore a condom each time with everyone.) Before May of 2009 I had never noticed any warts or other abnormalities, so I assume, based on the timing of all of this, that I contracted the virus when I had sex in September 2008 and, in what seems to be the typical progression, began experiencing symptoms months later. Would it be smart to contact the girl from September 2008 and let her know? Can she be tested for the presence of low-risk HPV and definitively learn her status?

- Should I stop shaving “down there”? For a few years I’ve been shaving hair off my scrotum and the base of my penis, about once a week, using the same kind of disposable razor I use to shave my face. When the warts appeared, I would shave right over them, and sometimes they would be cut and bleed. Did this or will this cause them to spread? If I don’t continue shaving, some of the warts in that area will be “buried” and I don’t think I’ll be able to determine whether they’ve gone away. I probably would not have noticed anything unusual down there at all had I not been shaving as I have. I also wonder if my being shaved increased my risk of being infected, simply because more direct skin-to-skin contact took place.

Sorry for the barrage of questions, but I’d appreciate anyone’s thoughts and certainly appreciate this board!

Hi detante,

Is it worth getting a biopsy done on one of the warts to know for sure that I have low-risk HPV?

This is rarely necessary, especially if you're trying to figure out the low risk/high risk angle. 90% or more of genital warts are due to just two low risk types, HPV 6 and 11. There's no practical need to know specifically just which genotype you're dealing with.

Is there any kind of referral network for doctors that specialize in STIs or even HPV specifically?

We don't have those kinds of referrals. In general, dermatologists and urologists are the ones you'd see for this (although general practice providers and public clinics tend to see warts often).

With cryotherapy, are warts supposed to be destroyed/removed instantly?

No. The treated area blisters a bit and the treated area eventually breaks away from the deeper tissue layers.

Does a follow-up exam in six weeks make sense?

Never heard a standard protocol about when to return for follow-up exams. Probably depends on the size and number of warts, just how large an area the treated and, honestly, how busy the practice is! If you're worried or something seems odd, call them to see if they can squeeze you in sooner.

Can I be reasonably certain about who I may have contracted the virus from?

This kind of detective work isn't usually reliable with HPV, although it's a universal reaction to do it! Warts will most often develop in a few weeks out to about 8 months, but could reasonably take years.

Would it be smart to contact the girl from September 2008 and let her know?

Few experts would encourage you to do so.

Can she be tested for the presence of low-risk HPV and definitively learn her status?

HPV tests are currently only approved for use with cell samples from the cervix as part of cervical cancer screening. Honestly, they most often don't run the low-risk panel these days. The answer to the question you ask, technically, is yes. On a practical level, at the clinic....not really. Also, even if she had HPV last year it may well be undetectable now!

Should I stop shaving “down there”?

Might be good to stop or use real caution if shaving near the warts.

Hope this helps.

Blessing on you, my son.

St. Fredo

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Fredo, thanks for taking the time to answer my questions. Just to follow up:

Biopsy: I was considering this to be sure that what I had was HPV/genital warts period, and not something else, as opposed to knowing the particular strain. However, I will probably just assume my dermatologist knows it when he sees it and has made a correct diagnosis.

Follow-up exam: My dermatologist missed one of my warts, and this a.m. I found another. I think I will try to get into the office to see him again before my already scheduled follow-up exam.

Who I contracted HPV from/telling her: I guess I can't be completely sure who I contracted this from, but given the timing as I mentioned above, it seems like the girl I was with in September 2008 is a good candidate. However, based on what you've said, I guess it doesn't make much sense to contact her.

Thanks again!

Keep checking in, if you don't mind, to let us know how you're doing. Thanks for the update!

Fredo

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ASHA Moderator

Fredo, just an update here as you asked. I visited the dermatologist again a week or so ago, and he "cryo'ed" a wart that was there the first time around but that we'd missed. He also looked at another spot that I'd thought might be a wart, but he didn't think so, and he didn't remove it. Just this weekend I found another reddish bump that could possibly be a wart, but it doesn't seem to be all that similar to the others I had. Unless any more develop, I'm going to wait until I visit the dermatologist again in about two months for a follow-up exam. Meanwhile, I'm applying Aldera cream prescribed by him.

A question I have is, when does the "countdown" begin when it's said that an infection probably clears in the majority of cases after 6-24 months of no reoccurrences? I first noticed the warts probably about four months ago and didn't think much about them, and had most of them removed in early July. When should the clock start "ticking"? From the July visit, or perhaps the follow-up visit I'll have in October (assuming no new warts develop)?

Thanks for your help!

Hey there,

Thanks for stopping by and letting us know how you are. The "6-24 month" number refers to when HPV was initially contracted. Recurrences, while they may happen at anytime, most often pop up in the first three months following removal of warts.

It sounds like you're doing things the right way, and again let me say how glad I am to hear from you. Please stop by again and let us know how things are going.

Best always,
Fredo

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Thanks for responding Fredo. Is it really from the time of contracting the virus? As I mentioned earlier, I'm pretty sure I actually contracted the virus back in September 2008. I started noticing what turned out to be warts around May or so of this year, well more than six months after I probably contracted the virus. Thanks.

There are few hard and fast rules here. Warts can be detected at anytime, weeks, months, or even years down the road. Most HPV infections don't persist more than a year or two, but of course do in some cases.

Keep in touch!

Fredo

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