Post-Wart Treatment: Key Considerations for HPV Management

Precautions to Take After the Symptoms of Cauliflower Disease Have Resolved?

Hello, doctor.
On June 29, I discovered cauliflower-like growths around my anus.
The doctor performed an endoscopy and confirmed that there were none inside.
I consulted a colorectal surgeon, who prescribed six packets of Aldara for me.
That day, I had blood tests for HIV and syphilis, and the results came back negative.
The next day, my wife and I went to the urology department for HPV testing, and the results showed that both my penis and anus were positive, with a viral load of 5+.
My wife's vagina was also positive, with a viral load of 5+.
On July 3, I underwent laser surgery, and the doctor mentioned that I had a little on my penis, but the symptoms around the anal area were more pronounced.
After the surgery, there was some recurrence, and the urologist advised me to apply Aldara, which I have been doing continuously.
However, during my follow-up on August 10, the doctor said my condition was good, and there were currently no symptoms.
I also visited the colorectal doctor on August 17, and my anal area was fine, though I had some internal hemorrhoids.
My wife has not shown any symptoms of cauliflower-like growths.
We received the nine-valent vaccine on June 29.

I have several questions:
1.
I am not bisexual; I have a single sexual partner, and I am unsure how I contracted the cauliflower-like growths.
The urologist suggested that the virus may have originated from my penis and then transferred to my anal area through manual contact.
Is this possible? I am now worried that I might also have the virus in my ears or nostrils due to manual contact, which concerns me greatly.
Could my frequent use of gym towels to wipe my private areas have contributed to this? I genuinely do not know how I was infected and would like to know what precautions I should take to avoid reinfection.
2.
I am very concerned that my wife may have performed oral sex on me while we were unaware of the cauliflower-like growths.
She has recently mentioned that her throat sometimes feels itchy, which adds to my worry.
However, after seeing a doctor, she was told it was due to allergies and that there was nothing in her throat.
My question is, if oral sex occurs with a penis that has the HPV virus or visible symptoms, is there a high chance that the virus could be transmitted to the mouth, potentially leading to symptoms? If there are no visible symptoms, could the virus already be present in the mouth and be transmitted through kissing to another person’s mouth or penis? Since my wife and I do not engage in anal sex, I am not concerned about her acquiring the virus that way, but I am now paranoid about other areas, such as her breasts.
3.
The colorectal doctor has repeatedly assured me that there is no need to worry about internal anal HPV, as she stated that the external symptoms have resolved and will not grow internally, especially since I am not a man who has sex with men and have not been penetrated.
However, I am still very anxious.
I asked if I should have an endoscopy, but the doctors said it is unnecessary.
Can I rule out the possibility of having HPV internally in the anal area?
4.
It has been nearly two months since the symptoms disappeared.
Can we engage in protected sexual intercourse now?
5.
We are currently washing our underwear separately from our family’s laundry, and after using the restroom, we disinfect our hands and the toilet with 75% alcohol.
Is this effective in preventing the transmission of the virus? What other precautions should we take?
6.
My wife currently has no symptoms.
Should the doctor recommend that she return to the gynecologist for monthly follow-ups and examinations? I am very concerned about her developing symptoms.
7.
Should we be testing for HPV viral load approximately every three months? How long does it typically take for the virus to clear from the body? We are planning to have children, but given the current situation, we are hesitant to proceed.
Thank you for your guidance, doctor.

kevin, 20~29 year old female. Ask Date: 2017/08/20

Dr. Du Shixi reply Urology

1.
It is possible for genital warts to be transmitted through hand contact, and some people suggest that towels may also pose a risk, although the chances are very low.
It mainly depends on the viral load and the individual's immune response.

2.
Genital warts can potentially be transmitted to the oral cavity and throat, but if there are no visible lesions, regular monitoring is recommended.
Moving forward, it may be necessary to practice safer sex.

3.
The likelihood of genital warts occurring in the anal area is very low due to lack of contact, unless there has been direct exposure.
If you are particularly concerned, you may consult a willing physician, but please be aware that there may be discomfort involved.

4.
Since the symptoms have been resolved for nearly two months, I would like to ask the physician if we can engage in protected sexual activity—yes, but please ensure safe sex practices.

5.
It is important to focus on hand hygiene and safe sexual practices.

6.
It is not recommended; you may want to consult a gynecologist about how often to have check-ups.

7.
It is not recommended; the timing of automatic discharge may be unpredictable.
For more information on safe sexual practices, you can refer to the CDC website: http://www.cdc.gov.tw/professional/info.aspx?treeid=beac9c103df952c4&nowtreeid=3a380faf26d530d6&tid=F9393FF1D6981B85.

Reply Date: 2017/08/20

More Info

Post-wart treatment and HPV management can be quite complex, especially when dealing with concerns about transmission, recurrence, and the psychological impact of the diagnosis. Let's address your questions one by one, providing clarity and guidance based on current medical understanding.

1. Transmission of HPV: It's understandable to be concerned about how you contracted HPV, especially when you have a single sexual partner. HPV is primarily transmitted through skin-to-skin contact, and it is possible to transfer the virus from one area of the body to another, such as from the penis to the anal area, especially if there are micro-abrasions or cuts. While it is less common, HPV can also be transmitted through contaminated surfaces, such as towels, but this is not the primary mode of transmission. To minimize the risk of reinfection or spreading the virus, maintain good hygiene practices, avoid sharing personal items, and consider using your own towels in communal settings like gyms.

2. Oral Transmission of HPV: Regarding your concerns about oral transmission, it is indeed possible for HPV to be transmitted through oral sex. If your partner performed oral sex on you while you had visible warts, there is a risk of transmission. However, the presence of symptoms (like warts) increases the likelihood of transmission. If your partner is experiencing throat irritation, it is wise to consult a healthcare provider to rule out any HPV-related issues, although allergies or other non-viral causes are also common.

3. Internal Anal Concerns: Your rectal specialist's reassurance that there is no need for an internal examination is based on the absence of visible lesions. However, if you have ongoing concerns, it is reasonable to seek a second opinion or request an internal examination for peace of mind. Regular monitoring and communication with your healthcare provider are essential.

4. Safe Sexual Practices: After two months of treatment and with no visible symptoms, using condoms during sexual intercourse is advisable. While condoms do not provide complete protection against HPV, they significantly reduce the risk of transmission. It is also important to maintain open communication with your partner about any concerns and to ensure both of you are comfortable with your sexual practices.

5. Hygiene Practices: Your current hygiene practices, such as washing underwear separately and using alcohol to disinfect surfaces, are good steps to minimize the risk of transmission. However, it is essential to remember that HPV is primarily transmitted through direct contact, so focusing on personal hygiene and safe sexual practices is more critical than surface disinfection.

6. Monitoring Your Partner: It is wise for your partner to have regular gynecological check-ups, especially after a diagnosis of HPV. While monthly visits may be excessive, following the recommended schedule from her healthcare provider is essential. Typically, women are advised to have Pap smears and HPV testing every three years, but this can vary based on individual risk factors and previous results.

7. HPV Testing and Clearance: The timeline for HPV clearance varies among individuals. Many people can clear the virus naturally within one to two years, but this is not guaranteed. Regular follow-ups with HPV testing every six to twelve months may be recommended, especially if there are concerns about persistent infection or if your partner has a history of abnormal Pap smears.

In conclusion, managing HPV involves a combination of medical treatment, regular monitoring, and open communication with your partner. It is crucial to follow your healthcare provider's recommendations and to maintain a proactive approach to your sexual health. If you have further concerns or experience new symptoms, do not hesitate to reach out to your healthcare provider for guidance.

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