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HPV? Something else? Advice going forward?
Hello,
For starters, thank you very much for listening.
I am a 29 year old male, and I have been in a monogamous relationship for 3 years (we married 4 months ago). About 3 months ago I noticed a few small bumps on the shaft of my penis. Neither my urologist nor dermatologist could make a visual diagnosis, but a microscopic biopsy came back positive for HPV. However, a DNA test of the same biopsied piece of skin came back negative.
Still, my dermatologist believs this is HPV and I have been undergoing freezing treatment for about 3 months. The small bumps on the shaft seem to be getting better after each treatment (meaning fewer return), but a new development has been an outbreak of many small, reddish bumps on the underside of the penis. The dermatologist at first thought it was just irritation, but now believes it is HPV, even though it looks quite different than the few other scattered bumps I have, so she froze this area last week as well.
I have also been experiencing a dry, reddened scrotum for some time now and the penis itself seems red and irritated often. I should also mention that I was diagnosed with a rather large varicocele about 2 years ago.
My wife and I are confused, scared and saddened by this entire ordeal. Can you help with the following questions?
1. Does this sound like HPV? Is it common for the microscopic to say one thing and the DNA test to say another?
2. Do you know of any link between a varicocele in the scrotum and skin conditions in the genital area? (I have read about a potential link between varicocele and angiokeratoma and Fordyce spots, but the literature is sparse).
3. Lastly, let’s assume this is HPV. How should my wife and I handle sex? We've had unprotected sex for 3 years, but have now started using condoms. Should we continue to use condoms until all signs of this are gone, and continue for a few months after that, or do the 3 years of unprotected sex mean she already has anything I had anyway?
For starters, thank you very much for listening.
I am a 29 year old male, and I have been in a monogamous relationship for 3 years (we married 4 months ago). About 3 months ago I noticed a few small bumps on the shaft of my penis. Neither my urologist nor dermatologist could make a visual diagnosis, but a microscopic biopsy came back positive for HPV. However, a DNA test of the same biopsied piece of skin came back negative.
Still, my dermatologist believs this is HPV and I have been undergoing freezing treatment for about 3 months. The small bumps on the shaft seem to be getting better after each treatment (meaning fewer return), but a new development has been an outbreak of many small, reddish bumps on the underside of the penis. The dermatologist at first thought it was just irritation, but now believes it is HPV, even though it looks quite different than the few other scattered bumps I have, so she froze this area last week as well.
I have also been experiencing a dry, reddened scrotum for some time now and the penis itself seems red and irritated often. I should also mention that I was diagnosed with a rather large varicocele about 2 years ago.
My wife and I are confused, scared and saddened by this entire ordeal. Can you help with the following questions?
1. Does this sound like HPV? Is it common for the microscopic to say one thing and the DNA test to say another?
2. Do you know of any link between a varicocele in the scrotum and skin conditions in the genital area? (I have read about a potential link between varicocele and angiokeratoma and Fordyce spots, but the literature is sparse).
3. Lastly, let’s assume this is HPV. How should my wife and I handle sex? We've had unprotected sex for 3 years, but have now started using condoms. Should we continue to use condoms until all signs of this are gone, and continue for a few months after that, or do the 3 years of unprotected sex mean she already has anything I had anyway?
MEDICAL PROFESSIONAL
Sorry, I don't know the answers to your questions. The best science can say at this point is that what you are experiencing, although not usual for genital warts and other HPV infecitons, happens sometimes; and usually no explanation can be found. If there is an explanation based on the body's immune system, it isn't known.
Thank you, that is good information and again very helpful.
Last question (I promise):
I had been taking Oxycodone for about a month for a back injury when the first signs of this showed up. I have since read that opioids can depress immune systems.
Let's assume for the sake of argument that is what happened here- I contracted HPV years ago, and this immune depressing event caused it to show up. In cases like that (eg, first appearance coming during pregnancy, etc.) does this first appearance give your body it's first real chance to fight it and now I can start eradicating, or does this mean I will likely deal with this every time my immune system "takes a hit"?
Said another way,, I'm almost certain I got this years ago, so does the late appearance mean it's here for good since my body didn't get rid of it over those years? Or is it just now going to start to try and get rid of it?
I know you can't answer definitvely, just curious about the way the infection works.
Thank you.
Last question (I promise):
I had been taking Oxycodone for about a month for a back injury when the first signs of this showed up. I have since read that opioids can depress immune systems.
Let's assume for the sake of argument that is what happened here- I contracted HPV years ago, and this immune depressing event caused it to show up. In cases like that (eg, first appearance coming during pregnancy, etc.) does this first appearance give your body it's first real chance to fight it and now I can start eradicating, or does this mean I will likely deal with this every time my immune system "takes a hit"?
Said another way,, I'm almost certain I got this years ago, so does the late appearance mean it's here for good since my body didn't get rid of it over those years? Or is it just now going to start to try and get rid of it?
I know you can't answer definitvely, just curious about the way the infection works.
Thank you.
MEDICAL PROFESSIONAL
The atypicality I meant was late (re)appearance of warts. I assumed you had not been at risk for new infection for several months or years. Having genital warts despite small numbers of sex partners is not at all unusual. Certainly the risk is highest in those with more partners, but your and your wife's sexual histories are not unusual with respect to warts.
People with damanged immunity sometimes have increased problems with warrts, but this mostly occurs in people who are obviously ill due to their immunity problem (overt AIDS, advanced cancer, etc); if you generally feel well, there should be no serious worries about it; the large majority of people in situations like yours have no underlying health problem. You might discuss this with your dermatologist -- but if he suspected anything along those lines, no doubt he would have told you.
People with damanged immunity sometimes have increased problems with warrts, but this mostly occurs in people who are obviously ill due to their immunity problem (overt AIDS, advanced cancer, etc); if you generally feel well, there should be no serious worries about it; the large majority of people in situations like yours have no underlying health problem. You might discuss this with your dermatologist -- but if he suspected anything along those lines, no doubt he would have told you.
Dr. Handsfield,
Thank you very much for such a detailed and thorough answer.
Not sure if I'm allowed a followup question, but
one thing about all of this still perplexes me:
I've had very few sexual partners before my wife, and none in the past 5 years. She too had only a couple of partners, and she has never shown any signs of hpv. Perhaps this is what you were referring too when you said "atypical".
Does the fact that this pops up now suggest I
need to worry about my immune system at all? I just cannot fathom where this came from and the timing is peculiar.
Thank you.
Thank you very much for such a detailed and thorough answer.
Not sure if I'm allowed a followup question, but
one thing about all of this still perplexes me:
I've had very few sexual partners before my wife, and none in the past 5 years. She too had only a couple of partners, and she has never shown any signs of hpv. Perhaps this is what you were referring too when you said "atypical".
Does the fact that this pops up now suggest I
need to worry about my immune system at all? I just cannot fathom where this came from and the timing is peculiar.
Thank you.
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help, but STD experts are really not the right source for questions 1 and 2, which are much more in the domain of dermatologists than STD, infectious diseases, or public health experts.
1) A dermalogist's diagnosis of genital warts/HPV is highly reliable, especially with a biopsy. I cannot say why the DNA test was negative, except that no test is perfect. Your dermatologist is in a better position to answer this than I am.
2) To my knowledge there is no known link, and from a biological perspective I see no reason to suspect one. However, I was unaware of any link between varicocele and the other conditions you mention. As I said above, this also is a question for your dermatologist.
3) OK, this question I can answer! Your wife undoubtedly has already been infected with the HPV strain causing your warts and at this time condoms are pointless. Since she hasn't had noticeable warts, most likely she won't get them; probably her immune system has long since eradicated her infection and she probably is now immune to this particular strain. If she does develop visible warts, she should visit her primary care and/or reproductive health doctor. Assuming no apparent warts, the next time she has a routine visit, she should tell the doc about your warts, then follow his or her advice. Most likely that will simply mean reemphasizing the importance of routine yearly pap smears, which she should do anyway.
This is a somewhat atypical situation and undoubtedly surprising to you. But it's not all that rare and it carries few if any important health implications for either you or your wife. You should view this as an unpleasant inconvenience, nothing more.
Regards-- HHH, MD
1) A dermalogist's diagnosis of genital warts/HPV is highly reliable, especially with a biopsy. I cannot say why the DNA test was negative, except that no test is perfect. Your dermatologist is in a better position to answer this than I am.
2) To my knowledge there is no known link, and from a biological perspective I see no reason to suspect one. However, I was unaware of any link between varicocele and the other conditions you mention. As I said above, this also is a question for your dermatologist.
3) OK, this question I can answer! Your wife undoubtedly has already been infected with the HPV strain causing your warts and at this time condoms are pointless. Since she hasn't had noticeable warts, most likely she won't get them; probably her immune system has long since eradicated her infection and she probably is now immune to this particular strain. If she does develop visible warts, she should visit her primary care and/or reproductive health doctor. Assuming no apparent warts, the next time she has a routine visit, she should tell the doc about your warts, then follow his or her advice. Most likely that will simply mean reemphasizing the importance of routine yearly pap smears, which she should do anyway.
This is a somewhat atypical situation and undoubtedly surprising to you. But it's not all that rare and it carries few if any important health implications for either you or your wife. You should view this as an unpleasant inconvenience, nothing more.
Regards-- HHH, MD
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