Clarification on previous wart question

[SkaterDave]

A follow-up Q. Feel free to read my first. In the first two weeks a January I had a single unprotected encounter in the morning. By the next day I broke out in a red splotchy rash on the underside of my shaft that resolved within three days ending with a lot of peeling/flaking of dead skin. At that time I noticed a small bump. At that time it was about five days after the encounter. I can 99% say with certainty that it was not there before. I am crazy about this type of thing and know my penis very well. Within two weeks, a young PP nurse told me she didn't know what it was. Three weeks after that, an older nurse practitioner said she didn't think it was a wart but a skin irritation, especially since it occurred so quickly. I stopped worrying. It never really grew in size except from a tiny, obvious spot to a little, several grains of sand size bump all within the first week. If it has grown it's been almost too little to notice but it may have just a wee bit. A few days ago I went to have it removed and the first young nurse was most sure it was a wart. I went to an old Derm and he also said it appearred to be a wart. I had it removed. Wish I had it biopsied though, really bad, since I wish to know with certainty. So, if I was exposed during the contact I feel I was exposed during, can one rule out warts? Is there anyway to know now? I was exposed in mid January but just had it removed this first week of May. At the end of June (6 mo after exposure, 1.5 after removal) I'll be seeing an ex from before this and we never used condoms and can't start now without it being suspicious. She is a good girl and I can't risk exposing her. But I don't know how to tell her. We will be sexual if I don't say anything, who knows if I do say. I kind of think it wasn't a wart but I kind of think it has to be since the old Derm said it was. Also, if we process HPV within 6-12-18 months or whatever,how come I keep reading posts about folks getting warts a year or years after exposure?

[Edward W Hook, MD]

You did not have to start a new thread for this follow-up question, you could have just asked it in follow-up to your earlier question.  

It seems that your only new question is how come some people get new warts long after exposure.  The simplest answer to this question is that there are over 100 different types of HPV and while certain types cause most infections, the others are also regularly encountered and do cause infection.  It is a numbers game of sorts –so many people having sex and HPV being so diverse and so common.  For the remainder, indeed there are some ( a minority) of people who do experience what are probably late recurrences of their original infections but this are uncommon unless there is some sort of intervening immunosuppressive process (i.e. chronic corticosteroid therapy, immunosuppressive cancer therapy, HIV, etc).  EWH

[Edward W Hook, MD]

You are correct that the acetic acid test has fallen out of favor and that this is because false positive results were quite common.  Whether the opposite was true or not is more difficult to say and I am not aware of studies to this end.  I would say however that you should consider that your excessive acetic acid exposure did not result in whitening of the bump is certainly more evidence that this may not have been a wart to start with.

As far as a "blood test" is concerned, what for?   There are no reliable commercial assays for detection of HPV using a blood test.  I am afraid your friend is misinformed.

EWH

[SkaterDave]

Strange, I thought I posted a reply to this but it doesn't seem to exist. I am being excessive and can only smile ruefully at your fatherly browbeating. You see. I've also been diagnosed with General Anxiety Disorder.  I am taking your advice and trying firmly put it in my head but it's not so easy as the shame, stigma, and guilt-driven dysfunction are so deeply ingrained in me.  I guess that is a topic for another expert perhaps.  

Anyway. I had two quick questions just to help round out my knowledge of HPV. The Dermatologist I saw said that the Acetic Acid Test has fallen out of favor in the last decade or more. He didn't say why. Then I read on a local clinics website that they don't use it anymore because bumps that aren't HPV related could also turn white and lead to a false diagnosis. All that makes sense to me.  Is the opposite also true? Can one have an HPV wart not react to acetic acid at all?  I myself have soaked the bejesus out of the bump I had at least four times, three times wrapping a paper folded paper towel around the shaft and soaking the crap out of it for a minimum of fifteen minutes and once literally dipping the whole shaft in a cup of it (anxiety at its best!). The bump never turned white at all, or any other color for that matter though my scrotum didn't like it too much.

Also, my buddy is recommending I deal with my anxiety by getting a blood test.  But I already know what you'll say about that.  From what I can tell, blood testing isn't presented as a reliable tool for men anyway, and it's probably not going to tell me anything useful. Any thoughts on that?  

FYI, I'm doing a much better job not freaking out about this.  My basic big problem is my personal need and personality trait to overshare and therefore the incredible feeling that I'm doing someone a disservice by keeping this to myself. I'm working on it though.  Thanks for everything.

[Edward W Hook, MD]

Your reaction to the possiblity of having a wart is excessive.  Please remember that over 85% of sexually active persons will have HPV infection and that monogomy is by no means protective.  You are buying into the shame, stigma and guilt-driven dysfunction that is ore common among Americans than in any other developed nation on earth.

"compomising her safety" - please.  She needs to get regular Pap smears and her small risk of adverse consequences, should she have HPV becomes close to zero.

As you point out, there is much to suggest that your "bump" was not a wart.  For better or worse however, you will never know since the doctor you saw dystroyed it.

I see no need to discuss this with your ex or, for that matter any other potential partner.

EWH

[SkaterDave]

Sorry for the unclear second post. What I was really trying to get at is this. I'm a bit upset that the Dermatologist I saw talked me out of biopsying the bump. Then I would have known for sure how to respond. If it isn't an HPV wart and I'm reacting to it as if it is, well, then that is terribly unfortunate. Part of me, perhaps the part in denial, feels my symptoms don't jive with the standard portrayal of the cycle. I can say with 99% confidence that I had no bump there prior to having unprotected sex in January. Having the fairly intense and extensive rash in the underside of my shaft a day afterward and then suddenly having the bump as it resolved only a total of five days after the encounter doesn't fit with what I've read. Then again, not much of what I've read on other "factual" sites is the same as what I've read from you and Dr. Handsfield. Does having a bump less than a week after exposure make sense? Is it too late to have any test done? At this point I have to tell an ex I'll be seeing in late June because I don't know the answer and can't risk compromising her safety. By the time I see her it'll have been six months since my possible exposure and six weeks after having the bump burnt off. I guess I'm just desperately trying to not tell her.  But I will because it's the right thing to do, to give her the facts and the choices.  Thanks for reading.