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HPV Wart return- unlikely?
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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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HPV Wart return- unlikely?

In mid-2009, I was diagnosed with HPV warts. Since August 2010, I have not had any recurrences (that I knew of), and considered myself clear of the virus and moved on with my life- physically and psychologically.

Three weeks ago, I noticed a small raised bump on the left side of my scrotum (which to me, looked like things I've had diagnosed as NOT warts in the past). My GP immediately told me that it was nothing. I went to the dermatologist today as a followup. He claimed "that is a wart. I assume that any raised bump with someone who had HPV in the past is a wart." He inspected me further and took note of two dark spots on the other side of my scrotum that have been there before I had warts and diagnosed them as warts as well. I attempted to tell him that I have had both GPs and my dermatologist back home that they were moles. He insisted they were warts and insisted on treating them. I was too upset to insist that he not treat them.

He noticed that I was upset and said "I'd rather be safe than sorry, all raised bumps around the penis shouldn't be there and are warts." This raised a few red flags in my head. He also argued that "once you have HPV, you are going to have warts pop up for the rest of your life." More red flags. I called my original doctor, and he assuaged my fears, telling me that what the dermo said just isn't true.

Now, my questions:

1) Who do you agree with: my dermatologist, or my original doctor who argued that my having had a wart recurrence three full years after my last diagnosis is pretty darn unlikely?

2) I know you are unable to make a diagnosis without having seen me, but based on what you have heard, what is the likelihood that I am still having warts pop up 50 months after first being diagnosed?

3) Does the current state of HPV literature state that warts are a transient virus?

I'm sorry for the long story and strange questions. I'm grasping at straws, as my dermatologist threw me into a terrible psychological spot.
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Welcome back to the forum.  But unfortunately, I can't help very much.  You're asking me to mediate between the conflicting opinions of different health care providers about a skin bump that I have not and cannot examine myself.

On balance, I am inclined to believe your GP is correct.  Genital warts certainly can recur more than 3-4 years after successful treatment, but usually they do not; and the scrotum is not the most common site for genital warts.  Indeed, I have to wonder why you didn't just accept your GP's diagnosis and fel you needed the dermatologist's viewpoint.  It would appear he or she is just being cautious; the advice to treat for warts if there is any doubt is not unreasonable.  But I think you'd have been better off if you hadn't done it.

At this point, my advice is that you have another conversation with your GP, and ask him or her to directly discuss your case with the dermatologist and come to a consensus about your diagnosis.

As for your last question, HPV DNA often (usually?) persists indefinitely, but not the virus itself.  But future recurrence of actual HPV lesions (warts etc) is uncommon and the virus generally is not transmissible to partners, so for practical purposes most infections can be considered transient.

I'm glad to hear you are more psychologically adjusted to HPV and genital warts than you seemed to be at the time of our discussion last year.  I hope these comments have been helpful.

Regards--  HHH, MD
6 Comments
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Avatar_m_tn
As a followup- is it normal  (in your experience) for dermatologists to take the "better safe than sorry" approach and treat everything that is suspect?
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Avatar_m_tn
Last followup, as I neglected to mention that the spots my dermo treated on the other side of my scrotum were in the crease of my leg, essentially on the backside of the scrotum- which to me, seems like an unlikely place to have been exposed to HPV, even in the case that gave me HPV in the first place back in 2009. Correct?
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239123_tn?1267651214
I agree this location is unusual for genital warts.
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Avatar_m_tn
Thank you for your comments, Doctor. Although my dermatologist's comments threw me for a psychological/emotional loop, my understanding of the virus (gained from your comments throughout these forums) and my own doctors give me serious doubt about my dermatologist's experience with HPV. Some of his comments (i.e., you will always present warts; you will always be contagious) were in complete opposition to what you, my GP, and other dermatologist (I recently moved across the country) have said. That, coupled with his insistence on treating what my old dermatologist had identified as a mole, give me serious pause about his expertise with respect to HPV. In addition, I can understand the "better safe than sorry" approach-- I only wish he hadn't said "yeah, that's probably a wart" then backtracked to say "why take a chance?"

I'm still very shaky after visiting him yesterday, and I will continue to work with a psychologist to fully understand that my HPV, for all intents and purposes, is gone. Nevertheless, thank you for your comments. They're a huge help in what is turning out to be a much tougher experience than I had hoped it would be back in 2009.
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239123_tn?1267651214
I'm hesitant to agree your dermatologist isn't knowledgeable about HPV; anxious patients aren't the best judges of their doctors' expertise in the condition they are anxious about!  However, since you lack confidence in him, if and when a future need arises for you to see a dermatologist, you should ask your GP for a different referral.  In any case, thanks formthe thanks; I'm glad to have helped.
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