Follow up with Dr E Hook

[sarahgill70]

Dear Dr Hook

I put forward my history to you last year: http://www.medhelp.org/posts/show/414905.
I went to a private STD clinic that month & young doctor & nurse saw to the bump. They said it was a wart, I was devastated. However, it took them a while to decide this even after examination. Seemed like they were unsure and I felt they rushed me out to be ready for their next client. I asked for biopsy to be sure & they said it was too small. The so called wart was frozen & within 3 days it had blackened & fell off. There was no soreness, no mark, scar or anything. The skin was normal. I have not had any bump develop since, it has been a year. I want to mention the 9 years turmoil I sufferred I also had bacterial vaginosis. This was treated same time last year & because of its long term duration it really ruined my skin down below but that is healed.

My questions are baring in mind  i am still not sexually active in last 8 years :

1 Is it likely I don't have hpv warts virus  and it was something else?

2 Could I have been misdiagnosed on that one little bump that even they looked unsure of? (they took the topic of warts lightly and told me get on with my life - hard to do when you are an asian girl with cultural pressures to get married)

3 Am I at risk of cervical cancer? wouldn't it have developed by now and shown signs? I have no discharge and no bleeding in between periods. I have not had sex for years so I cannot tell if sex is painful or if I will bleed after sex)

4. could BV have messed with my skin to cause these bumps and now I am BV free there are none that I can see?

for 9 years I am living in such a confused painful state because I don't now if I have hpv or not. I have been putting off my marriage for fear that if I do have it I will transmit it to my fiance. I want a normal life Dr Hook. I am still living in the unknown and it is killing me, has killed the best years of my youth and now whats left of my future.

[sarahgill70]

I highly respect yours and Dr Hook's expertise and knowledge. I cannot thank you enough for your honest advice and it has alleviated almost all of the burden I have been carrying for many years. I cried in relief for the first time properly in years when I read your response. Having no one to talk about it with as it is so taboo in my culture I have never been able to share my problem. I have never had bumps that have grown more in size after inspection, or in clusters or in a line where scratching is thought to spread the infection etc. The last fleshy bump had a slight concave appearance to it - just like the shape of a magnified red blood cell. The STD doc asked if i was itchy below I said yes and her expression told me 'it was the warts causing the itch' however, for me it was BV (i know itching is not typical of BV but can be). As soon as I became BV free my itchiness and dampness left overnight. I mention this becasue the STD doc may have taken all these things into account and then decided to say its warts. Where as for me, that bump I presented with had no itch or irritation. As for sexual activity with anyone, in ALL its forms, there has been completely none of it in over 8 years. My fiance is abroad and intimacy will occur after marriage.

I will speak to my healthcare provider about Gardasil - I hope I am eligible at my age (33) I am willing to pay anything for it. Would it be useful if my fiance got the vaccine too, assuming he agreed?

And just out of curiousity, as I looked this up alot when I used to be anxious but didnt find anything, but for others reading this, how far do you think, realistically, therapeautic vaccines will be available for the GW virus?

I thank you for all your help Dr - you have no idea howyouhave helped.

[H. Hunter Handsfield, M.D.]

There is a software glitch that I have brought to the attention of MedHelp IT folks.  The link works if you paste it into a browser without the period at the end.  Presumably they'll be able to fix it.

[H. Hunter Handsfield, M.D.]

Greetings.  Dr. Hook and I share the forum and take questions interchangeably and pretty much randomly.  But there is almost never signficant disagreement between us; our careers have been professionally and personally linked for 3 decades.  When there is uncertainty, either of us asks the other to comment.

That an STD experienced doctor and nurse thought your lesions were warts certainly has to be taken seriously.  But your description shows they were uncertain, and visual diagnosis of warts is not a precise science by any means.  Dr. Hook and I and other very experienced experts often are not sure.  When in doubt, lesions are often treated as warts to be safe.  The other option is to biopsy the lesion for microscopic examination, but that takes time and money and is more painful than just treating.  Many skin lesions or bumps other than warts are damaged or destroyed by many of the treatments used against warts, so the fact that the lesion cleared up doesn't help one way or the other.

Considering both the detailed description in you thread last year plus the information here, especially the lack of sexual exposure in recent years, it seems very unlikely you had genital warts, despite the clinic's diagnosis.  It is very rare for warts to persist more than a few months; they go away on their own without treatment and it rarely takes more than a year.

To the specific questions:

1,2) See above.  Whether or not the lesion was a wart, at this point you can be sure you are disease free.  From a medical perspective, there is no reason not to get married or otherwise become sexually active.

3) Different HPV types cause warts versus cancer.  Even if the problem was a wart, it does not imply an increased risk of future cervical cancer.  Of course, if you have ever been sexually active, it is conceivable you have (or have had) infection with a cancer-causing HPV type; those types actually are more common than the wart-causing types.  But this applies to every sexually active human being, and yet the vast majority never get cervical cancer.  This really should not be a cause of worry for you.

4) BV does not interfere with recognition or treatment of warts or other HPV infections.

You are letting an impersonal virus control your life to an unwarranted extent.  Getting genital HPV is a normal consequence of human sexuality; we all (at least 80-90% of human beings) have it at one time or another, and the vast majority of infections are asymptomatic and harmless.  It is never appropriate to alter one's sexual lifestyle for fear of HPV.  If you follow standard pap smear recommendations, you will be completely protected from cervical cancer.  Further, you can eliminate the risk of infection with the wart-causing HPV types and the 2 types that cause most cases of cancer by getting immunized with Gardasil, the HPV vaccine.  Ask your personal health care provider about it.

If despite this advice you remain obsessed with HPV and its mostly nonexistant health risks, please discuss your feelings frankly with your personal physician.  Your thinking about this really isn't normal and it's obvious having a negative effect on your health and happiness.  Counseling might be in order.  I suggest it from compassion, not criticism.  And I guarantee Dr. Hook would agree.

Best wishes--  HHH, MD

[sarahgill70]

I apologise but the above link redirects you to someone else's post for some reason. My post of history to you originally was made on Jan 25, 2008 11:39AM, it is on page 3 of genital warts archive with the title 'Im at my wits end....please help' your then responses are also there.