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Diagnosed with HPV, what to do now?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Diagnosed with HPV, what to do now?

Dear Doctors,

First i would like to thank you for taking your time and answering questions of concerned patients. I have been married for about two years. About 9 month ago i notcied something that looked like a row of small pink growths on my labia minora and went to an OBGYN for diagnosis. After about two month of tests she finally told me i had HPV on the labia but the cervix was clear. At the same time i noticed on the inside edge of labia minora something that looked like change of texture on the inner surface of the labia. It changed color from pink to whitish-grey and the cell itself looks bigger with visible cell separations. It looks like a cell that has more liquid in it than usual and the walls of the cell are slightly swollen. Last month i noticed that the whitish cells had spread from the edge of the labia to half way up towards the clitoris and i can see some more of it in the area between labia majora and clitoris. It doesn't look like a wart, but as part of the cell itself, with a slightly lighter color. Also it has a conitnuous pattern, where the cells that are close to each other are the only ones that have the change, which is not the case in most pictures i saw of genital warts. Last week my Obgyn looked at it and told me it was HPV.
My questions are as follows: 1. Is it possible that this change in texture of the vulva is something other than HPV? If it is HPV, did i mess up by not treating it and letting it spread so much? What can i do to stop it from spreading and reverse it?
2. I would like to go to a doctor who specializes in HPV or STD's and is familiar with the way it looks. However i am not able to find anything online in the area i live in (San Diego), would you know where should i look?
3.  i am concerned that we could have gotten RRP from oral sex and want to see a specialist but am not sure if it should be a dermatologyst, a gyno or someone else. What are possible treatments for rrp and how dangerous is it?
Tags: HPV
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The topic of HPV and genital warts is a complex one.  I will try to provide some facts.  For addition information on this most common of STDs, I would suggest search for other HPV- and wart-related Q&A on this site, as well seeking addition information on sites such as the American Social Health Association (ASHA) web-site or hotline (disclosure, Dr. Handsfield and I are both on the Board of ASHA)..

Now, on to HPV.  By way of background, HPV is the most commonly acquired STD.  Over 85% of sexually active women will have HPV infection at some time in their lives.  In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears.  In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-10 months.  In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated.  With this as background, let's address your questions.

1.  It certainly could be something other than HPV.  There are a wide variety of different dermatological problems that can appear on or around the vagina.  At the same time, common things are common and HPV is certainly VERY common.  I will not venture a guess as to what this is becasue that would not be in your best interest. A gynecologist is the right person to help you sort out what this is and how to deal with it.  I'm sure that your GYN sees lots of HPV and can likely address your concerns.  Alternatively, you may want a second opinion.  On this forum we cannot recommend referrals, it is beyond the scope of what we can do.  Treatment has pros and cons and a delay in treatment is not a bad idea.  In fact, in many situations, it is a good idea as many (most) HPV infections ressolve on their own.  If treatment is warranted your health care provider can discuss the options with you to best fit what is going on and your needs.  There are a number of options.
2.  See above.  You might call the Health Department and ask if there is someone who they recommend.  As I said above however, HPV is so very common that just about all OB-Gyns have considerable experience and expertise.  You just need to find one that you feel good about.
3.  Your risk of RRP is vanishingly rare.  No one would treat it unless it was clearly present and symptomatic.  This is just not a major concern.  I would advise you to focus on your genital lesions at this time.

Hope this helps.  EWH

Thank you for your answers.
I do feel that the information i get about HPV is contradicitive and vague, especially from my doctor. May be you can clarify for me the following:
1.Do you think that i shoud see Gyn or Dermatologyst with both the lesions and the bump on my toungue? I read that if the warts have spread considerably, they are more persistant and harder to treat, is that true?
2. Considering the risks of rrp how should we modify our sex life now to avoid further spread and disturbance of the warts that i have (if it is warts). Do we need to use condoms? What happens when we want to conceive? Is oral sex out of the question for good? I am not sure as to what can we and can't do now.
3. I have had frequent urinary tract infections in the past year. I am wondering if it could have anything to do with the warts or HPV?
4. Finally, the gyno told me she didn't want to do another HPV test on the cervix, as it wasn't a year yet since the last time, however everywhere on the web it says repeated testing should be made within six month. Should i insist to do another HPV exam or is it not necessary?
One more question. My gyno told me i should consider doing the HPV vaccine. Are you familiar with any data that talks about it's effectivity with patients who are already infected?

Thank you, H.
Straight to your questions:

1.  No, I doubt that the bump on your tongue is HPV or, if it is, that you got it from oral sex.  If it really concerns you or if it is changing, I would see and Ear, Nose and Throat specialist rather than your gyn.
2.  I urged your before not to be concerned about RRP or to modify your sex life because of concern about it. I still feel that way.  It just does not happen.
3. No relationship between recurrent UTIs and HPV
4.  I agree.  Remember that HPV is virtually omniscient.  The reason for being interested and for follow-up is to detect the evolution of HPV into pre-cancerous lesions needing treatment.  Well over 95% of HPV infections resolve on their own and do not need intervention.  The entire process of disease progression occurs slowly, over years, thus there is no need for a repeat HPV test any time soon.
5.  Getting the HPV vaccine is reasonable. Your warts are likely caused by HPV type 6 or 11.  In people who have one HPV type, the vaccine protects against HPV infection caused by other types.  EWH
A related discussion, HPV on Lips was started.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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