HPV Confusion

[petrified]

I have three questions (in order of importance):

(1)  HPV:  about 7 months ago I was diagnosed with having HPV (via swab as well as “site inspection”).  I essentially accepted the diagnosis.  The “warts” have all been gone for  3+ months after using Aldara cream and freezing.   Well, the story gets interesting/confusing……………I have had on again/off again vaginal burning for 8+ months - - my ob/gyn & gp referred me to a Vulvar pain clinic in Philadelphia since they didn't know how to help me.  The doctor at the clinic did two biopsies and tested for all strains of HPV, fungal & dermatoses.  Here’s the huge confusion…………..the DNA/Biopsy results came back negative for all strains of HPV!!!   I don’t understand………..is this possible?  How did I test positive for HPV via swab/viral culture and then test negative with DNA/Bioopsy?  The only thing I can think (via the reading I did on this site) is since HPV can “hide” or apparently “disappear” - - did my body actually rid itself of HPV?

(2)HSV:  I have tested negative for HSV using HerpesSelect Type Specific testing at 17 & 24 weeks past exposure - - both results were negative (HSV 1 & 2).  I have never had a “typical” herpes outbreak, but have had atypical symptoms (vaginal  burning - - on again/off again for 8+ months - - I can't tell you the cycle or frequency since I haven't tracked it well enough).  Given I have now been diagnosed with Vulvodynia Vestibules & Lichen Simplex Chronicus (per the biopsy results)…………..is it safe to assume I can 100% emphatically put HSV out of my mind?  (To better explain my “psychosis”:  I was diagnosed with HSV via an IgM test and then did too much reading - - it became a double edged sword - - I got properly tested and found out I’m negative, however, with all the reading I did I found out some people never seroconvert).

(3)  The doctor at the Vulvar Pain Clinic told me that the only “difficult” conversation I need to have with a new sex partner is that I’m incredibly sensitive in my vulva and I should use lubricant……………do you agree?  (meaning, I don’t need to inform them about HPV or HSV).

Thanks for your help.

[H. Hunter Handsfield, M.D.]

It sounds like you have idiopathic vulvodynia. In Latin, vulvodynia means pain of the female genitalis (vulva), and idiopathic means the cause is unknown.  The pain usually is of a burning quality; otherwise, the Latin name tells just about the full story to the extent medical science can do.  It is a fairly common syndrome, and very frustrating to patients and providers alike.  Or perhaps the lichen simplex is the explanation; I can't judge that.  In any case, I'll bet all I have said so far, and all I will say below, is more or less exactly what you were told by your doc at the Vulvar Pain Clinic.  Test me:  print this reply and take it with you to discuss at your next visit to the clinic.

To your specific questions:

1) HPV has been speculated as a possible cause of idiopathic vulvodynia, but has not been proved and most experts don't believe HPV causes it.  I can't explain your discrepant HPV tests, except for the possibility that between the postive test and the negative one, your immune system and Aldara eradicated the infection.  Or perhaps the first test was falsely positive.  Between the two tests, the biopsy is the more reliable result.  So if you had HPV originally, or if you didn't, it now is gone; and it doesn't explain the burning sensation.

2) Just like HPV, HSV has been speculated as a cause of vulvodynia, but no research supports that explanation. Anyway, your negative blood test results exclude that possibility.  Despite what you have read, not seroconvering is rare.  You don't have genital herpes.

3) Your provider at the vulvar pain clinic is exactly right.  Why would you want to tell future sex partners about infections you don't have?

Good luck---  HHH, MD

[HHH,MD]

I meant to add that your previously positive HSV IgM antibody test is meaningless.  See my own thread below on this topic, and search the STD forum for information about "herpes diagnosis" and "IgM".

HHH, MD

[scaredwitless]

How reliable is a HerpeSelect test at 6 months, despite "atypical" herpes symptoms? By this time, would most people have seroconverted if HIV negative?