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Male HPV biopsy - false positive?
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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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Male HPV biopsy - false positive?

Dear Doctor,

I am a 35-year-old heterosexual male and was recently diagnosed with HPV. A few weeks ago, I discovered a single, tiny "wart" near the line where the pubic hair and shaft meet. I saw the nurse practitioner at my urology clinic. She did not think that my "wart" was sexually transmitted but sent me anyway to a dermatologist for reassurance. My "wart" was so small that the dermatologist had a hard time seeing it and was unsure what it was. At my request, he biopsied the spot. The results say, "The histologic changes are most consistent with a condyloma acuminatum."

I am a bit skeptical (though not in denial) about my results. I have had only one actual intercourse partner in my entire life. During our six-month relationship, which was monogamous  and ended last November, we always used a condom for intercourse but did have unprotected oral sex. I have also had unprotected oral sex with approximately four other girls over the last thirteen years (most recently about six weeks ago).

The other reason I'm skeptical is that the PA at the dermatologist is very young and didn't seem to know much about STDs.

Here are my questions:
1. Is the biopsy definitive or could this be a false positive? (My one sexual intercourse partner once had a false positive test result for high-risk HPV.)
2. Do you think I should be tested again, if possible?
3. Do you recommend testing for other STDs at this time?
4. If I do have HPV, should I worry about spreading it to other parts of my body (e.g., using towels more than once or masturbating)?

I value your opinion. I have been a long-time and avid reader of your posts. Thanks for your help.
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Welcome to the STD forum.  Thanks for your confidence in this forum; I hope I can help.

Normally a biopsy is definitive, but perhaps not in this case.  You and your nurse practitioner are correct that this is an atypical presentation for genital warts.  (Had you been my patient, I would not have agreed to your request for biopsy.  You should have stopped when you were ahead!  Given your sexual history, which is virtually zero risk for most STDs and extremely low for HPV, why did you insist??)  From the wording in your biopsy result, the pathologist apparently was not sure about HPV, so despite my comment above, it seems there is doubt about the result.  To the specific questiobns:

1) Accurate interpretation of a biopsy depends entirely on the skill and knowledge of the pathologist who reads it.  Given the doubt expressed in the report, you may not have HPV.

2) You should go to the doctor who did the biopsy and explain all this.  He or she may simply ask for another reading of the biopsy, or might request that another pathologist examine it.  Perhaps there are additinonal tests that could be done on that specimen.  If this doesn't sort things out, your doctor might want to re-biopsy you.

3) In view of the overall situation, especially your sexual lifestyle, I see no need for testing for other STDs.  However, I have the impression you are the anxious/nervous sort.  (Why else would you have insisted on the biopsy?)  If so, and if you would sleep better knowing that some lab tests were negative, talk to your doctor about urine tests for gonorrhea and chlamydia and a blood test for HIV and syphilis.  If you are tested, you certainly can expect negative results.

4) Many or most HPV infected people have infection in more than one spot, without any visible skin abnormality.  If you have (or had) genital HPV, the infection may already involve other areas of the penile or genital-area skin.  However, spread to non-genital areas is rare and not worth worrying about.  And you certainly need not worry about masturbation; any spread around your genital area probably occurred within a short time after you caught the HPV infection.

Please return with a follow-up comment after your doctor has weighed in and/or clarified the result with the pathologist  In the meantime, don't worry about all this.  Even if you have HPV, you can expect it to go away without ever causing any significant health problem.  If you have followed the forum closely, you will have seen many reassuring comments about genital HPV.  Don't get too worked up about this.

Regards---  HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
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