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Strange presentation of anal wart
Hi Doctor --
I've got what I think is a pretty unusual case and I'm looking for some guidance.
I'm a straight male with no history of any anal sexual exposure. I was recently diagnosed with an anal wart (nothing on my genitals), which obviously shocked me. The doctor agreed it was an odd presentation so he did a biopsy to confirm.
The lab confirmed it was a wart during biopsy but apparently felt something looked odd so they did subtype testing as well. They narrowed it down to one of the "common wart types," either type 1, 2 or 4, I believe. They didn't proceed with further specification after determining it was NOT 6, 11, 16 or 18.
I understand this is very odd to have something besides type 6 or 11 causing an anogenital wart.
I have the following questions:
1. Is there any reason to believe types 1, 2 or 4 will clear faster or slower than the typical genital strains?
2. Does this have any implications for likelihood of tranmission? Since types 1, 2 and 4 don't "like" the anogenital area, does this suggest I'm less likely to transmit this to a sexual partner?
3. Having had the wart removed, is there any benefit to proceeding with immiquimod use to help speed up my body's immune response to clear the virus? My doctor said it might help but didn't seem to think it was that important.
4. In general, do you have any advice on how I should treat this differently than a typical genital wart?
Thanks.
I've got what I think is a pretty unusual case and I'm looking for some guidance.
I'm a straight male with no history of any anal sexual exposure. I was recently diagnosed with an anal wart (nothing on my genitals), which obviously shocked me. The doctor agreed it was an odd presentation so he did a biopsy to confirm.
The lab confirmed it was a wart during biopsy but apparently felt something looked odd so they did subtype testing as well. They narrowed it down to one of the "common wart types," either type 1, 2 or 4, I believe. They didn't proceed with further specification after determining it was NOT 6, 11, 16 or 18.
I understand this is very odd to have something besides type 6 or 11 causing an anogenital wart.
I have the following questions:
1. Is there any reason to believe types 1, 2 or 4 will clear faster or slower than the typical genital strains?
2. Does this have any implications for likelihood of tranmission? Since types 1, 2 and 4 don't "like" the anogenital area, does this suggest I'm less likely to transmit this to a sexual partner?
3. Having had the wart removed, is there any benefit to proceeding with immiquimod use to help speed up my body's immune response to clear the virus? My doctor said it might help but didn't seem to think it was that important.
4. In general, do you have any advice on how I should treat this differently than a typical genital wart?
Thanks.
II think they may be confusing you because Verruca means wart. There are different types of warts; Verruca Vulgaris is the term for a common wart. A genital wart can also be called Verruca Acuminata, Condyloma Acuminata and Venereal Wart--these are different terms that all mean the same. It is possible to tell differences under a microscope but you can not get a definitive HPV yes or no without a genetic test. So if they looked under the microscope and did not think it looked like 6,11,16 or 18, maybe this is what they told you. However, the pathologist should know that not all HPV’s infections are single infections, some are mixed infection. All HPV is a viral infection. The HPV diagnosis can not be done visually just by looking at a wart. This is another possibility, there are some “off label” tests (not FDA approved) that are done in some labs—maybe they did one of those to rule out 6,11,16 or18. But you would have to know the accuracy of the test in order for it to be reliable. Also, if they had the specimen and they did do genetic testing, why did they not test for all HPV’s (This is part of the reason that I question if a genetic test was done and I doubt they did a PCR test—I would ask your Dr. what testing they did—that is a simple question and I cannot speculate as to what they did. But the answers you received seemed odd--maybe 1,2 or 4 is pretty general). There are currently 12 or more low risk HPV’s and 15 or more High Risk and some sub groups.
There is another possibility; not everyone falls into neat little categories. So maybe it is a common wart in an unusual place, but it would still be a viral infection. There are times that medical tests don’t provide all the answers. There are illnesses that have no explanations.
Let's look at how the diagnosis is done in females—you cannot tell by a Pap or Colposcopy if a woman is HPV positive (you can be suspicious but not definitive). They have to add the HPV test or HPV DNA testing, the HPV test can be positive even without any visual cell changes.
I’m not sure if you will ever know for sure or not. I think if I were in your place that I would just presume it was. Most people will get HPV at some and there should be no stigma. I would wait to make sure the wart that you have clears up and after 6 months of no outbreaks, you should consider yourself cleared. Remember that regardless of the “wart type” you have; all HPV are viral infections and you want to make sure the virus has cleared up. Good Luck…
There is another possibility; not everyone falls into neat little categories. So maybe it is a common wart in an unusual place, but it would still be a viral infection. There are times that medical tests don’t provide all the answers. There are illnesses that have no explanations.
Let's look at how the diagnosis is done in females—you cannot tell by a Pap or Colposcopy if a woman is HPV positive (you can be suspicious but not definitive). They have to add the HPV test or HPV DNA testing, the HPV test can be positive even without any visual cell changes.
I’m not sure if you will ever know for sure or not. I think if I were in your place that I would just presume it was. Most people will get HPV at some and there should be no stigma. I would wait to make sure the wart that you have clears up and after 6 months of no outbreaks, you should consider yourself cleared. Remember that regardless of the “wart type” you have; all HPV are viral infections and you want to make sure the virus has cleared up. Good Luck…
Just wanted to clarify, there were two diagnoses done: One was a a biopsy, which the pathologist examined under a microscope and determined "verruca." The sample was then sent off for some further type of testing at my request. Not sure what kind of test it was
Hi -- Thanks a lot for your detailed response. Just out of curiosity, are you a pathologist? You sound very informed on the details of the procedure.
Here are some more details about the information I got.
-The initial diagnoses of "common wart" (technically the pathologist called it a "verruca") was done visually. I spoke to the pathologist on the phone and he said it is sometimes able to tell a verruca or "common wart" from a condyloma just from microscopic examintion. At my request, even though it was unusual for a wart, the pathologist then sent the sample to a lab for type testing. I don't know what kind of test they did, but my doctor said they were able to eliminate 6, 11, 16 and 18, and narrowed it down to something in the family of 1, 2 and 4. They did not provide a specific type. Does this mean they used something besides PCR? What else would it be?
-In the meantime, I saw a colon-rectal surgeon to look for internal warts. She was also skeptical of the "common wart" diagnosis, and had the slides sent to the pathologist that she typically uses. This pathologist also said the slides looked like a common wart and not a condyloma. This was just by looking at the slides.
Does this make sense?
Here are some more details about the information I got.
-The initial diagnoses of "common wart" (technically the pathologist called it a "verruca") was done visually. I spoke to the pathologist on the phone and he said it is sometimes able to tell a verruca or "common wart" from a condyloma just from microscopic examintion. At my request, even though it was unusual for a wart, the pathologist then sent the sample to a lab for type testing. I don't know what kind of test they did, but my doctor said they were able to eliminate 6, 11, 16 and 18, and narrowed it down to something in the family of 1, 2 and 4. They did not provide a specific type. Does this mean they used something besides PCR? What else would it be?
-In the meantime, I saw a colon-rectal surgeon to look for internal warts. She was also skeptical of the "common wart" diagnosis, and had the slides sent to the pathologist that she typically uses. This pathologist also said the slides looked like a common wart and not a condyloma. This was just by looking at the slides.
Does this make sense?
You are an unusual case in the way that this has been reported to you. It would be important to know what HPV testing you had, in order for you to rule out a genital HPV infection. If a pathologist placed your tissue on a slide and determined your diagnosis visually, then it can be a subjective interpretation. This is a histological report. The only way to identify HPV is with genetic testing—it is not usually done in men in the U.S. The only way for a pathologist to identify HPV strains is with HPV DNA testing, and low risk HPV 6 & 11 is not usually done in the U.S. To accurately isolate a specific strain it needs to be tested by PCR (polymerase chain reaction). It is a complicated test that amplifies your DNA and does DNA sequencing. The most accurate method would then compare the PCR results with the GenBank. Most labs in the US are not set up to do this type of testing, it is usually done at universities or research labs. If your testing was done by PCR and matched with the GenBank then you are assured your results are accurate. If your testing was done this way they would have told you the specific HPV strain (number) that you were positive for. I think I would ask your Dr. what type of testing was done (after all you probably paid for it and you might be able to see it on your bill). Common warts can have a different presentation under the microscope but it is not usually possible to identify genital HPV without a genetic test. Did they give you a specific number or did they generalize and say it looked like a common wart under the microscope so it must be 1, 2 or 4? It is possible to have mixed infection with more than one HPV type. If it was a genetic test, my thought is they would test for other low risk and high risk HPV’s not just 6, 11, 16 & 18. Accuracy is only as good as the test and the lab performing it.
I would follow up with your Dr. and ask some specific questions regarding your testing and/or request your records and your lab results and only then would you know your future risk. It is probable that your Dr. gave you the best advice he could based on the testing that was done—to me it just appears confusing. The testing for HPV in men at present is poor to non existent. I would want to know if the HPV test was a DNA test or histological test. Understanding your results is important.
I know you want to believe what you have been told; but it just does not make sense to me the way you have reported it. It is possible that some of the information I misinterpreted in the posting.
I would follow up with your Dr. and ask some specific questions regarding your testing and/or request your records and your lab results and only then would you know your future risk. It is probable that your Dr. gave you the best advice he could based on the testing that was done—to me it just appears confusing. The testing for HPV in men at present is poor to non existent. I would want to know if the HPV test was a DNA test or histological test. Understanding your results is important.
I know you want to believe what you have been told; but it just does not make sense to me the way you have reported it. It is possible that some of the information I misinterpreted in the posting.
Whoops -- I meant to post this in expert forum, but if anyone has any advice....
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