Genital Warts

Q:  Several weeks ago my boyfriend was diagnosed by his dermatologist in Beverly Hills, California as having an active case of genital warts on his penis. He received treatment in the office on two visits, consisting of some sort of burning to the small rash-like warts, and was given some cream to take home to put on several times a week. This cream also caused a burning sensation, but he appeared to be cleared within 3 weeks.

His MD strongly suggested that I needed to be seen by a GYN to be scoped and RNA tested. I was seen by my GYN who told me I was negative and that no further visits were necessary.

There seems to be a great discrepancy between the information provided to both of us by our respective physicians. Due to the outstanding reputation, recognition and prominence of his physician, he is inclined to only accept his information and suggestions. My GYN strongly rejects the Beverly Hills dermatologist's opinion that the genital warts received by my boyfriend were contracted through handshaking with one of his friends and that any recurrences are extremely rare. Please assist me in determining the most reliable information currently available on this subject.

A:  Genital warts are caused by the human papillomavirus (HPV) and are usually sexually transmitted. What gets confusing is that there are over 30 types of HPV, some like types 1, 2, and 3 which cause warts on fingers, type 4 which likes the bottom of the feet, and types 6 and 11 which are the genital ones. Several HPV types are linked to cancer risk, like type 35 for cervical cancer.

HPV is a hardy virus that can be spread by skin-to-skin contact with another person, sexual activity, or by self-innoculation (from carrying the virus on your fingers to other parts of your body). It can lie dormant in your body, so your boyfriend may have gotten the virus some time ago, but only now manifested the warts. About 70% of women who are infected with HPV may have no symptoms, and the HPV is discovered only by pap smear.

Dwight P. Cruikshank, MD, Professor and Chairman of Obstetrics and Gynecology at the Medical College of Wisconsin, agrees with your gynecologist that if there were no lesions on your genitals and the pap smear was negative, there would be no reason to do further testing. The role of RNA typing of the virus is controversial, and there would be no need for this if you don't even have HPV. Although HPV can recur, according to Dr. Cruikshank, the latest evidence is that people can clear their body of HPV-it is not necessarily there for life. Poor immunity or nutrition, chronic medical conditions, and smoking will decrease the chances of getting rid of HPV.

If you've been sexually active with your boyfriend while he had the genital warts, it will be extremely important to have annual pap smears and monitoring for HPV, since about 50-70% of sexual partners also get infected.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.