Dear Dr. G,

I understand you are covering issues of STI in April, and I hope I have time to submit my query.

I am writing to you with the guilt of my past sexual encounters and truly hoping that you can help me resolve this burden of remorse.

I am a thirty-five-year-old happily married man who has a very active sex life with my wife.

I recently noticed a small coral-like growth emerging from the base of my penis, and it began to worry me.

I went to the doctor, who told me the growth was a genital wart.

I was shocked when I found out the wart is related to the Human Papillomavirus (HPV), which is essentially a sexually transmitted infection (STI).

I am afraid I am faced with the dark secret of my past that torments me now, as I was not exactly a promiscuous person in my youth.

I was even more horrified when I learnt that I can easily transmit the virus to my wife, and this could cause cervical cancer.

I would like to put Dr. G on the spot regarding the issues of my “coral in the pants.”

What exactly is HPV? I thought this was a virus that only affects women?

I thought that, like many viruses, our immunity could eliminate the infection naturally.

Are the viruses that contagious with every sexual encounter, and how can I reduce the risk of transmission to my loved ones?

I understand HPV is not curable; however, I am just wondering whether I should avoid having sex with my wife now.

I am also anxious to find out whether the warts can lead to cancer in men.

Regards

Coral Callum

Genital warts are skin lesions arising from the external genitalia, including the penis, vagina, labia, and cervix. The infections are also known to spread to the oral cavity and anus in both men and women. This infection is caused by the transmission of the Human Papillomavirus (HPV) during sexual contact. The virus may be cleared by natural immunity or remain on the skin of the genitalia, emerging as warts later in life. Of the 170 subtypes of HPV, more than 40 are transmitted through genital and anal contact, and HPV 6 and 11 are commonly linked to genital warts. HPV transmission occurs in both men and women during sexual contact.

Nearly all sexually active individuals are infected by HPV at some point in their lives, making it the most common sexually transmitted infection globally. 90% of affected individuals show no symptoms despite the infections, and the virus is thought to resolve spontaneously within two years. However, in others, HPV persists in the genital area, resulting in either warts or precancerous lesions. Risk factors for virus transmission include sexual intercourse at an early age, multiple sexual partners, poor hygiene, and smoking. The host’s natural immunity also plays an important role in controlling the emergence of the disease.

The diagnosis of the HPV virus in women is well established by obtaining samples from the cervix for PCR typing of the virus types. However, such diagnostic tests in men are not as straightforward and accurate as PAP smears in women. The visible “flower-like” lesion in the pants may clinically suggest the presence of an HPV infection. The old-fashioned diagnosis is further determined by using a vinegar solution to identify the colour changes of the lesion. In many cases, normal skin tags can be mistakenly diagnosed as genital warts. Scraping the lesion for DNA analysis of the virus subtype is the most accurate method of diagnosis.

The treatment of genital warts in men and women typically involves chemical cauterisation or surgical removal of the lesions. These treatment modalities are often painful and lead to unsightly scarring of the remaining tissue. Furthermore, high-grade HPV-induced genital warts can result in multiple recurrences, causing distress and straining sexual relationships between couples. This is particularly concerning, as such lesions can lead to different types of cancer.

The Centres for Disease Control and Prevention revealed that male condoms may reduce the risk of HPV transmission, but to a lesser degree compared to the protection provided against other forms of sexually transmitted infections. This is because HPV can also be transmitted by exposed genital skin that cannot be completely covered during sexual contact.

The most effective way to protect against HPV is to get vaccinated. Although the vaccine is intended for both sexually naïve boys and girls at the age of 13, protection is also demonstrable up to the age of 45. Other ways to diminish the transmission of HPV include reducing the number of sexual partners and avoiding sexual contact with a partner when warts are present.

The existence of genital warts has been documented since ancient Greece, while causation by a virus was only determined in 1907. These days, almost 80 million Americans are infected with HPV, and about 14 million new cases are added each year, resulting in 1% of sexually active adults living with recurrent genital warts. The curious nature of HPV transmission is that it is highly contagious with each sexual contact, but the manifestations may vary from being harmlessly dormant to precariously insidious.

Nearly all sexually active adults are infected with the HPV virus at some point in their sexual lives. Men and women haunted by their past, while facing the corals in pants, often put Dr. G on the spot for advice. His view is to maintain a healthy lifestyle, stay monogamous, and ultimately, give nature a helping hand by getting vaccinated to fend off future recurrences and the risk of cancers.