and Managing Genital Warts: A Guide for Couples

Treatment and Concerns Regarding Cauliflower (Cauliflower Ear)

Hello Dr.
Hsu,
Situation: I have a steady girlfriend, and we have been together for 7 years.
We have confirmed that we are each other's exclusive sexual partners and have no history of risky sexual behavior.
About six months to a year ago, I noticed a small bump on my penis, about the size of a grain of rice, and subsequently developed two more.
Initially, I thought it was a bacterial infection, but they did not go away.
In July of this year, I visited a urologist who performed a biopsy and diagnosed it as genital warts (condyloma acuminatum) and treated it with electrosurgery.
My girlfriend showed no visible signs of infection, but she also went to the hospital for HPV and cervical cancer screening, and her results came back negative for any infections.
Since discovering the infection in July, my girlfriend and I have not engaged in sexual intercourse (the doctor recommended a three-month observation period).
Recently, my girlfriend found a small bump on her vulva and went to see a gynecologist.
The doctor informed her that it was also genital warts (located in the pubic hair area, and the vaginal examination showed no abnormalities).
The doctor recommended electrosurgery for removal and mentioned that even though the HPV test was negative, it is possible that the virus was not detected.
I found some cases online that support this possibility.
Questions:
1.
I understand from my research that genital warts cannot be completely cured, which has left both my girlfriend and me feeling very down.
What treatment options do we have to prevent recurrence? We regularly exercise to boost our immune systems, but I understand that genital warts can affect even healthy individuals, and exercising does not guarantee immunity.
Both doctors who performed the electrosurgery only prescribed topical anti-inflammatory medications and advised that no further medication was necessary, stating we should return for check-ups only if we notice any abnormalities.
This has left us feeling very anxious.
Is there really no other treatment available, such as medication or dietary supplements?
2.
It has been three months since my electrosurgery, and I have not noticed any other abnormalities.
Does this mean I have completed the observation period? How much longer should I continue to observe? Once my girlfriend completes her observation period, how long should we wait before resuming sexual activity? Besides using condoms, what else should we be cautious about to avoid recurrence?
3.
I read online that some doctors recommend HPV DNA testing.
For women, it is suggested to wait until there is no virus present before getting vaccinated to prevent new infections (though it is ineffective against existing infections).
For men, it is generally not recommended (according to U.S.
guidelines).
Is this treatment approach worth considering? Additionally, since we have not tested for the specific HPV type, and my girlfriend's cervical cancer screening was normal, should I also undergo a penile cancer screening? Can this be done at a general urology clinic? I understand that HPV types 16 and 18 are associated with penile cancer.
Is this transmissible? (We understand that 90% of genital warts are due to sexual activity, but we have not engaged in risky behavior, and while there are external factors, the likelihood seems low.)
4.
We plan to have children in the future.
What precautions should we take to ensure that our child is not affected? Is there a relationship between this and genetic inheritance? We are very concerned about the potential impact on our child.
I apologize for asking so many questions, but it is difficult to get thorough answers in busy clinics.
We have great trust in your expertise and experience, and we sincerely thank you for your response!

HM, 20~29 year old female. Ask Date: 2015/11/07

Dr. Xu Weikai reply Urology

1.
Cauliflower can definitely be cured; as soon as it appears, it should be addressed immediately.
Do not let it spread.
If it recurs, resolve it right away.
After a few repetitions, it can almost always be cured, allowing you to say goodbye forever.
Note: If it cannot be cured, then almost everyone would be a carrier, which does not align with the current situation.
Certain viral infections, like herpes, can remain latent in the nerve ganglia, making them incurable.

2.
Generally, if there are no symptoms for three months, it indicates recovery.
A very small number of patients may remain asymptomatic for over a year.
3.
If you are concerned, use protection.
If both partners have not shown any lesions for over three months, protection may not be necessary.
4.
Besides sexual contact, many accidental exposures can also lead to infection.
There have been cases of transmission through shared mice in internet cafes.
Therefore, I advise the public to wash their hands before using public restrooms (to avoid bringing unknown pathogens into the body).
5.
Regarding vaccination, you can consult a relevant physician.
As for other ways to enhance immunity, such as exercise, I strongly agree.
While I cannot guarantee its effectiveness, it can help improve overall health.
6.
The Taiwan Centers for Disease Control provides information on infectious diseases for public and professional reference.
You can visit their site, which is more reliable than information that may be misrepresented online.

Reply Date: 2015/11/07

More Info

Understanding and managing genital warts, particularly those caused by the human papillomavirus (HPV), can be a challenging experience for couples. It is important to approach this situation with accurate information and a clear plan for treatment and prevention. Here’s a comprehensive guide addressing your concerns:
1. Treatment and Recurrence Prevention: Genital warts, or condylomata acuminata, are indeed caused by certain strains of HPV. While it is true that there is currently no cure for the virus itself, the warts can be effectively treated. Common treatment options include topical medications (like imiquimod or podofilox), cryotherapy (freezing the warts), laser therapy, and electrosurgery, which you have already undergone. After treatment, it is crucial to monitor for any new growths. Regular follow-ups with your healthcare provider are essential, even if they initially suggested no further visits unless symptoms arise. Maintaining a healthy lifestyle, including regular exercise and a balanced diet, can support your immune system, but it does not guarantee prevention of HPV-related issues.

2. Observation Period: After your electrosurgery, a three-month observation period is a standard recommendation. If you have not noticed any new warts or symptoms during this time, it is a positive sign. However, HPV can remain dormant, and new warts can appear later. It is advisable to wait at least three months after your girlfriend’s treatment before resuming sexual activity. Using condoms can reduce the risk of transmission, but they do not provide complete protection against HPV since the virus can be present on areas not covered by the condom. Open communication with your partner about any changes or concerns is vital.

3. HPV Testing and Vaccination: HPV DNA testing can provide more information about the specific strains of HPV present. While it is true that certain vaccines (like Gardasil) can protect against some strains of HPV, they are not effective against strains that are already present in the body. For women, vaccination is recommended before they become sexually active or if they have not been previously infected with the strains covered by the vaccine. For men, routine HPV testing is not typically recommended unless there are symptoms. However, if you have concerns about penile cancer, discussing this with a urologist is a good idea. The strains most commonly associated with penile cancer are HPV types 16 and 18, which are also linked to cervical cancer.

4. Family Planning: When considering starting a family, it is important to discuss your HPV status with your healthcare provider. HPV is not known to affect fertility or cause birth defects, but it is essential to ensure that both partners are healthy. Regular gynecological exams for your girlfriend and check-ups for you can help monitor any changes. Genetic factors related to HPV are not a concern for children, as HPV is not transmitted through genetic inheritance. However, it is always wise to discuss any concerns with a healthcare professional who can provide personalized advice based on your medical history.

In summary, while dealing with genital warts and HPV can be daunting, effective treatment options are available. Regular monitoring, open communication with your partner, and consultation with healthcare professionals are key to managing your health and reducing the risk of recurrence. If you have any further questions or concerns, do not hesitate to reach out to your healthcare provider for guidance tailored to your specific situation.

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