HPV ordeal

[stressedout8]

Hello Dr, I wasn't sure whether to post in dermatology or STD since my questions fall into both areas. I am hoping with your expertise you can help me with both. A few months ago my Dr visually diagnosed me with HPV under the foreskin (28 y.o male) - tiny whitish bumps in a cluster only visible when I peel my foreskin back. She prescribed condylox which I used diligently and although it made an improvement some warts remained at follow up visit and she suggested cryo. I had the cryo done approx. 3 weeks ago and it has cleared that area but some warts (they are all tiny, smaller then pimple heads) remain (border). 3 weeks on and there is what appears to be scar tissue where the warts were frozen - white, tougher tissue 1cm in diamater in a vshape following the area she sprayed. The whole area feels irritated/sore especially after masturbation. Question 1 - is permanent scarring what I am dealing with based on your experience with people receiving cryo for HPV or will it resolve in time? Question 2 why is the condolox not clearing things adequately? 3. If it is scar tissue which has formed rapidly (within two weeks) what can I do? Would rubbing the tissue help break it up? The presumed scar and remaining warts have put my sex life on hold and I feel very depressed about the whole ordeal. Question (4) is around protocol for potential partners - should I inform all sex partners even if I wear a condom? What are the transmission odds? Is unprotected oral a no go? When am I safe to resume oral/full sex without informing partners? Excuse the barrage of questions but I am extremely anxious and upset. To summarize - I have what I believe to be a scar from cryo?, ongoing hpv (months into treatment), discomfort and irritation. (5) I am contemplating an adult circumcision because I believe the cut would fall lower than scar and warts potentially eliminating all the damaged/infected tissue. Is that a viable option or truly desperate/senseless? Thanks and high Regards. Jim

[stressedout8]

Apologies Dr, I just noticed you'd already replied to 5).

[stressedout8]

Thanks for the reply Dr Hook. Did you see question 5? Is that a possible solution?

To any body reading this who have had cryo in that area and experienced white scar like tissue - did it resolve in time? Any tips on how to improve things down there? I'd greatly appreciate any relevant responses

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to provide some guidance but I think you really need to see another helath care provider, perhaps a dermatologist to sort things out.  there is no current therapy for warts which are 100% effective.  Both condylox and cryotherapy have about an 80% response rate so if the lesions were warts (visual diagnosis is sometimes incorrect) that the warts persist is not unheard of.  Please remember that all of these therapies are essentially destructive, thus scarring may occur afterwards.  When scarring occurs, it tends to get better with time.

Let's address your specific questions:
Question 1 - is permanent scarring what I am dealing with based on your experience with people receiving cryo for HPV or will it resolve in time?

See above,  It should imporve with time.  You might see a dermatologist .  They often have therapy that can facilitate resolution o fscars.

Question 2 why is the condolox not clearing things adequately?

Answered above.  No therapy for warts is 100% effective.  This does not mean that you are abnormal or have particualrly treatment resistant warts.

3. If it is scar tissue which has formed rapidly (within two weeks) what can I do? Would rubbing the tissue help break it up? The presumed scar and remaining warts have put my sex life on hold and I feel very depressed about the whole ordeal.

This is rather rapid for scarring to appear.  Scars tend to improve with time and increased manipulation may make it worse rather than better.  I suggest you discuss this with a dermatologist.  

Question (4) is around protocol for potential partners - should I inform all sex partners even if I wear a condom? What are the transmission odds? Is unprotected oral a no go? When am I safe to resume oral/full sex without informing partners?

In general we do not feel strongly about informing partners as HPV infections are so very common.  Here is a link to another response by Dr. Handsfield that goes into detail:  http://www.medhelp.org/posts/STDs/Past-HPV/show/1814012  ;

Question 5.   Circumcision for this process is a bit dramatic.  I would hold off and discuss with a dermatologist.  EWH

[stressedout8]

sorry Dr, yet another question I forgot to include - presuming it is scar tissue would applying condylox directly to it help break up the scar tissue? I ask because the potential scar is within mm of the area where warts are still visible.