Confusion...please Clarify

[MakaveliMOB]

Dr. Rockoff,

I am lookng for peace of mind, and clarity. I am hoping to get such a response. I have gained a vast amount
of knowledge  HPV and the diseases that 'can' manifest from it.

To be brief: I had a lesion on my Right Medial-Thigh (as described by my Derm)

Exact Location: It was on the inner thigh (where there would be NO friction during Sex), more than several inches away from the groin, and below the scrotum. So the genitals do not touch this area. So when standing in and upright position, it would be the area where your 2 inner thighs meet. Below the scrotum, on the thigh, on the inner thigh.

Biopsy Diagnosis: Benign Keratosis.

I had them do an Immunophenotype stain for HPV. Strains 6,11,16,18 were Negative. I know 6, 11 cause 90% genital warts. 16,18 are very common too. It came back positive for 31,33,51.

Immunophenotype Diagnosis:  Verruca Keratosis.

I was not pleased with my Derms interpretation of this, nor do i think he really knew what the Dermatopathologist was saying.

I was very confused because, i know HPV is classified as Mucous Membrane Strains, Cutenous Strains, depending on what type of skin it can affect. I know that most  genital warts are caused by 6,11,16,18 but i also know that 31,33,51 can also be found in the genital area as well as other skin areas. I've seen research on lesions of the head having strain HPV 33 in it.

So i called the DermatoPathologist. He corrected me several times on things, and said that all warts are Veneral, and are transmittable, and that they classify Warts by their malignant potential and their location. He said because it was on the thigh and not the penis, base of penis (where most friction is), and the scrotum or groin, he didnt call it a Condyloma. He said that Location is what lets them distinguish, not Strain type.

But when I asked my Grandfathers Urologist, he said that it probably was a genital wart because it was close to the genitals.

I know you ll probably tell me its gone and to forget about it, but i really would like to know what I should classsify this, as a Genital Wart or Regular Verruca Vulgaris.

Please clarify ... I hate it when I get different answers from different doctors...

What would you call it in your practice?

[MakaveliMOB]

Yes. I suppose I will never know. I just know I rubbed that area myself a lot too.

The patients who have had them on the thigh without them being on the genitals, I m sure they were on the portion  of the thigh where there would be rubbing or friction? Or at least started there and spread.

Just seems odd for it to grow in an area without friction during sex.

--thanks

[Alan Rockoff, MD]

Maybe.  Most genital warts are on the shaft, but I've seen them elsewhere, including in young males who have them in the pubic areas and on the thighs near the genitals but not on them.  The pathology doesn't always show viral changes of wart, even when it is a wart.

Bottom line: doesn't matter.

Dr. Rockoff

[MakaveliMOB]

Sorry Doctor,

I just noticed i replied under another name ive used in the past.

Just to clarify,


Why would you call that a Genital Wart? Because of the strain or because of the location?


Strains 6,11 are found in 95% of Genital Warts. Strains 16,18 are found in 70% of Genital Malignancies, and found on the Genital Skin of males.

So 31,33,51  are found in very low levels, and are also found in Non-Genital Sebhorrehic Keratosis.


If you consider location, like you have always told ppl on this site, Warts are usually present on the Penile Shaft. And that sometimes, rarely they are on the scrotum, and more rarely they are in the groin. Even more rarely, they can be on the thigh, but thats usually the case when there are a bunch of warts already on the groin and they are spreading out.

But for it to be on the thigh outside the Penis, Scrotum, Groin (several Inches away), and on an area without and friction. And on an area, which is not that moist genital skin, how would this be a genital wart.

I'm not in denial, I 'm just trying to understand how you diagnosis this. Because, they sent this to the "best Dermatopathologist" in the area, and he said Strains dont matter, and that location does, and if that was an area without rubbing and was not on the genitals , then it probably was not a genital wart.


-Thanks.

[MakaveliMOB]

Thanks for the response.


Is it because you feel it was too close to the genitals too? So the dermatopathologist is wrong i suppose?

I just dont understand why this isnt such a clear cut diagnosis, seems like different doctors say different things.


-Thanks.

[Alan Rockoff, MD]

A genital wart.

It doesn't matter what you call it.  You get rid of it, which you did, and move on.  At least that's my suggestion.

There is no way to say with complete certainty whether you are contagious.  Since condoms don't prevent HPV transmission, there's nothing else to do but what you've done.  (Of course condoms are important for preventing transmission of herpes and HIV.)

Best.

Dr. Rockoff