Genital Wart diagnosis?

[hpv_concern]

Hi

I have followed these boards for some time know, though I am not sure if this forum or the dermatology forum is the correct place to post this. I went to my local doctor as I found 3, 1 mm in size flesh colored bumps on my penis (on the shaft near the top of the penis, but not on the head). They feel like the skin and are slightly raised.  

Once I showed the doctor the location, he got some magnifying glasses and looked closer. He then said it could be genital warts and ruled out HSV or any other STD. He referred me to a dermatologist. I, along with the doctor, was confused slightly by this diagnosis, as the location of the warts are where condoms cover. I have only had unprotected vaginal sex once in my life time and that was 6 months ago. 3 months afterwards, I had a full panel of STD testing (HSV 1 and 2, Chlamydia, Gonorrhea, Syphilis, and HIV) and all were negative

I have a few questions:

1. The doctor told me that the dermatologist would put acetic acid on the area. I think this is the the "vinegar test"? I thought that the test was unreliable as other conditions would also turn white from the application? Is there an HPV DNA test, and is it normally ordered to confirm diagnosis?

2. If they are warts, was the unprotected sex 6 months ago the likely cause of the warts (if they are warts)? More to the point, what is the likelihood of HPV transmitting to an area covered by a latex condom for the entirety of genital contact?

3. I have read that most warts will heal on their own. I assume treatment would make them heal faster? Can you tell me what percentage of patients have recurring warts/warts that won't heal?

4. I have read conflicting reports on how long you stay contagious. For most people, are the HPV strains that cause warts still a concern after say a year of no outbreaks?

Thank you in advance for your help

[Edward W Hook, MD]

The vinegar test is not very specific.  I would believe the dermatologist. EWH

[hpv_concern]

I am confused by the freezing treatment. I didn't get a chance to take a lose look at the area (since the warts are so small) until now. All the freezing did was make the area turn darker and raise the warts a little bit. They are still the same size and shape, is this normal with the freezing process?

[hpv_concern]

Thanks for the quick response! I don't understand the test then, but I will only be using dermatologists for this stuff from now on. Thank you again for your help.

[hpv_concern]

small update:

So, the person I was sent to was not a dermatologist, and he did do a vinegar test, and it did come back negative (the bumps did not turn white). So, I went to an actual dermatologist, and he immediately said they were warts and froze them off.

I am confused, I thought the vinegar test could give false positives, but not false negatives? I am sure that the dermatologist knew what he was doing, but I am just a little surprised by the diagnosis given the vinegar test results.

[Edward W Hook, MD]

Yes, recurrence would typically occur in about the same place as the original lesions.  EWH

[hpv_concern]

If the recur, would they be in the same place?

[Edward W Hook, MD]

Welcome to the Forum. What you describe sounds like warts but the dermatologist can tell you for sure.  Condoms certainly reduce the risk for HPV, including warts but the protection is not perfect.  HPV can be transmitted though genital contact prior to or after intercourse.  In answer to your questions:

1.  You are correct, the acetic acid/vinegar test is unreliable. On the other hand, an experienced dermatologist can make an accurate diagnosis if these are typical genital warts without testing.  Believe the dermatologist if he/she tell you that you have warts.

2.  Yes, research suggests that, unlike other STDs which typically become apparent soon after sex, warts may take several months to occur. The time frame you describe would not be atypical for warts.

3.  Treatment does eradicate warts with about a 70-80% success rate.   those that fail treatment typically go away but then recur within a few weeks or months.

4.  If your warts do not reappear after 3 months you are not at risk for recurrence and do not need to worry about spreading the infection to others.

I hope these comments are helpful. Have faith in the assessment an management offered by your dermatologist.  EWH