acetowhitening question

Dear Doctor,

Under what condition(s) would genital warts not respond to acetowhitening (i.e., not turn white with acetic acid application)?  I have read over previous threads regarding the "vinegar test," and understand that the consensus seems to be that it isn't very reliable.  However, it also seems that the primary reason for this is that benign areas may respond to acetic acid application ("false positives"), not that potential warts won't turn white ("false positives").  So, in effect, acetowhitening highlights both warts and other benign areas, which explains the unreliability of the test.  

Could you please shed some light on the subject?

Much thanks.

[Alan Rockoff, MD]

I stopped using it so many years ago that I don't really have much light to shed.  I wouldn't rely on it for the reasons you mention, wither pro or con.  The proper way to diagnose warts is to have them examined, and in occasional cases, biopsied for confirmation.

Best.

Dr. Rockoff