Recurrence and Transmission of Genital Warts: A Patient's Journey

Cauliflower infection

Hello, a few years ago I had genital warts in the coronal sulcus of my glans.
Upon discovery, I immediately underwent electrosurgery, but a few weeks later, the same area relapsed.
I then switched to traditional Chinese medicine, where a corrosive ointment was used to remove the lesions, along with oral herbal medicine.
They also provided me with a small jar of white ointment to apply at home (I'm not sure if it was Wartrol or Leda Mei).
After using it, I experienced itching, stinging, and then peeling.
I returned for follow-up visits several times, during which I did not engage in any sexual activity.
During the treatment, I would immediately seek medical attention if I noticed even a small bump.
It has been nearly two years since my last follow-up visit.
About six months ago, I started dating a new girlfriend, and to avoid transmitting anything to her, I consulted both traditional Chinese medicine and Western medicine.
The Western doctor visually assessed me and said there were no lesions, advising me to use condoms.
The Chinese doctor also said there was no problem and that I could engage in sexual activity.
As a result, I performed oral sex (without a condom) and intercourse (with a condom before penetration).
Recently, I noticed a bump near my girlfriend's clitoris, which has a slightly white tip and a base that is close to skin color.
After observing it for a while, the base seems to have diminished, but the tip remains white.
Additionally, there is a similar bump on the right side of her vaginal opening.
I am very worried that I may have transmitted genital warts to her, although the appearance is not exactly like my previous warts; both are single lesions and feel smoother without prominent points.
However, I am still concerned about the possibility of transmission, which has left me mentally and physically exhausted.
Does this mean the treatment was ineffective? I have also been closely monitoring the site of my previous electrosurgery, and aside from the visible scar (which is whiter and slightly harder than the surrounding skin), there has been no significant change compared to over a year ago.
Doctor, can I consider myself cured? Am I still contagious? Thank you!

Xiao Lie, 20~29 year old female. Ask Date: 2015/02/06

Dr. Wu Yuxin reply Dermatology

Cauliflower is prone to recurrence; even if it is currently treated to the point where it is not visible to the naked eye, it may still be in a latent stage and could recur years later.
Additionally, during the latent stage, it is also possible to transmit the infection to others.

Reply Date: 2015/02/06

More Info

Understanding the recurrence and transmission of genital warts, particularly in the context of your experience, is crucial for both your peace of mind and the health of your partner. Genital warts are caused by certain strains of the human papillomavirus (HPV), which is a sexually transmitted infection. Here’s a comprehensive overview based on your situation.

Recurrence of Genital Warts
Genital warts can recur after treatment due to the nature of HPV. While treatments like cryotherapy (freezing), electrosurgery (burning), or topical medications can effectively remove visible warts, they do not eliminate the virus from the body. HPV can remain dormant in the skin cells, and under certain conditions, it may reactivate, leading to the formation of new warts. This is why you experienced a recurrence shortly after your initial treatment.

Treatment Efficacy
From your description, it seems you have undergone multiple treatments, including both Western and traditional Chinese medicine approaches. The fact that you have not observed any new warts for nearly two years is a positive sign. However, it is important to note that the absence of visible warts does not guarantee that the virus is completely gone. HPV can still be present in the body, and while the immune system often suppresses the virus, it can reactivate.

Transmission Concerns
Regarding your concerns about transmission to your new partner, it is essential to understand that HPV is primarily transmitted through skin-to-skin contact during sexual activity. If you have been treated and have not had any visible warts for an extended period, the risk of transmission is lower, but not zero. The use of condoms can significantly reduce the risk of transmission, but they do not provide complete protection since HPV can infect areas not covered by a condom.

Your partner's new symptoms, such as the white bumps near the clitoris, could potentially be related to HPV, but they may also be caused by other factors, such as irritation or a different skin condition. It is crucial for her to see a healthcare provider for an accurate diagnosis. If these bumps are indeed genital warts, they may have been transmitted from you, but it is also possible that they are unrelated.

Next Steps
1. Consult a Healthcare Provider: Both you and your partner should consult with a healthcare provider for a thorough examination. A dermatologist or a gynecologist can provide insights into the nature of the bumps and recommend appropriate treatment if necessary.

2. Regular Monitoring: Continue to monitor for any changes in your skin or any new symptoms. If you notice any new growths or changes in the previously treated area, seek medical advice promptly.

3. Discuss with Your Partner: Open communication with your partner about your history with genital warts is essential. Discussing your concerns and ensuring both of you are on the same page regarding sexual health can help alleviate anxiety.

4. Consider HPV Vaccination: If you haven’t already, consider discussing the HPV vaccine with your healthcare provider. The vaccine can protect against the most common strains of HPV that cause genital warts and cervical cancer.

Conclusion
In summary, while you may not have visible warts currently, the potential for HPV to remain dormant means that there is still a risk of transmission. It is crucial to maintain open communication with your partner, seek medical advice for any new symptoms, and consider preventive measures such as vaccination. Remember, managing HPV is a long-term process, and staying informed and proactive about your health is key.

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