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Evidence of clearing and treatment options
Hello Drs.-
I was diagnosed with HPV warts in June of last year (first noticed them in March or April) and have undergone numerous treatments at with my GP. He has been extremely great with the situation, repeating many of the things you have said here (it's a minor inconvenience, your body will clear it in time). Thus far, I have gone for 9 treatments and will be going for my 10th in a week (the little buggers are dissipating, but keep returning). I am getting discouraged, as my doctor told me that many people are treated once or twice, and then never again. Is it normal to be going back 9-10 times? I am aware that sometimes it takes up to two years to clear, but I am worried I may be one of those unfortunate lifers.
Still, I do have some hope. I have noticed that when I do have reocurrences, the warts have gotten smaller and much less noticeable than the reoccurences I was having last year. Although I know there is no "hard" evidence to suggest as such, can this be an indication that my immune system is kicking in and starting the "clearing" process? My treatments have also been spaced out more... originally every two weeks has become once every two months.
With respect to treatment, my doc has been using dicholoroacetic acid to treat the warts. I understand trichloroacetic acid to be the more common treatment. After treatment, some of the skin he treats turns light. Can treatment from DCA do any permanent damage to the pigment in my skin? Eventually, I'd like to be at a point where my immune system clears this and I don't have to talk about my treatments.
Finally my doc has suggested I get the HPV vaccine (I'm a 28 y/o male). I will be glad to to protect myself from the strains of HPV I haven't gotten yet. My doctor says that it may also help to "get rid of the strain you have once and for all." I was under the impression that Gardasil doesn't do squat for already-present infections. Is this a gray area?
Thanks very much for all your work!
I was diagnosed with HPV warts in June of last year (first noticed them in March or April) and have undergone numerous treatments at with my GP. He has been extremely great with the situation, repeating many of the things you have said here (it's a minor inconvenience, your body will clear it in time). Thus far, I have gone for 9 treatments and will be going for my 10th in a week (the little buggers are dissipating, but keep returning). I am getting discouraged, as my doctor told me that many people are treated once or twice, and then never again. Is it normal to be going back 9-10 times? I am aware that sometimes it takes up to two years to clear, but I am worried I may be one of those unfortunate lifers.
Still, I do have some hope. I have noticed that when I do have reocurrences, the warts have gotten smaller and much less noticeable than the reoccurences I was having last year. Although I know there is no "hard" evidence to suggest as such, can this be an indication that my immune system is kicking in and starting the "clearing" process? My treatments have also been spaced out more... originally every two weeks has become once every two months.
With respect to treatment, my doc has been using dicholoroacetic acid to treat the warts. I understand trichloroacetic acid to be the more common treatment. After treatment, some of the skin he treats turns light. Can treatment from DCA do any permanent damage to the pigment in my skin? Eventually, I'd like to be at a point where my immune system clears this and I don't have to talk about my treatments.
Finally my doc has suggested I get the HPV vaccine (I'm a 28 y/o male). I will be glad to to protect myself from the strains of HPV I haven't gotten yet. My doctor says that it may also help to "get rid of the strain you have once and for all." I was under the impression that Gardasil doesn't do squat for already-present infections. Is this a gray area?
Thanks very much for all your work!
MEDICAL PROFESSIONAL
From your description, I'm not sure the recurring small bumps are warts at all. Maybe just hypertrophic (overgrowing) skin in response to treatment, etc. Given the uncertainty plus your waning confidence in your doctor, consultation with a dermatologist makes even more sense. Beyond that, I won't speculate about how long this might continue, since I'm not sure what the problem is.
Thank you very much for your prompt response, doctor.
I believe that the warts being treated are, in fact, staying away and that the ones I am noticing are new warts (albeit much smaller, fewer in number, and less noticeable than the ones that have popped up in the past). Assuming that this is the case, it sounds like you believe sticking with the BCA treatments is alright?
Truth be told, though, I'm getting impatient with my doc continuously telling me "your body is reacting well and this should be gone soon", only to have to return every so often for another treatment. I don't want to think he's just "sticking to script," but I am getting increasingly frustrated with this not resolving when everything I read suggests it should clear (even without treatment) in a few months. As for my doctor's expertise: he is a GP at a campus health center and says he treats 8-10 cases of genital warts a WEEK. This seems high, but still suggests that HPV warts are very prevalent.
Still, I am concerned about how my infection's persistence. In your experience, how long do you find new warts to persist to the point that new, visible warts are no longer popping up?
I believe that the warts being treated are, in fact, staying away and that the ones I am noticing are new warts (albeit much smaller, fewer in number, and less noticeable than the ones that have popped up in the past). Assuming that this is the case, it sounds like you believe sticking with the BCA treatments is alright?
Truth be told, though, I'm getting impatient with my doc continuously telling me "your body is reacting well and this should be gone soon", only to have to return every so often for another treatment. I don't want to think he's just "sticking to script," but I am getting increasingly frustrated with this not resolving when everything I read suggests it should clear (even without treatment) in a few months. As for my doctor's expertise: he is a GP at a campus health center and says he treats 8-10 cases of genital warts a WEEK. This seems high, but still suggests that HPV warts are very prevalent.
Still, I am concerned about how my infection's persistence. In your experience, how long do you find new warts to persist to the point that new, visible warts are no longer popping up?
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help.
It isn't clear to me whether your warts are clearing after treatment, and new ones continue to occur; or if the same warts are simply responding slowly, or shrinking slightly then enlarging again. If the first, the treatment probably is fine; new warts will eventually stop recurring. However, if the same warts are simply persisting, it probably is time to start a new treatment. There are several recommended genital wart treatments, and bichloroacetic acid (BCA) is among them (it is neither more nor less effective than TCA). But no treatment is more than about 60% effective. When treatment is not highly effective after 3-4 applications, the recommendation is to switch to something else -- for example, cryotherapy (freezing), podophyllin, or one of the prescription medications (podofilox [trade name Condylox] or imiquimod [Aldara]). You might discuss these options with yoru doctor. When used properly, none of the wart treatments cause significant skin damage, scarring, etc.
I can't comment on the strength of your immune system's response to your HPV infection. The speed of resolution, and whether your warts are shrinking or not, probably isn't much different regardless of one person's immune system.
As for HPV immunization, your doctor is wrong about vaccine helping clear your current infection; your understanding is correct, i.e. no effect on existing infections. At age 28, it is statistically likely that you have already been infected with at least one or two of the HPV types covered by the vaccine -- in addition to whichever type (HPV 6 or 11) responsible for your warts. The vaccine generally is not recommended over age 26. On the other hand, it wouldn't do any harm and might well prevent a future infection. (However, since you're above the recommended age, it might not be covered by your health insurance -- in which case you'll pay around $500 for the vaccine plus administration fees.)
If your doctor is uncertain about other wart treatments, or doesn't have much experience with them, you might discuss the possibility of referral to an expert, like a dermatologist, for further threatment recommednations.
I hope this helps. Best wishes-- HHH, MD
It isn't clear to me whether your warts are clearing after treatment, and new ones continue to occur; or if the same warts are simply responding slowly, or shrinking slightly then enlarging again. If the first, the treatment probably is fine; new warts will eventually stop recurring. However, if the same warts are simply persisting, it probably is time to start a new treatment. There are several recommended genital wart treatments, and bichloroacetic acid (BCA) is among them (it is neither more nor less effective than TCA). But no treatment is more than about 60% effective. When treatment is not highly effective after 3-4 applications, the recommendation is to switch to something else -- for example, cryotherapy (freezing), podophyllin, or one of the prescription medications (podofilox [trade name Condylox] or imiquimod [Aldara]). You might discuss these options with yoru doctor. When used properly, none of the wart treatments cause significant skin damage, scarring, etc.
I can't comment on the strength of your immune system's response to your HPV infection. The speed of resolution, and whether your warts are shrinking or not, probably isn't much different regardless of one person's immune system.
As for HPV immunization, your doctor is wrong about vaccine helping clear your current infection; your understanding is correct, i.e. no effect on existing infections. At age 28, it is statistically likely that you have already been infected with at least one or two of the HPV types covered by the vaccine -- in addition to whichever type (HPV 6 or 11) responsible for your warts. The vaccine generally is not recommended over age 26. On the other hand, it wouldn't do any harm and might well prevent a future infection. (However, since you're above the recommended age, it might not be covered by your health insurance -- in which case you'll pay around $500 for the vaccine plus administration fees.)
If your doctor is uncertain about other wart treatments, or doesn't have much experience with them, you might discuss the possibility of referral to an expert, like a dermatologist, for further threatment recommednations.
I hope this helps. Best wishes-- HHH, MD
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