genital warts

[fmn33]

I had a biopsy done 2 days ago of a lesion to see if it is a genital wart.  It was pretty high up in the crease of my leg, above my pubic hair line. Atypical, from what I understand- which is why they actually biopsied.  It had been there without changing for over one year.  I had sex with someone over a year ago, who was diagnosed with genital warts shortly after. I always thought it was just the one spot.  But just today I noticed two pink slightly raised spots about 2 inches higher than the first one, almost to my hip.  I also looked around the entire area with a magnifying mirror and also noticed about 4-5 tiny red/pink spots about 2 inches from my groin, into the inner (almost front) of my thigh.  My doctor did a pelvic exam 2 days ago as well and did not see anything worrisome on the labia or inside the vagina. (I also had a pap- no results yet).  
Could genital warts spread this far from the actual genitals?  Also, my underwear line would rub right against the original spot- could that have spread it higher into my hip area?

[fmn33]

Thank you for the quick response.  Yes, I do understand that I most assuredly have/had HPV and that this is normal, rather than a rarity. I'm actually quite accepting of that fact, knowing that I'm in good company with nearly 9/10 other women.  
But no one wants to be the girl unlucky enough to develop the physical signs of warts.  And while I do understand that it's trivial compared to cervical cancer, and a myriad of other health problems, it's still difficult to accept that for the next two years I may have to be constantly wondering, "where's the next one going to show up, are there more that are just too small to see/treat, where/when/will they come back, who am I going to put at risk down the line."
The emotional/psychological effects hurt far worse and will last much longer than any little skin bump.  I recently started dating someone new. We haven't been intimate yet (as I'm waiting to sort this issue out), and I can't wait to see how fast he'll run in the opposite direction if this biopsy confirms my fears.  People can say, well a person like that "isn't worth it," but how can you blame someone for looking out for their own health.  If I had the luxury of knowing my previous partner had genital warts, I would have avoided the encounter as well.  And I'm certain most people feel the same.

[Edward W Hook, MD]

Welcome to the Forum.  I doubt that these are genital warts and will suggest what I hope you find is a logical approach to evaluation of the lesions you describe below  At the same time, as I read your questions I found myself wondering why you were concerned about the possibility that these could be warts.   I worry that you think this is unusual.  If you have been sexually active with others, chances are that you have HPV, just about everyone does.  For better or worse, at present HPV is a "fact of life" and most people have it or will have it at some point in the future.  Despite this fact, only a tiny minority of persons with HPV get the consequences of infection (primarily women and primarily cancer and pre-cancerous lesions).  HPV is the most commonly acquired STD.  Over 85% of sexually active women will have HPV infection at some time in their lives- further, lifetime HPV prevalence is similar irrespective of whether persons are monogamous or not.  The figure for men is less well studied but similar.   In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears.  In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-24 months.  In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated.  For men there is far less risk of any sort.  If your lesions are warts (I doubt that they are) it is not that big a deal.  Have them treated and be done with it.

As for the lesions you describe, first please remember that all HPV infections are not STDs- there are over 100 different types of HPV and less than half have been found in the genital tract.  The location you describe for the lesion you had biopsied would be an unusual place for a wart to occur.  They typically occur on the lips of the vulva.  Once you know if the first lesion you have noted is a wart or not.   If it is, you can ask a dermatologist to evaluate the other lesions.  If it is not, you should consider what else the other lesions might be. There are many processes that cause small reddish bumps on the legs and thighs- these include folliculitis, cysts and other dermatological conditions.

I hope these comments are helpful.  EWH