Recurrence of Genital Warts: Insights and Precautions

Cauliflower has relapsed again?

I was diagnosed with genital warts in 2015 and underwent laser removal of the lesions.
I had 5 to 6 follow-up visits, and around September 2016, after my last laser removal, I received the third dose of the quadrivalent Gardasil vaccine on the same day.
Since then, I have not experienced any recurrence.
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: 2020/12/23

Dr. Jian Weihong 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 vaccines currently available cannot treat existing infections, meaning that lesions that recur may have had the virus already latent in skin cells before vaccination, and thus the vaccine cannot prevent the reappearance 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) is still necessary.
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 latent in cells; treatment can only be administered when symptoms reappear.

Reply Date: 2020/12/23

More Info

Genital warts, caused by certain strains of the human papillomavirus (HPV), can indeed be a persistent issue for many individuals. Your experience of having undergone laser treatment multiple times, followed by vaccination with the quadrivalent HPV vaccine, raises several important points regarding the recurrence of genital warts and the immune response to HPV.

Firstly, it is essential to understand that while the quadrivalent HPV vaccine is effective in preventing infections from the specific HPV strains it targets (types 6, 11, 16, and 18), it does not eliminate existing infections or warts. The vaccine is most effective when administered before the onset of sexual activity, as it helps the immune system to recognize and fight off the virus before it can establish an infection. However, if you have already been infected with a strain of HPV that is not covered by the vaccine, or if you have a persistent infection with one of the strains that the vaccine does cover, you may still experience recurrences of genital warts.

The immune system plays a crucial role in controlling HPV infections. In many cases, the body can clear the virus on its own over time, but this process can vary significantly among individuals. Factors such as stress, immune system health, and overall well-being can influence the likelihood of recurrence. It is not uncommon for individuals to experience recurrences of genital warts even after treatment and vaccination, as the virus can remain dormant in the body and reactivate under certain conditions.

Given your situation, here are some precautions and insights to consider:
1. Regular Monitoring: Continue to monitor any changes in your genital area. If you notice any new growths or changes, seek medical advice promptly. Early intervention can help manage recurrences effectively.

2. Follow-Up Care: Maintain regular follow-up appointments with your healthcare provider. They can help monitor your condition and provide additional treatments if necessary.

3. Healthy Lifestyle: Focus on maintaining a healthy lifestyle to support your immune system. This includes a balanced diet, regular exercise, adequate sleep, and stress management techniques.

4. Safe Practices: Practice safe sex to reduce the risk of transmitting HPV to partners and potentially reinfecting yourself. Using condoms can lower the risk, but they do not provide complete protection since HPV can infect areas not covered by a condom.

5. Vaccination: If you have not already received the full series of the HPV vaccine, discuss this with your healthcare provider. Completing the vaccination series may provide additional protection against other HPV strains.

6. Educate Yourself: Understanding HPV and its implications can help you manage your condition better. Stay informed about the latest research and treatment options available.

7. Emotional Support: Dealing with recurrent genital warts can be emotionally taxing. Consider seeking support from counseling or support groups to help you cope with any anxiety or stress related to your condition.

In conclusion, while the HPV vaccine significantly reduces the risk of new infections and helps your immune system combat the virus, it does not guarantee immunity against all strains or prevent recurrences of existing infections. Regular monitoring, a healthy lifestyle, and open communication with your healthcare provider are key to managing your condition effectively. If you have further concerns or questions, do not hesitate to reach out to a healthcare professional who specializes in sexually transmitted infections or dermatology.

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