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HPV Questions (confused)
Hello Doctor,
I'll preface my questions with the understanding that no answers are an actual diagnosis but rather an opinion, but I am looking for your opinion as I am extremely confused and tired at this point.
In 2010 I had a single bump on my penis shaft biopsied for HPV which came back negative. I reviewed the pathology report with my dermatologist. The diagnosis was a verrucous keratosis sebborheic in nature and not genital warts. The biopsy itself removed the growth and no follow up treatment was necessary. I had no issues from that time on.
Early last month I noticed a small (maybe 2mm) growth nearly identical to the one in 2010, and virtually in the same exact spot. I saw a new dermatologist who scraped the area for biopsy. I received a call saying the biopsy was "normal", however during my follow up visit the derm said it was a Condyloma. I glanced at the pathology report, and it was nothing like the one in 2010 lacking a description of the diagnosis etc. My derm told me that I could have transmitted a wart from my or someone else's hand to genitals. He also wants me to come back to use a solution to "draw out" any additional warts naked to the eye. Here are my questions, as I am drained and confused.
1.) Can a keratosis reoccur? In this case in the same area?
2.) I have read that you cannot transmit a wart from hand to genitals etc. however I am being told otherwise by my derm. Can you weigh in?
3.) Outside of an acetic acid test, what else would be used to "draw out" warts?
4.) Could the biopsy be wrong or suggestive?
Dr., sorry to say this, but with all of the differing information I have very little confidence in a diagnosis. I see this as one of two ways. Either I was misdiagnosed the first time or this time as I have a hard time believing a singular spot in the same location is a new infection and coincidental. Perhaps I am wrong though. I am very anxious over this and greatly value your opinion! Thank you in advance!
I'll preface my questions with the understanding that no answers are an actual diagnosis but rather an opinion, but I am looking for your opinion as I am extremely confused and tired at this point.
In 2010 I had a single bump on my penis shaft biopsied for HPV which came back negative. I reviewed the pathology report with my dermatologist. The diagnosis was a verrucous keratosis sebborheic in nature and not genital warts. The biopsy itself removed the growth and no follow up treatment was necessary. I had no issues from that time on.
Early last month I noticed a small (maybe 2mm) growth nearly identical to the one in 2010, and virtually in the same exact spot. I saw a new dermatologist who scraped the area for biopsy. I received a call saying the biopsy was "normal", however during my follow up visit the derm said it was a Condyloma. I glanced at the pathology report, and it was nothing like the one in 2010 lacking a description of the diagnosis etc. My derm told me that I could have transmitted a wart from my or someone else's hand to genitals. He also wants me to come back to use a solution to "draw out" any additional warts naked to the eye. Here are my questions, as I am drained and confused.
1.) Can a keratosis reoccur? In this case in the same area?
2.) I have read that you cannot transmit a wart from hand to genitals etc. however I am being told otherwise by my derm. Can you weigh in?
3.) Outside of an acetic acid test, what else would be used to "draw out" warts?
4.) Could the biopsy be wrong or suggestive?
Dr., sorry to say this, but with all of the differing information I have very little confidence in a diagnosis. I see this as one of two ways. Either I was misdiagnosed the first time or this time as I have a hard time believing a singular spot in the same location is a new infection and coincidental. Perhaps I am wrong though. I am very anxious over this and greatly value your opinion! Thank you in advance!
MEDICAL PROFESSIONAL
Thanks for the thanks. Glad to have helped.
Dr., Handsfield, I can't thank you enough for your time to give your perspective. To answer your question, I am 29 and was told although not common, that sebborheic keratoses can and do occur. I am fair skinned and have plenty of moles so at the time it seemed feasible. Something just isn't adding up, and I understand that either way in the big picture this is not a huge deal, but as it stands, this adds stress and confusion to disclosure etc. In the 2 and a half years since the spot first showed up until present, neither of my two partners in that time frame developed any visual symptoms. I obviously want to be responsible, so I guess I will explain this whole situation as best as I can when the opportunity presents itself to the next person.
Anyhow, thanks again for your time and thorough discussion. I greatly appreciate it as I am sure everyone else does!
Anyhow, thanks again for your time and thorough discussion. I greatly appreciate it as I am sure everyone else does!
MEDICAL PROFESSIONAL
Welcome to the forum and thanks for your question. However, I'm not sure how much I can help. Your questions would be better answered by a dermatologist than an STD specialist.
I'm curious about your age. Seborrheic keratoses are age associated; my understanding (remembering back to my rudimentary dermatology training more than 30 years ago) is that they are primarily seen in older persons -- in whom gential warts are rare.
To your specific questions:
1) This is definitely something to ask your dermatologist. I don't know the frequency with which seborrheic keratosis may recur.
2) I guess I'll just have to disagree with your dermatologist. The evidence against hand-to-genital HPV transmission (and vice versa) is strong: different HPV types cause the large majority of genital versus hand warts. If such transmission could occur, then genital warts due to hand types shoudl be common, as should genital types causing hand warts. But this rarely occurs.
3) Although you can find websites that promote acetic acid testing to identify HPV-infected tissues, in fact this is a terrible way to diagnose HPV lesions. We never use it in my STD clinic, and I recommend against anybody ever trying it. HPV infected tissues often don't turn white, and many white changes are not due to HPV. The only legitimate purpose for this test is in helping gynecologists decide exactly where to biopsy a woman's cervix. And there are no other tests either that would "draw out" HPV.
4) I would not think a biopsy would be inconclusive. On the other hand, I agree with your reasoning: it is very peculiar that a recurrence of a warty lesion in exactly the same spot would be due to an entirely different diagnoses. You should discuss this with your dermatologist. In doing so, I would suggest that the current pathologist be sent the slides or tissue from your earlier biopsy, if they were retained in the lab. (Most pathology labs hold on to slides, if not tissues, for many years.) Examining the two specimens side by side might help determine which diagnosis, or perhaps both, was accurate.
I hope this has helped with perspective, if not definitive answers. Best regards-- HHH, MD
I'm curious about your age. Seborrheic keratoses are age associated; my understanding (remembering back to my rudimentary dermatology training more than 30 years ago) is that they are primarily seen in older persons -- in whom gential warts are rare.
To your specific questions:
1) This is definitely something to ask your dermatologist. I don't know the frequency with which seborrheic keratosis may recur.
2) I guess I'll just have to disagree with your dermatologist. The evidence against hand-to-genital HPV transmission (and vice versa) is strong: different HPV types cause the large majority of genital versus hand warts. If such transmission could occur, then genital warts due to hand types shoudl be common, as should genital types causing hand warts. But this rarely occurs.
3) Although you can find websites that promote acetic acid testing to identify HPV-infected tissues, in fact this is a terrible way to diagnose HPV lesions. We never use it in my STD clinic, and I recommend against anybody ever trying it. HPV infected tissues often don't turn white, and many white changes are not due to HPV. The only legitimate purpose for this test is in helping gynecologists decide exactly where to biopsy a woman's cervix. And there are no other tests either that would "draw out" HPV.
4) I would not think a biopsy would be inconclusive. On the other hand, I agree with your reasoning: it is very peculiar that a recurrence of a warty lesion in exactly the same spot would be due to an entirely different diagnoses. You should discuss this with your dermatologist. In doing so, I would suggest that the current pathologist be sent the slides or tissue from your earlier biopsy, if they were retained in the lab. (Most pathology labs hold on to slides, if not tissues, for many years.) Examining the two specimens side by side might help determine which diagnosis, or perhaps both, was accurate.
I hope this has helped with perspective, if not definitive answers. Best regards-- HHH, MD
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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.
