Aa
Uncertainty over genital warts
Hello Dr. Handsfield,
For background information about a previous thread we had, here is the link http://www.medhelp.org/posts/STDs/Am-I-or-my-girlfriend-at-risk/show/1516769?personal_page_id=2160702#post_6890709
I have noticed a tiny lesion on my penis. I started speculating if this was related to my oral sex encounter I received or to the genital wart I removed 3 years ago.
I decided to see a dermatologist. I explained to her that I thought I have a wart. She thought it is likely to be a wart and offered to freeze it. I asked if she is 100% sure it is a wart and she said the only way is to do a biopsy, which I refused. I decided not to freeze it and see my primary doctor who was the one who removed the wart I had 3 years ago. He said that it looks like a wart and thought he should freeze it but when I discussed it with him to ensure that he's 100% sure, he said he was not necessarily sure because it is very small and could be in its early stage but he thinks it may be one, but then asked me to wait and see if it grows and said that he'd rather be 95% sure than 75% it is one, as he thinks that freezing the penis skin a lot is not that good for the penis. He said to continue monitor it and if it grows in 1,2,or 3 months, come back and he'll freeze it.
My questions:
1- is there a way to be 100% certain it is a wart?
2- If it is a wart, could it be the same HPV strain that caused the wart I had 3 years ago to re-emerge, or could it be the oral sex I received from a different woman that caused a new strain?
3- Do you recommend freezing it just in case before it grows?
4- If it is not a wart, what could it be? Herpes would not be as subtle, right?
5-the 2 practitioners I saw could not confirm 100% it is a wart and just stated that "it is very likely to be one". It makes me more confused and I am also concerned to pass on any new HPV I have acquired through this one time oral encounter to my girlfriend.
Thank you
For background information about a previous thread we had, here is the link http://www.medhelp.org/posts/STDs/Am-I-or-my-girlfriend-at-risk/show/1516769?personal_page_id=2160702#post_6890709
I have noticed a tiny lesion on my penis. I started speculating if this was related to my oral sex encounter I received or to the genital wart I removed 3 years ago.
I decided to see a dermatologist. I explained to her that I thought I have a wart. She thought it is likely to be a wart and offered to freeze it. I asked if she is 100% sure it is a wart and she said the only way is to do a biopsy, which I refused. I decided not to freeze it and see my primary doctor who was the one who removed the wart I had 3 years ago. He said that it looks like a wart and thought he should freeze it but when I discussed it with him to ensure that he's 100% sure, he said he was not necessarily sure because it is very small and could be in its early stage but he thinks it may be one, but then asked me to wait and see if it grows and said that he'd rather be 95% sure than 75% it is one, as he thinks that freezing the penis skin a lot is not that good for the penis. He said to continue monitor it and if it grows in 1,2,or 3 months, come back and he'll freeze it.
My questions:
1- is there a way to be 100% certain it is a wart?
2- If it is a wart, could it be the same HPV strain that caused the wart I had 3 years ago to re-emerge, or could it be the oral sex I received from a different woman that caused a new strain?
3- Do you recommend freezing it just in case before it grows?
4- If it is not a wart, what could it be? Herpes would not be as subtle, right?
5-the 2 practitioners I saw could not confirm 100% it is a wart and just stated that "it is very likely to be one". It makes me more confused and I am also concerned to pass on any new HPV I have acquired through this one time oral encounter to my girlfriend.
Thank you
MEDICAL PROFESSIONAL
Welcome back to the Forum. As you probably know, Dr. Handsfield and I share the forum. You got me this time. FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.
In addition, this question could have been asked as a follow-up to your earlier thread since it is related to your earlier questions. I will address them here however rather than referring you back to Dr. Handsfield. At that time you can follow up with him or me but not both of us. If you prefer to continue with Dr. Handsfield, please refer to this interaction.
HPV infections an warts can be confusing. This is because the field is evolving rapidly and new knowledge is accruing regularly. It sounds like your doctors, as well as Dr. Handsfield have all given you good advice which is consistent with each other's advice.
1. There are many processes, most of which are not infectious, which can cause the sorts of lesions you describe. In addition, when a person has their concerns heightened so that they start to inspect themselves closely they very often detect new bumps which may or may not have been present for some time. Both the dermatologist and your regular doctor indicated, the only way to be sure if this lesions is a wart is with biopsy with testing. This is both expensive and people, in general, do not like to have their genitals biopsied if not needed. The plan of watchful waiting as your regular Dr. has suggested is a reasonable one as well.
2. Unlikely to be a recurrence after 3 years. If a wart is going to recur it typically does so within 3 months of treatment.
3. Freezing it would have been reasonable. Freezing is destructive therapy which removes lesions of all sorts (warts and other non-infectious dermatologic processes) allowing normal skin to grow back into where the skin has been frozen. If you want the lesion to be gone, freezing it sooner than later will increase chances of getting rid of it easily, at the possible cost of not knowing 100% what it was. That really is not a big deal however, at least in my mind since if it is HPV you still will not know where or from whom you got it (and as Dr. Handsfield has said, it is most unlikely that it is from your receipt of roal sex)
4. See above. Not herpes. The list is long and most things that cause skin irregularities are not infectious.
5. See my comments above. Also refer to Dr. Handsfield’s earlier comments about transmission. This is not something to spend a lot of time worrying about., EWH
In addition, this question could have been asked as a follow-up to your earlier thread since it is related to your earlier questions. I will address them here however rather than referring you back to Dr. Handsfield. At that time you can follow up with him or me but not both of us. If you prefer to continue with Dr. Handsfield, please refer to this interaction.
HPV infections an warts can be confusing. This is because the field is evolving rapidly and new knowledge is accruing regularly. It sounds like your doctors, as well as Dr. Handsfield have all given you good advice which is consistent with each other's advice.
1. There are many processes, most of which are not infectious, which can cause the sorts of lesions you describe. In addition, when a person has their concerns heightened so that they start to inspect themselves closely they very often detect new bumps which may or may not have been present for some time. Both the dermatologist and your regular doctor indicated, the only way to be sure if this lesions is a wart is with biopsy with testing. This is both expensive and people, in general, do not like to have their genitals biopsied if not needed. The plan of watchful waiting as your regular Dr. has suggested is a reasonable one as well.
2. Unlikely to be a recurrence after 3 years. If a wart is going to recur it typically does so within 3 months of treatment.
3. Freezing it would have been reasonable. Freezing is destructive therapy which removes lesions of all sorts (warts and other non-infectious dermatologic processes) allowing normal skin to grow back into where the skin has been frozen. If you want the lesion to be gone, freezing it sooner than later will increase chances of getting rid of it easily, at the possible cost of not knowing 100% what it was. That really is not a big deal however, at least in my mind since if it is HPV you still will not know where or from whom you got it (and as Dr. Handsfield has said, it is most unlikely that it is from your receipt of roal sex)
4. See above. Not herpes. The list is long and most things that cause skin irregularities are not infectious.
5. See my comments above. Also refer to Dr. Handsfield’s earlier comments about transmission. This is not something to spend a lot of time worrying about., EWH
MEDICAL PROFESSIONAL
Great question but also one that only you can answer. In general I am less adamant about disclosure of HPV at all than I am about other STDs, reasoning that HPV is so very common that one should typically anticipate that they have been exposed rather than hoping or assuming that they had not been which, for anyone who has had sex with two or more partners, is unrealistic. At the same time disclosure is the appropriate course of action for anyone who may have exposed a sex partner to an STD.
In your own case, the facts are that you MAY have exposed a partner to a wart, if that is what it is. In addition, we believe that transmission/acquisition is both less frequent than with genital exposures and less likely to lead to adverse consequences. I think such a message is appropriate. It is however, of course, you call and may be influenced by the maturity of your partner and their ability to deal with these facts.
Hope these comments are some help. EWH
p.s. Please remember, even if the lesion you recently became aware of gets larger, it may or may not be a wart. It may be easier to examine when larger but a biopsy is the only real way to KNOW. EWH
In your own case, the facts are that you MAY have exposed a partner to a wart, if that is what it is. In addition, we believe that transmission/acquisition is both less frequent than with genital exposures and less likely to lead to adverse consequences. I think such a message is appropriate. It is however, of course, you call and may be influenced by the maturity of your partner and their ability to deal with these facts.
Hope these comments are some help. EWH
p.s. Please remember, even if the lesion you recently became aware of gets larger, it may or may not be a wart. It may be easier to examine when larger but a biopsy is the only real way to KNOW. EWH
MEDICAL PROFESSIONAL
You have interpreeted my comments well.
So could this be a wart? Possibly. For reasons no one understands, while most warts appear within a few weeks/months of exposure a small proportion can "pop up years later. You, or your GF may have had HPV for some time, IF this is a wart at all.
As far as contact with your GF is concerned, IF this is a wart, she's likely already been exposed. I would not worry. After all, remember, 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. The figure for men is less well studied but similar.
I don't mean to sound cavalier about this but warts are just not that big a deal, particularly if you seek care should lesions appear and if your GF gets her regualrly recommene PAP smears.
EWH
So could this be a wart? Possibly. For reasons no one understands, while most warts appear within a few weeks/months of exposure a small proportion can "pop up years later. You, or your GF may have had HPV for some time, IF this is a wart at all.
As far as contact with your GF is concerned, IF this is a wart, she's likely already been exposed. I would not worry. After all, remember, 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. The figure for men is less well studied but similar.
I don't mean to sound cavalier about this but warts are just not that big a deal, particularly if you seek care should lesions appear and if your GF gets her regualrly recommene PAP smears.
EWH
MEDICAL PROFESSIONAL
No, I would not venture a guess as to the percentage, there are too many uncertainties. If I did, I, just like eanyone who provided you an answer based on the information available, would be guessing. Suffice it to say this visk is very low. EWH
Thank you again,
Just to clarify regarding what you said " In addition, we believe that transmission/acquisition is both less frequent than with genital exposures and less likely to lead to adverse consequences." Do you mean oral-to-genital transmission/acquisition is less frequent and does not lead to the same consequences?
I'd hate to assume it is a wart and even if it was, given the fact that oral-to-genital transmission is very low, would also hate to have the person think they acquired HPV (I guess it would be the oral type) if that is not the case.
I guess my question, given the following facts:
- it may or may not be a wart
- oral sex transmission from genital to mouth/throat rates are very low
What are the chances that the person who gave me oral sex caught oral HPV? Is there a rough quantitative percentage you think is reasonable? I just don't want to cause more damage to a person, but at the same time, I don't want this person to panic for something not worth panicking for or something that it is more likely she did not catch?
Your help is appreciated
Just to clarify regarding what you said " In addition, we believe that transmission/acquisition is both less frequent than with genital exposures and less likely to lead to adverse consequences." Do you mean oral-to-genital transmission/acquisition is less frequent and does not lead to the same consequences?
I'd hate to assume it is a wart and even if it was, given the fact that oral-to-genital transmission is very low, would also hate to have the person think they acquired HPV (I guess it would be the oral type) if that is not the case.
I guess my question, given the following facts:
- it may or may not be a wart
- oral sex transmission from genital to mouth/throat rates are very low
What are the chances that the person who gave me oral sex caught oral HPV? Is there a rough quantitative percentage you think is reasonable? I just don't want to cause more damage to a person, but at the same time, I don't want this person to panic for something not worth panicking for or something that it is more likely she did not catch?
Your help is appreciated
Thank you,
I wonder if stress plays a role if having dormant warts for years pop up again,or maybe as you said, this could a result of over-examination
At any rate, I think the only thing I could so at this point is wait and see if this lesion gets bigger and if it becomes clearer whether it is a wart or not, and then act upon it and have a doctor freeze (if it ends up being one).
On final question I have. Whether I decide to freeze it now, not being certain it is a wart, or whether I do it later if I become more certain about it, am I ethically bound to notify the person who gave me oral sex 2 months about it? I know it is less likely that HPV gets transmitted though oral sex encounters, but what is your opinion on this? and for the sake of being more informed, would it be different (in terms of notification) should we had vaginal sex?
Thank you,
I wonder if stress plays a role if having dormant warts for years pop up again,or maybe as you said, this could a result of over-examination
At any rate, I think the only thing I could so at this point is wait and see if this lesion gets bigger and if it becomes clearer whether it is a wart or not, and then act upon it and have a doctor freeze (if it ends up being one).
On final question I have. Whether I decide to freeze it now, not being certain it is a wart, or whether I do it later if I become more certain about it, am I ethically bound to notify the person who gave me oral sex 2 months about it? I know it is less likely that HPV gets transmitted though oral sex encounters, but what is your opinion on this? and for the sake of being more informed, would it be different (in terms of notification) should we had vaginal sex?
Thank you,
Thank you doctor, I appreciate your response and I trust your opinion and that of Dr. H.
Just to make sure I understand. In your opinion,if it is unlikely that it is a wart from the same strain I had 3 years ago, and at the same time, it is unlikely that HPV gets transmitted through oral sex, then my conclusive thinking is that may not be a wart since the only sexual encounters I have had in the past 3 years is with my girlfriend (oral and vaginal) and this one-time oral sex encounter with this woman 2 months ago.
But if I reach this conclusion, it does conflict with the opinion of the 2 doctors I saw, who seem to think that it is very likely (to use their languages) that is is a wart, although could not confirm it, "75% sure" according to my primary doctor. The thing that is driving me crazy is how could I have got it?
Do you think I should wait and see and resume my sexual encounter with my girlfriend, who does not know about this oral sex encounter. I just don't want to pass on any new STD to her...
Thank you again,
Just to make sure I understand. In your opinion,if it is unlikely that it is a wart from the same strain I had 3 years ago, and at the same time, it is unlikely that HPV gets transmitted through oral sex, then my conclusive thinking is that may not be a wart since the only sexual encounters I have had in the past 3 years is with my girlfriend (oral and vaginal) and this one-time oral sex encounter with this woman 2 months ago.
But if I reach this conclusion, it does conflict with the opinion of the 2 doctors I saw, who seem to think that it is very likely (to use their languages) that is is a wart, although could not confirm it, "75% sure" according to my primary doctor. The thing that is driving me crazy is how could I have got it?
Do you think I should wait and see and resume my sexual encounter with my girlfriend, who does not know about this oral sex encounter. I just don't want to pass on any new STD to her...
Thank you again,
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
