Recurrent Genital Warts and Molluscum

[quin44]

I was diagnosed with genital warts and molluscum contagiosum at the beginning of this past February. Since then I've gone to a clinic every other week to receive liquid nitrogen treatment. Since beginning treatment my warts have been reduced significantly but there is an area on my foreskin where the wart begins to grow back instantly after it is removed with liquid nitrogen. There are also 6-8 warts on my pubic area that have recently reappeared, been removed, reappeared again and removed again after being gone for a few months. I was pretty much cured of molluscum after 3 or 4 months but more lesions have been noticed by my doctor recently on the scrotum and under/bottom side of my penis that I suspect have been there for a while but were so small they went unnoticed. I'm not as worried about the molluscum because it seems to be easier to treat and less aggressive than the warts. I hadn't had sex for 8 or 9 months when the warts and molluscum appeared, so I know I've been infected with these each of these viruses for at least a year. I was wondering what you recommend the next step for treatment for me should be. Do I have more aggressive strains of these viruses that makes them come back? Or is my body more susceptible to them? Is there solid evidence suggesting that lifestyle has a significant effect on my body's ability to fight off these viruses? I've already quit smoking but I'm wondering if quitting drinking and exercising more is really likely to have an impact on my conditions. Is the fact that they keep coming back a sign that it's going to be something I'm going to have to deal with for years? Any light you can shed on my situation would be much appreciated.

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  I'm glad to have helped.

[quin44]

Thanks for your responses and also for your work overall. I've gained a lot of valuable information about this condition from your posts on this forum.

[H. Hunter Handsfield, M.D.]

None of this information changes my opinions or advice.

[quin44]

I have no immunodeficiency that I am aware of.

[quin44]

Just to clarify: I am assuming I have had the virus for over a year because I had not had sex for 8 months when the warts appeared and I have now had the warts for 8 months, adding up to a total of 16 months since the point when I assume I first came in contact with the virus. So there was an 8 month period form the time I assume I came in contact with the virus during which I had no warts, and I have now had warts for 8 months.

I'll give you so more background on myself: I'm a 21 year-old uncircumcised male, who has had unprotected vaginal sex with 5 different women and had only protected sex with an additional 2. I've been tested for syphilis, gonorrhea, chlamydia and a type of hepatits, I don't recall which - all tests came back negative. I tested negative for HIV about a year and a half ago. I have had 2 partners since then who I had unprotected sex with so it would be wise to get re-tested. I'll do that as soon as possible.

[H. Hunter Handsfield, M.D.]

I should also add that I'm assuming you are not HIV positive or have any other immunodeficiency.  You don't say your sexual lifestyle and risks in particular.  But have you been HIV tested and negative?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'm not sure how helpful my comments will be, but I'll try.

First, regarding molluscum contagiosum:  I know this isn't your main concern, so I'll just say lesions commonly keep appearing up to a few months, but eventually they will stop.  There are no long term health consequences.

As for the warts, there are some atypical features.  Genital warts rarely continue to recur as long as a year.  In addition, widespread warts -- involving several areas of the gentials, such as penis, scrotum, and pubic area -- are unusual.  Any involvement at all in the pubic area is unusual (although it's a common site for molluscum).  So perhaps the first need here is to be certain the diagnosis is correct, i.e. that the poorly responding and rapidly reappearing lesions in fact are genital warts.

Assuming the diagnosis of warts is correct, there is a lot of individual variation on which treatments work best.  If a particular treatment isn't working well -- either warts are not clearing up or they recur promptly -- the standard approach is to try an entirely different treatment, or combination treatment.  For example, you could speak to your doctor about podophyllin, podofilox (Condylox is the most common brand), imiquimod (Aldara, Zyclara); or perhaps laser cautery or electrocautery.  Another approach might be to continue to have them frozen, while also adding podofilox or imiquimod.

"Do I have more aggressive strains of these viruses that makes them come back?"  Probably not.  No particular wart-causing HPV strains are believed to be inherently more aggressive than others.

"Or is my body more susceptible to them?"  Conceivably yes; different persons' immune systems may be inherently more effective in clearing HPV than others'.  However, almost all persons eventually have effective clearance.

"Is there solid evidence suggesting that lifestyle has a significant effect on my body's ability to fight off these viruses?"  No; there is no evidence at all along these lines.  Stopping smoking is obviously a good move, and getting into good physical condition and avoiding excess alcohol are excellent lifestyle changes, but you shouldn't get your hopes up that they will make much difference in your warts.

My bottom line advice:  Discuss the diagnosis of these recurring lesions with your doctor.  If there is any doubt about warts versus other explanations, perhaps you should have a biopsy or referrral to another dermatologist for a second opinion.  Finally, once the diagnosis is secure, discuss the various treatment options above with your dermatologist.

Best of luck with it --  HHH, MD