Persistent HPV

[laotzu]

Hello Doctor,

I'm currently a 28 year old male, and first presented with symptoms 1 - 2 years ago. I've had 1 partner, and she never presented with symptoms, and also had clean gynecological exams throughout our relationship. We both noticed a small growth at the very base of my penis; it got progressively a little bigger, but was never very large. I knew: one, I had only had one sexual partner; two my sexual partner wasn't showing signs of the virus; and three, she had most and then all the vaccine. Initially, I ignored it, not thinking it was HPV -- but ~6 months or so after first noticing it, it got worse. Facts: I work out frequently, eat very healthy, and also used marijuana with regularity (2 - 3 times a week, max).

I treated (briefly) with vinegar. I go to a primary care Doc, and she tells me it's molluscum, and tells me not to worry about it. My girlfriend was very put off by it, however, so I went to see a dermatologist PA, who diagnosed me with HPV -- and I do think it makes more sense. He used cryo, which worked until it came back worse, and now aldara, which is possibly working and possibly making everything worse. It's now spread to the shaft with some very small warts, and intermittently throughout the genital region. I've been on the aldara for three weeks, but it seems there's a new, small wart every week or so. It's now possible I've been infected for over two years, which I've read is fairly rare.

My question is, essentially, is it likely getting worse now before it gets better, and does the combination of one sexual partner, who never showed signs (even with frequent, unprotected sex, and even after the wart(s) were noticed), seem odd? Could I have extended the infection my smoking marijuana, which I've now stopped?

I'm seeing a new doctor in a few days, and if you have any suggestions, that'd be helpful. I'm doing everything I can to boost my immune system, the only issue now is the inability to sleep.

[Edward W Hook, MD]

There's no reason for you not to get the vaccine.

Molluscum is not always and STD.  I think you need to know what is going on.

Not much more to say here.  EWH

[laotzu]

I told him exactly everything I mentioned above, including having only one sex partner, my G/F having partial vaccine the first time we had sex, smoking marijuana -- all of it.

Logically, how could I have gotten molluscum without her showing signs of having it, since we had such frequent unprotected sex? That is: if she was immune to the infection because of childhood exposure, how could she have passed it to me?

He said if anything came back, he would biopsy without hesitation; I've never had more than a few growths, it's just they've lasted for so long. Unfortunately, I still believe it to be HPV, because I can't get to a logical basis for contracting MC from someone who must have been immune to it. HPV sort of meets the same test, but I know people can present differently. I'm going to use the Aldara just on the 2 growths which are slightly visible, because I don't want to stop treating everything. I'm not going to use it to the extent that I was before.

He seemed to go back and forth on giving me the vaccine, because he said he's never given it to a male. But he's going to look into it for me. He also said if another growth appears, to see one of the derms in his office.

Thanks,
MM

[Edward W Hook, MD]

Thanks for the follow-up. I'm surprised that if you expressed yourself to your doctor in the same fashion that you did to me that he would not do a biopsy (unless he was not a dermatologist).  

Glad to hear that he feels, as i did, that this was unlikely to be HPV.

AS far as the HPV vaccine is concerned, whether these are warts or not, you can take it.  I would encourage you to do so.

I also agree with the idea of stopping the Aldara.  EWH

[laotzu]

So, I saw my primary doctor today, who I hadn't seen before. He seemed certain that it wasn't genital warts, and said it certainly looks more like molluscum. He didn't want to biopsy it, and froze the one growth that was still fairly apparent. He said that based on the length of time, my sexual history, and the appearance of the warts, he didn't think HPV was correct. I'm relieved and bothered at the same time. I'm now supposed to wait a couple of weeks and see if anything new appears, and if it does, he'll biopsy it. I told him I want to know with certainty because if it's not HPV, I'd like the HPV vaccine, and will pay out of pocket for it. He seemed to think there was a slight chance it is HPV, and I still think so, as well -- except for the fact that it's been around so long, and I'm pretty healthy. Basically I remain in limbo, which is where I've been for years, and which led to the end of my rather healthy relationship. If it's molluscum, why didn't it spread to my girlfriend? But if it was HPV that caused genital warts -- and she had to have given it to me, because I've never done anything with anyone else -- why didn't she show any symptoms?

I know it's possible for her to not show them, but it seems unlikely. Is it possible to not show symptoms of molluscum?

Awful.

Additionally, he told me stop the Aldara, which just seems to be burning the healthy skin off my scrotum. I trust him more than the other docs I've previously seen, but stopping the Aldara seems like a step backwards.

[laotzu]

Thanks Dr. Hook. I did shave, sort of -- mostly I buzzed it. I haven't shaved or buzzed it in a couple of months, probably, except for some light trimming. I have continued to masturbate, though lately I've used some sort of a buffer so it's not skin to skin. I'm not going to do that, any more, obviously. I had read that it shouldn't spread the infection, especially if you washed -- which I always did. The dermatologist diagnosed it as HPV because molluscum usually is dimpled, and these are not. Part of me thinks it's definitely HPV, though there are a couple of wrinkles there that don't make sense. The aldara doesn't seem to be doing anything for the lesions, which haven't changed in weeks (grew to a point, and stopped, with no coloration change). Cryo, as I noted, definitely impacts them -- but they just come back stronger.

I'm not seeing another derm, though -- I'm seeing my primary care doctor, who I trust a little more; he's not the one who initially diagnosed me, because I was panicky and took whoever was available. I'll ask for a biopsy, which I asked for at my initial appointment with I was diagnosed with MC. I was supposed to have a 6 week follow up with my derm, but I may ask for a different doctor so I can get another opinion. My appt is Wednesday, I'll respond with whatever information I'm given.

[Edward W Hook, MD]

Welcome to the Forum.  I think getting a second opinion from another dermatologist is a good idea.  It is rather unusual for HPV infection to persist for two years and even worse for HPV to be getting worse with treatment. On the other hand, this might be the case with molluscum or some other dermatological process.  

As for what might be making things worse, could I ask, do you shave in the area where the lesion has appeared.  The reason I ask is that shaving can make such lesions both recur and spread.  if not, then the second opinion is the way to go.  You need a definitive diagnosis to guide your treatment.  While HPV is common, many non-HPV genital lesions are mistaken for HPV.  A biopsy (not a big deal, painless, not scarring and sometimes even curative) may be a good place to start.  

Finally, there are no data to suggest that smoking marijuana significantly weakens the immune system or makes HPV infections harder to mange.  

Please let us know what your 2nd dermatologist says.  EWH