Recurrence of Genital Warts: Causes and Prevention

Cauliflower recurrence

I was diagnosed with a genital wart infection in 2015 and underwent laser removal of the lesions.
I had 5 to 6 follow-up visits, and around September 2016, I had my last recurrence treated with laser removal on the same day I received my third dose of the quadrivalent Gardasil vaccine.
Since then, I have not had any recurrences.
However, at the end of November this year, I discovered a growth at the base of my genitals, and upon examination, it was confirmed to be a recurrence.
Shouldn't I have developed immunity? Why did it recur after such a long time? What should I be aware of?

Wunai, 30~39 year old female. Ask Date: 2020/12/18

Dr. Liu Mingyue reply Urology

Genital warts, commonly known as "cauliflower," are associated with human papillomavirus (HPV) infection.
Currently, more than 170 types of HPV have been identified, and even the 9-valent vaccine provides only about 90% protection against genital warts (90% of genital wart cases are caused by those 9 types of HPV).
Furthermore, the currently available vaccines cannot treat existing infections, meaning that lesions may have already been dormant in skin cells before vaccination, and the vaccine cannot prevent the recurrence of these lesions.
To avoid infection from HPV strains not covered by the vaccine, practicing safe sex (having a single sexual partner and using condoms) remains essential.
Regarding the already infected strains, since it is impossible to determine where the virus may still be hiding, there is currently no method to eliminate the virus that is latent within cells; treatment can only be initiated when symptoms reappear.

Reply Date: 2020/12/18

More Info

Genital warts, caused by certain strains of the human papillomavirus (HPV), can indeed recur even after treatment and vaccination. Understanding the causes of recurrence and how to prevent it is crucial for managing this condition effectively.

Causes of Recurrence
1. HPV Persistence: After initial infection, HPV can remain dormant in the body. Even if visible warts are treated, the virus may still be present in the skin cells. This can lead to new warts appearing later, as the immune system may not completely eliminate the virus.

2. Immune Response: The body’s immune response plays a significant role in controlling HPV. Some individuals may have a weaker immune response, making them more susceptible to recurrence. Factors that can weaken the immune system include stress, illness, or certain medications.

3. Incomplete Treatment: If the initial treatment does not completely remove all infected tissue, warts can recur. Laser treatment is effective, but if any HPV-infected cells remain, they can lead to new growths.

4. New Infection: It’s also possible to be reinfected with a different strain of HPV, especially if sexual partners are not vaccinated or are carriers of the virus.

Prevention Strategies
1. Vaccination: The HPV vaccine, such as Gardasil, is effective in preventing infections from the most common strains of HPV that cause genital warts and cervical cancer. Completing the vaccination series is crucial for long-term protection.

2. Regular Check-ups: Regular follow-ups with a healthcare provider can help monitor for any signs of recurrence. Early detection can lead to prompt treatment.

3. Safe Sexual Practices: Using condoms can reduce the risk of transmitting HPV, although they do not provide complete protection since HPV can infect areas not covered by a condom.

4. Boosting Immune Health: Maintaining a healthy lifestyle can support your immune system. This includes a balanced diet, regular exercise, adequate sleep, and stress management.

5. Avoiding Irritation: Avoiding irritation to the genital area can help prevent warts from developing. This includes being cautious with personal hygiene products and avoiding tight clothing.

What to Do If Recurrence Occurs
If you notice new growths or symptoms, it’s essential to consult with your healthcare provider promptly. They may recommend further treatment options, which could include:
- Repeat Laser Treatment: If warts are present, laser treatment can be effective again.

- Topical Treatments: Medications like imiquimod or podofilox can be prescribed to help treat warts.

- Monitoring: Regular monitoring may be necessary to ensure that any new warts are addressed quickly.

Conclusion
While it can be frustrating to experience a recurrence of genital warts, understanding the underlying causes can help you take proactive steps to manage your health. The HPV vaccine is a powerful tool in prevention, but it is not a guarantee against all strains or against recurrence. Staying informed, maintaining regular check-ups, and practicing safe sexual health can significantly reduce the risk of future outbreaks. If you have concerns about your specific situation, discussing them with your healthcare provider is the best course of action.

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