Warts/biopsy/etc

[fullofquestions81]

Hello thanks first off all for a great and helpful forum. Other answers have been very useful but I feel the need to make my own question since what my own doctor has said is a bit confusing.

The doctor is a dermatologist. Recently he identified some warts (flat warts) on my body, hands and feet. I'm not worried about this. But then I saw a few spots on my stomach, near the belly button, and asked the doctor if they were warts also. He didn't think so but agreed to freeze them with liquid nitrogen just so I wouldn't think about it.

I have now found some other small spots on my upper stomach and chest that look a lot like the warts that are on my hands/feet. Last time I went to the dermatoligst he said they could always biopsy any wart if I wanted. Now I am wondering, if the warts on my stomach and chest ARE indeed warts, should I have them biopsied to see what 'type' of HPV they are, in case they are the types that are sexually transmitted or related to genital warts? Would the biopsy even tell the 'type' of HPV or to find that out would it be something more extensive??

Or because of where they are, should I just ignore them or get them frozen and not worry about the biopsy?? I wuold rather do this since I feel like it would just create additional worry...but I also want to be a responsible person and 'do the right thing' in regard to sexual partners and so on. Again, if these are warts, they are on my stomach and chest, not genitals, so I'm hoping it's not ani ssue where I'd have to discuss with sex partners, etc...just to avoid that anxiety!

Thank you.

[Edward W Hook, MD]

Yes, I am talking about disclosure of genital HPV.  

Partner notification is discussed at this link written by Dr, Handsfield.
  http://www.medhelp.org/posts/STDs/hpv-QA/show/742564


EWH

[fullofquestions81]

--and if there is a particular link to the discussion of disclosure that you could include, that would be helpful. I am trying to search but not having too much luck.

[fullofquestions81]

Well, he's an excellent doctor, just perhaps not so used to dealing with anxiety issues. The small blemishes on my stomach he didn't think were warts; he mentioned some other things they 'could' be.

One final point--when you said you don't routinely counsel people to discuss genital HPV, you are referring to genital HPV in the form of genital warts as well?

[Edward W Hook, MD]

Many tests can be perfromed on biopsies, depending on just how much you want to spend.  Kowing what type of virus was present however is unlikey to change what you do.  As I said however, if these lesions are HPV they are not likely to be the type of virus that infects the genital tract.  

I agree with your inference that you deserve more information form your dermatologist about what this is however and that just making the lesions "go away" is not sufficent for you. If this dermatologist cannot provide the information you need, perhaps you should talk to another doctor.  EWH

[fullofquestions81]

Thank you doctor.
So you mean that a biopsy would say 'HPV or not,' but that's it...and in order to find out the exact strain it would mean a test beyond biopsy--perhaps the DNA test that is sometimes mentioned? Is that about right?

My dermatologist seems to think that simply hitting any spots with liquid nitrogen will put my mind at ease, when this is not really the case. I don't want to go down a rabbit hole of testing and testing and more testing. If it's unlikely that warts on chest or stomach are the same type as genital warts than I will just relax.

[Edward W Hook, MD]

Welcome to the Forum.  You are asking questions that you should be asking your dermatologist.  My suspicion is that the lesions you are describing are not warts but if they are not, the dermatologist should be offer you an alternate diagnosis.  

If they did turn out to be warts, they are most unlikely to be the types of warts that cause genital warts. There are over 130 different HPV types and different types seem to "like" to cause infections in different locations.  Thus warts occurring on the stomach and chest would be unlikely to cause infection of the genitals.  

A biopsy would tell you if these are warts or not and, if they are, if they are HPV or not. Typing however is typically rather expensive.  I'm not sure what you would do with typing data anyway.  

Even if you were to have genital HPV, we do not routinely recommend discussing this with all partners.  For all practical purposes nearly all (at least 85%) of sexually active persons have genital HPV although most persons are unaware that they do.  Most infections run their course without consequence.  This topic is extensively discussed in other responses which you can find by using the search function on the site.

I hope these comments are helpful. If I were you I would not worry.  I would ask the dermatologist for a diagnosis and go from there.  EWH