Please Clarify about HPV / Genital HPV

[MakaveliMOB]

Hi Doctor,

I am hoping you can clarify some things about HPV for me. I have spoke with you briefly about this in the past, to later be confused  by several other physicians.

A couple of months ago I found a flat lesion on top of my skin on my right Medial-Thigh. It was on the inside (not an area that touches the genitals, or can really be exposed to female genitals during intercourse). My dermatologist said it was a Seborrheic Keratosis, but biopsied it anyway. It came back as a "Benign Keratosis".

He calmed my fears by saying it was not Condyloma. So then I did some research myself on "NIH Pubmed" and read that most Keratotic lesions have HPV in them, and most normal skin also has HPV on it. So I had the doctor order  an  Immunostain test which check for HPV  types. It came back as HPV 6,11,16,18 Negative. HPV 31,33,51 were Positive. Diagnosis: Verruca Keratosis.

The dermatologist said it was a wart but not a Genital Wart (Condyloma). I read, that over 90% of Genital warts are caused  by  HPV 6/11. So can I presume this was not an STD? I did rub that area a lot, before i recognized this lesion.

I know that HPV DNA is all over the normal adult skin, including the Genital area, so could this have just been skin contaimination with the HPV DNA? When they did the super sensitive test?

--Thanks in Advance.

[H. Hunter Handsfield, M.D.]

As I probably told you last time, your source for your diagnosis and advice about its possible causes is your own health care provider.  Further, everything you say about yours suggests your dermatologist is well on top of this issue.  I have nothing to add to his advice and have no explanation or advice about the identification of selected HPV types in the lesion or about when or where you contracted them.  And with another apology, I have neither the time nor the energy to read the abstracts you attached as comments and have deleted them.

You seem more concerned than necessary to be about the distinction between seborrheic keratosis vs genital warts vs other diagnosis and about where your HPV came from.  It doesn't seem very important and I do not understand why you insisted on the HPV testing to begin with.

Best wishes--  HHH, MD

[MakaveliMOB]

Hi Doctor,

I dont mean to be rude, but I was looking to get better "educated" from you on hpv/genital warts, and other lesions it may cause. I did not expect to pay the donation fee for you to let me know that my dermatologist is already on top of it.

Thanks.

[H. Hunter Handsfield, M.D.]

It is MedHelp policy to limit all intial questions to the 1500 words permitted in the initial screen; according to standard procedure, the extention of the initial question into additional comments should have resulted in my deleting the entire question without response.  The purpose of the Med Help forums is to answer direct clinical and prevention questions, not to provide feedback on peoples' own research in the detail you were seeking. It is unreasonable to post the equivalent of 2-3 single-spaced pages that would take 20-30 minutes to read and absorb, certainly not for $10.00.  In any case, the dontation is just that, a donation--not a fee that entitles a questioner to unlimited service.

HHH, MD

[MakaveliMOB]

Doctor HHH,

Well I am sorry if i was off subject or expecting more. I just thought that some of that information might have been of interest to you.

The reason why I posted in the first place was because i dont really think my dermatologist knew what the diagnosis meant himself. It is hard to find a doctor in my area that is knowledgable about STDS.

I just want to know if its a STD Genital Wart, or just a Wart, it was not on the Genital Area nor did the Genitals touch that area, nor could that area be rubbed during intercourse. The diagnosis was  NOT Condyloma Acuminate (sp?), rather it was Verruca Keratosis.

Thanks

[H. Hunter Handsfield, M.D.]

I really would like to help, but you are asking dermatology questions, not ones that I (or most STD experts) can answer.  I am not familiar with "verruca keratosis".  Some dermatologists sub-specialize in dermatopathology; if your dermatologist can't answer, you might ask him/her for referral to such a person.  Or consider posting your question on the MedHelp dermatology forum for Dr. Rockoff's opinion.

Minor point of terminology:  The terms "condyloma accuminatum" (plural "condylomata accuminata") are not synonymous with genital warts.  This is simply one form of genital wart, the typical cauliflower-shaped lesion, especially on moist surfaces.  Other genital warts are called papular, keratotic, and flat.

HHH, MD

[MakaveliMOB]

Thanks. I appreciate the clarification.

[verbals]

wow, I'm sure my comment will be deleted, but I just wanted to say that I've read quite a few threads on this board and I'm so surprised at how the doctor has no regards for some of the people posting.  not everyone is a genius physician, and they may in fact really be confused about their condition.  i just found a lot of the posts very belittling.
this particular topic was of great interest to me because i myself had the exact same thing happen to me.  i don't see why it's so hard to believe that HPV is difficult to understand. there are many different strains, so of course we'd be concerned as to which are capable of affecting which areas, and whether or not it counts as an STD.  whatever, obviously there'll be no answer to be found here.

[simplepimple]

Hey "Verbals" and anyone else in cyber world reading this comment. Don't beat up on HHH MD. Let it be. We have choices in cyber world for information from friendly professional MDs from  www.thebody.com   and you know what? It's free! A FULL staff of MDs dealing with HIV and many other STD FACTs, latest news and of course huge forums where you will get friendly and interesting answers to all your questions. WITHOUT the feeling that you were belittled my friend =)

Free friendly up to date HIV / STD FACTs and professional advise (all MDs have profiles with pictures and background) at  www.thebody.com

FREEDOM TO CHOOSE!