Psychological Aftermath of HPV

I have sort of an unorthodox question for you . To give you a brief background of my history, I was last diagnosed with a genital wart in August 2010. I've had regular checkups with my doc, during which he has not seen any warts. He's described me as "clear".

On December 30, I noticed a small bump on the right side of the shaft of my penis, about 2.5 inches from the base. The bump was small, raised, but nowhere near as big as my past warts, and not cauliflower textured. Also, nowhere near where I had my warts when I was treated before. I went to a D.O. who has experience treating STDs, and he took a look (magnified and with light) and said that it wasn't a wart. He couldn't say definitively what it was, but he was sure it wasn't a wart. His official diagnosis: rash (because he didn't know what else to put).  

Still, my mind wouldn't rest. I went back to my original doctor. He looked and said "yeah, that's not a wart, it looks like an enflamed oil gland or something." Having my regular doctor tell me that put me at ease for a month. However, this past Thursday, I looked at it, and although it hadn't changed (in fact, it seems to have gotten smaller after the edges sort of dried and flaked off), I again became worried . I went back to my regular doctor, and again, he put my mind at ease by telling me it wasn't a wart (he magnified and lit the area and gave the same Dx). I took some comfort in that, but I still find myself worried.

I know that a) TWO doctors have told me it isn't a wart , b) it isn't anywhere near where my warts appeared before, c) it is no bigger than the tip of a pen (and seems to be smaller than before)

My question: As doctors, what would you recommend for getting past the psychological worry that comes with freaking out over every bump. I've taken steps to get psychological counseling to deal with this, but I am curious about how you would deal with a patient like me to put their mind at ease about this sort of thing.

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.  Actually, I have little experience with patients concerned about the psychological impact of genital warts or HPV.  In an STD clinic, the vast majority of patients are seen only once or twice.  What follows is based on my training and experience as a reasonably competent physican and, I believe, a caring one.

Although your concern is an STD (genital warts), the question is essentially psychological.  How does anybody learn to live with any medical uncertainty, or with a sense of impact by a medical condition?  How do people deal with "the heartbreak of psoriasis", as it was worded in a TV ad of the 1950s?  Or in past years with the stigma that arose from erroneous beliefs that peptic ulcer disease or ulcerative colitis were due to stress or other psychological problems?  Or with embarrassment that they have an emotional/physiologic disorder like depression?

The best we can do here is give facts about HPV and genital warts.  The fact is that your infection apparently is gone and probably will never return.  You're continuing to react to the impact of an impersonal bit of DNA, with a protein coating, that evolved to exploit human intimacy for its own propagation.  So what?  Maybe it will also help to know that at least 80% of all humans catch genital HPV at least once, and that it is a normal and expected consequence of human sexuality; and that probably around 20% of all Americans get genital warts.  So you aren't exactly alone!

If your concerns persist, I strongly recommend you go beyond "taking steps" toward psychological counseling. Actually, there are no steps along that path, except to see your primary care physicians for his or her referral advice, or to pick up the phone and make an appointment.

Good luck--  HHH, MD

[DasKapital]

As an added comment, I realize that this question may be so unorthodox as to be "too weird to answer." If that's the case, then I am grateful to have donated a few bucks to this service. It really is a wonderful thing.

[DasKapital]

Thanks for your quick response, doctor. The frustrating part (for me) is cognitively knowing that infection is gone and I am reacting strangely. I suppose it is the uncertain nature of the virus during infection that lingers after infection is apparently gone. I just need to get it through my head that nearly everyone clears the virus in a few months after developing warts and I'm almost three years out from that little event, certainly beyond that clearance range based on everything I've read. I also think the vast reading I've done on the topic needs to stick as well so when issues like what I'm dealing with now come up, I don't overreact (e.g. warts tend to recur where they first show up, not somewhere completely different, and not almost two years after the last diagnosed wart...I am right in this, correct?)

Anyway, thanks for your continued insight. I've scheduled an appointment with my psychologist to talk through this sort of thing. Getting my "gut" in alignment with my brain is difficult, but something that I need to do if I am ever going to put my HPV experience completely in my rearview mirror and leave it there.

If you'll entertain one last question (for a third opinion), aside from my doctors' Dxs, am I right in assuming that all other signs point to "not a wart" in this case? Completely different location, very small (and seemingly smaller than I noticed six weeks ago), no cauliflower texture.

Thanks again.

[H. Hunter Handsfield, M.D.]

Your doctor has examined you; that judgment is much better than mine can be whether the recent bump was a wart.  An online forum cannot diagnose anything and I won't try.  But from your doc's opinion plus your description, I agree a new wart seems unlikely.

Beyond that, you are exactly right:  psychological acceptance of intellectually understood fact is a purely psychological problem -- which is beyond the domain of this forum.  Good luck with it.