Can I assume a Misdiagnosis and that the doctor was just trying to rip me off?

[extremelyconfused]

Hi Doctor, I'm 20 years old, bisexual, and have had receptive intercourse, although always protected.

About a month ago, I noticed that with having diarrhea I could see small traces of blood when wiping. So, being the hypochondriac that I am, I decided to investigate and noticed a small bump on the outside of my rectal opening, it resembled that of a pink skin tag or bump. But just to make sure, I decided to go to the proctologist to see what he had to say. He told me that I had genital warts both internally and externally and that I would have to have them burned off, and he would call me to give me the cost of the procedure since I didn't have insurance, and could get it a bit cheaper. That Monday, I was called and told that it would be about $3500 or $3700 and I'm assuming that since they called the hospital to get the rate, that it was going to be done there. So, I went home for christmas break and read about Aldara and asked my home doctor if he would give me a prescription for it, even though i knew it could only be used externally. So, that Friday, the 15th, i began using it and used it for 3 weeks before I had returned to where I was living and noticed that the 1 or 2 external bumps that I had were gone. So this past wednesday, the 10th I went to the STD clinic to have her look to see if there were any external warts and if the bumps that were internal were, in fact, warts. I figured that at the STD clinic she sees them everyday and would know what they were if she saw them. She said that she saw nothing externally and what she saw internally did not look like warts and that I appeared fine to her and that these could be papillae or polyps or just completely normal. So last night, the 12th, I went to the emergency room and had them check this out. The doctor there told me that there was nothing at all externally, and that what was internal were not warts. She even inserted her finger and said that what she felt was completely normal and that I was completely healthy and do not have genital warts.


Have you ever heard of a $3500 procedure to remove genital warts  or was this doctor trying to rip me off? Why would he call a hospital to get a rate? I thought this was an in-office procedure. (this rate "included anesthesia".. local or general.. I have no idea, but am scared to find out!)

How likely is it that my external warts could have went away on their own without treatment in 3 to 4 weeks (or actually even less if what I am seeing are not warts)

Could the two external bumps have been something resulting from a fissure? The Dr. at the STD clinic said she saw fissures externally.

What are the chances that he could have misdiagnosed me, and I never had any warts in the first place.

And what should I do now? Should I go to a fourth doctor even though I know that they're going to tell me I'm fine too.
And what about future partners? Is it safe to assume that I never had Genital warts?

Thanks so much for everything! You are Amazing!!

[H. Hunter Handsfield, M.D.]

Most proctologists are pretty much up to speed on rectal warts, and if he looked for internal lesions (e.g., by anoscopy, not just by digital exam) and diagnosed warts, it seems you probably have them.  However, since that diagnosis now conflicts with the opinions of 2 other providers, there still is reason for doubt.  If you follow through with care by the protologist, you should ask him to biopsy a lesion to document the diagnosis before you go through the more extensive therapy that he has recommended.

If you do have internal warts, the proper treatment is a matter of debate.  In general, proctologists have been taught that it's an important health problem, and they have been trained in surgical management--so his recommendation of surgical (and expensive) treatment probably is honestly made.  I'm not surprised by the $3500 cost.  However, most non-surgical providers believe that 1) it is very hard to identify all the internal lesions, 2) therefore difficult to remove them all, 3) therefore often such treatment is unsuccessful, and 4) it probably doesn't matter because most such infections will clear up on their own, without any treatment at all.  For these reasons, in my STD clinic usually we don't even look for asymptomatic internal warts; we just treat the external ones.  The surgical treatment, whether with local or general anesthesia, is quite a big deal; lots of pain for at least a couple of weeks, and with uncertainty that it makes any real difference in short term cure or long term health.

Anal fissures often are accompanied by local swelling, which might be perceived by the patient as a bump.  But I can't speculate whether that explains your situation.  

Even with only protected anal sex, the odds are good you have had one or more anorectal HPV infections somewhere along the line; almost all gay men have had it one time or another.  But I can't tell whether that explains your current rectal health issues.

Bottom line (no pun intended):  You might consider a third opinion, perhaps from another proctologist.  Or you might seek a provider who has a largely gay practice and is sensitive to both the lifestyle and health issues of gay/bi men.  There are such providers in most metropolitan areas; word of mouth from other gay/bi men is a good place to start.  Most STD clinics also know who those providers are, so you could ask there.

Thanks for the thanks about the forum.  Best wishes--   HHH, MD

[extremelyconfused]

Thanks doc, I guess I'll get going on that next exam and this time I will definitely find a different proctologist.

But you didn't answer the one question of whether or not these warts could have cleared up in a matter of 3 weeks. I mean for the treatment method he advised and now there's nothing.. I'm wondering the validity of any of his statements. (He also told me I'll have HPV for life and will always be contagious and that it's like Herpes - which I know isn't true)
I know that the warts normally clear up in a matter of a few months on their own with no treatment, but 3 weeks? Sounds a little short termed to me, as well as the external bump that cleared up in 2 to 3. Aldara can work well.. but it's success rate is about 60% in 6 to 8 weeks, not 2 to 3

I mean, even if the biopsy comes back negative, can I assume that there were no previous warts that he saw that didn't clear up already? That's my major concern now.

I just cannot get all of this off my mind. It's what I think about all day every day... I think i'm going crazy, if I'm not there already.

Thanks again ;)

[H. Hunter Handsfield, M.D.]

I agree 3 weeks is too quick for warts to clear up.  And treatment of external warts with Aldara (or anything else) would not resolve internal warts.

If there is no lesion to see, there is nothing to biopsy.

[marly250]

A related discussion, Misdiagnosed warts? was started.

[collegekiddo]

A related discussion, concern was started.