Sexually Transmitted Diseases/General Genital Wart questions

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QUESTION: Mark,

I was hoping you could answer a few of my questions about genital warts for me.

1) Once a bump is noticeable, if it is genital warts, how fast would growth be seen into a more obvious genital wart, (Such as the finger-like projections or cauliflower growth)? I know that acurrate time frames cannot be given, but would it be something seen overnight, in a week, or a month? Like slow or fast growing?

2)Would a genital wart stretch with skin? Or would the skin surrounding it stretch, and the wart remain its original size?

3)If a family physician were to look at your penis and feel it, stretching the skin, and conclude it is just a normal penile variation, would you trust him or get a second opinion?

Thanks and let me know,

Sean

ANSWER: Hi Sean,
Once a bump is noticeable, it is in fact a wart. The human papillomavirus (HPV) is "subclinical," meaning it isn't easily observable or obvious, without special techniques. Once a bump is visible, than it may be a fast or slow growing wart, which may in part depend on the strain of HPV, and the number of viruses present, and the immune system's reaction to the wart. A pregnant woman, for instance, has her immune system suppressed to allow for the unimpeded growth and development of the fetus-- which is a combination of foreign proteins from the father and would be rejected by a fully functioning and competent immune system, and the proteins from the mother. Such immune system suppression usually causes very rapid growth of warts. As soon as baby is delivered and immune system "turns itself on again," the warts frequently are gone, regressing without treatment!  The faster the wart grows, the faster it usually succumbs to medical treatments; and vice versa-- slow growers respond much more slowly to medical treatments. There are, of course many exceptions to these rules!

HPV infects the top layer of epithelial skin (usually anogenital skin, but not always). The virus accelerates cell growth. So the wart itself is really just aberrant epithelial skin, unrestrained by the immune system and the cell's internal mechanisms to "naturally die" or slow growth to normal growth.

So a wart might stretch, just as it's underlying skin. If a family physician or health care provider has experience with warts, than I would trust them. Experience is an important component of knowledge here!

Good luck!
--mark
 

---------- FOLLOW-UP ----------

QUESTION: ok, thank you for your quick response. But in regards to my first question, what would you consider fast growth? I believe that my bump has been around forever, but I just noticed it due to dry skin and extra examination down there. If I were to see no growth in lets say 1-2 months, can I safely assume that it is nothing at all? Once again, my doctor did tell me it was nothing to worry about, but I do want to keep a close eye on it.

thanks again!
Sean

Answer
Hi Again, Sean,
Fast growth is over several weeks time. However a wart will not keep growing. It may grow quickly for several weeks, than persist, as the immune system may be trying to keep the wart from growing or replicating. Everyone is different! Every wart may be different, and a particular wart may be comprised of cells infected with more than one wart virus strain. If you see no growth or changes in 1-2 months, it may still be a wart!  The good news is that warts are more infectious during periods of active growth (which induces more viral growth and shedding of infectious viral particles).  A second piece of good news, is that your sex partners have probably already been infected with HPV, one of the consequences of sex with another partner.

Good luck!
--mark  

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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