Warts

Hi doctor,
As you probably know from my previous posts I am extremely worried about genital warts. My history is that over 2 years ago (march 2010) I had protected sex with a CSW. I am in a relationship for the past 12 years and currently engaged. After a couple of clear std exams I finally put the stupid encounter behind me. However lately I have noticed a lump on the skin that connects the foreskin to the penis. It is very near the opening of the penis and is small. 2 weeks ago I went to an std specialist who put acidic lotion on it and told me that he wasn't sure if it was a wart or not. When I left the office he told mr that he was "happy enough" it was not a wart!! This didn't fill me with confidence! I got a second opinion from another std specialist last Thursday and he said he could see no wart. However my mind still played tricks with me after the first doctor, so I got a third opinion today. I went to a female std specialist and and showed her my concern. She said it could be a small wart and applied liquid nitrogen to area. She put it on maybe for 1 minute but in the end said it was not a wart because it was not soaking up the liquid nitrogen. Now I am home and the lump is bigger than ever. Would This be from the liquid nitrogen? My main question is what do you make of this? I know your cannot say whether I do or don't have a wart but I'm terribly confused from the visits to the specialists. Any advice you could give me doctor would be greatly appreciated. Thanking you in advance

[H. Hunter Handsfield, M.D.]

Welcome back to the forum. But I am concerned about your continued inflated fears of HPV and genital warts!

You have seen two physicians who have assured you that the apparently minor anomaly of your penis is not a wart.  Then you kept searching for the answer you didn't want -- and, successfully, you found it.  What were you thinking, for goodness' sake?  And in any case, it sounds like the third clinician also believed the minor irregularity wasn't a wart, but decided to treat you because of your anxieties.  Indeed, I have to suspect you talked her into it.  Right?

Anyway, surely you don't expect that a distant, online expert -- who cannot examine you personally -- would have a different opinion.  Given the advice you have had, my opinion is also that you don't have warts.  I believe it was a mistake for you to be treated for the possibility -- but you probably put the third physician in a damned-if-you-do-damned-if-you-don't" position, so I'm not criticizing her.  But the upshot is that you and she have made it even more difficult to know for sure what is going on.  Tissue-destructive treatment like cryotherapy will probably make it impossible to tell for certain for at least a few more weeks.

In answer to your specific question, the answer is yes:  freezing causes tissue destruction, which is inherently traumatic and inflammatory.  Swelling and redness is an expected consequence.  That's one reason why this has made the ultimate diagnosis more difficult.

My final comment is a question for you.  Why do you care so much?  While nobody wants genital warts, they are a minor condition that rarely does harm.  My strong belief is that you do not and did not have genital warts -- based on the time since the sexual exposure you are concerned about, an apparently unchanging penile skin anomaly for many months or a couple of years, and the opinion of two physcians plus uncertaity of the third.  But if you did, the spot has now been treated and this should cease to be a concern for you.

I imagine this response seems harsh.  But you really have overreacted to a minor issue that shouldn't be nearly as upsetting as it apparently has been.  At this point my advice is to mellow out and stop worrying about it -- and to follow-up with the physician who treated you and follow her advice.  You might consider printing out this thread as a framework for further discussion with her.

Best wishes--  HHH, MD

[maximushoney]

Thank you for being honest and straight with me doctor. The main reason why I want to get definite cinfirmation is because I do not want to infect my fiancé with this infection, and the answers I was getting were not definite. Also I did force or ask the doctor today to apply the liquid nitrogen, I think this was just her way of identifying the warts. I rang her back this evening explaining that my penis was red and swollen. She reassured me that this was normal and that she did not see any warts because the liquid nitrogen did not Soak up the liquid. Does this found correct to you? Also how long after applying the liquid would you think it be safe to have sex again with my fiancé? Thanks for helping me and being honest with me.

[H. Hunter Handsfield, M.D.]

Of course you're concerned about infecting your fiance. Transmission to partners is by far the primary concern of all people with (or at risk for) STDs.  But the fact is that it is exceedingly unlikely you had warts; if you did, it is a fair possibility your partner has already been infected with the same HPV type(s); if not, that if you infected her, she would never know it; and if she did develop warts, they would be once again a minor inconvenience, not an importatn health threat.  HPV is simply an impersonal bit of DNA, wrappted in a protein coating, that happened to evolve to explot human intimacy for its own existance.  It should not ever be allowed to interfere with intimacy, romance, and rewarding sex!

The terminology your doctor used about liquid nitrogen and its effects don't really ring true, but I'm sure she was trying to put uncertainties and potentially complex biology into understandable terms.

I believe it has always been safe for you to have unprotected sex with your fiance.  And your terminology -- "have sex again" -- indicates you and she have been sexually active all along.  Thus, if in fact you have a wart-causing HPV infection, she is already infected.  So what is your concern?  Whether you have sex now will make no difference in her risk.

So suck it up, move on, have unprotected sex to your and your finace's hearts' content, and stop worrying about this.  In the overall scheme of your relationship, this is irrational BS.  

[maximushoney]

Thank you doctor for your help, I believe your right and I need to move on. I have one final question for you. My fiancé had a smear test maybe 9 months ago and everything came back fine, now I know this is not a test for HPV but if she had anything would it of shown up? Also would a wart have to be present for me to transmit the virus to her because I am not sure how long this growth is here. We have being having sex doctor but on a limited scale as I so afraid of infecting her, but as you have pointed out if I have the virus then I probably have infected her already. If you could answer these question doctor, then I wont be bothering you again. Again thank you for your professional service. Regards .

[H. Hunter Handsfield, M.D.]

These additional questions show that my main goal -- to reassure you and get you to stop worrying entirely about HPV -- has not been achieved.  They also are almost perfectly designed to assure your continued and heightened anxiety -- because the answers will not be the reassuringly negative ones that you obviously would hope for.

HPV is usually transmitted by people without warts or other symptoms.  Treating warts, and clearing of warts, presumably reduces transmission risk but probably does not entirely prevent it.

Your partner's negative Pap smear shows she doesn't have any pre-cancerous abnormality of the cervix, with is the important result.  It does not clear her from having HPV.  There is no way to do that.

But none of this matters. You're just going to have to come to understand -- somehow, someday -- that having genital HPV is a normal and expected conseqence of human sexuality, unavoidable for practical purposes.  But happily the large majority of infections never cause harm or symptoms.

So please re-read all my comments and move on without worry.  I'm taking you at your word:  that was your last question, and for sure this is my last reply.