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Avatar universal

hpv as causative agent

This is probably an unusual question on this forum, but here it is.  I am a 33 year old Caucasian male and just received a confirmed biopsy of squamous cell carcinoma in situ (Bowen's disease).  The lesion was in my right inguinal genital area close to the "v" line and about an inch below my waistline.  Basically, it was closer to my waist than my penile shaft.  Ten years ago at the age of 23 I noticed a brown nevus in this same location and blew it off because it appeared similar to other nevi on other areas of my body as I am fair skinned.  Just recently I noticed that it looked bigger from ten years ago.  Being anxiety driven about melanoma since it looked like a nevus, I went to my dermatologist for the biopsy.  He removed the nevus and the biopsy came back as mentioned above.  He prescribed Aldara cream for twelve days and said I caught it early in the in situ stage.  My questions are:  1.  What is the chance that this lesion was HPV related?  I have never had any lesions or warts of any kind in this area.  2.  If not HPV, what other reasons as I am a non-smoker, maybe genetic predisposition? 3.  If this is HPV related, is this a common area for HPV lesion about an inch below waistline close to right v fold?  4.  If this is HPV related, what is my chance of recurrence since the lesion had been present for ten years and if I have immunity from this first lesion now.  5.  Lastly, is this a concern or does it sound like I have caught it and treated it early as long as I do routine maintenance every three or six months to catch a new recurrence?  Lastly, I really appreciate the work both of you gentlemen do as it definitely relieves anxiety and is very educational.

Regards,

Tony T
3 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the STD forum.  I'll try to help, but you should understand that STD specialists do not provide care for Bowen's papulosis and typically are not experts in it -- at least not in the US (the situation is often different in Europe and elsewhere, where dermatology and STD care are more closely aligned with one another).  If I ever had a suspected case, I would refer it to a dermatologist.  I will answer your questions as best I can, but your dermatologist probably will have more accurate information than we do on this forum.

1) Bowen's disease is definitely caused by HPV. My understanding is that it often happens around rather than direclty on the genitals -- a difference compared with other HPV lesions, like typical genital warts.

2) It's HPV.  I can't say anything about cofactors that might have an influence in addition to HPV per se.

3) To my knowledge, this is not an atypical location.  See no. 1.

4) I cannot say anything about the recurrence potential for Bowen's disease.  Your dermatologist knows.

5) Again, your dermatologist knows the answer; I do not.

Thanks for the thanks, but sorry that I couldn't be of greater help.  Best wishes--

HHH, MD
Avatar universal
Since this is hpv it is most likely hpv 16 then?  Do I have to worry about a penile lesion ever occurring since this lesion was in the pubic area?  Since this was my only lesion does it make sense that a recurrence would come back only in the same place?  Will I be considered cured and immune after resolution as is the case with warts?  Should my wife worry or just have her annual paps?  Sorry for the ?'s.  This will put my mind to ease and end this thread.  Thanks again
239123 tn?1267651214
MEDICAL PROFESSIONAL
I believe BP is usually caused by HPV-16.  Once it's gone, probably you'll have no problem in the future, but I cannot say the risk of recurrence is zero or where it might occur.  Once again, your dermatologist knows as much or more about this aspect than I do.

Your wife undoubtedly has already been infected with the same HPV strain you had, probably many years ago.  Assuming her pap smears have been normal over the years, it is likely her immune system has cleared it, i.e. she no longer is infected and will never have any problem with it.  However, her regular reproductive health care provider should know about your diagnosis, then your wife should follow his or her advice -- which probably will include regular pap smears, although not necessarily as often as once a year, if her past pap smears have been normal.

Don't make this a bigger deal than it is.  You are infected with a relatively minor virus.  Even with the high risk (cancer causing) HPV strains, the vast majority of infections do not lead to cancer.  With proper medical management -- as advised by your dermatologist and your wife's ObG -- you'll never have a serious problem.
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