[Question #11170] Confused about HPV

16 months ago

Hi doctor,

For context, I was vaccinated with the HPV4 vaccine all three shots 11 years ago, before any sexual experience.

I noticed some skin growth on my lower abdomen near the pubic region.

My primary care doctor said it was a skin tag and nothing to worry about. A few days later I noticed a darker tiny skin growth near the base of my penis, in my pubic region. This was outside the fold, further from the penis, that connects the base of the penis and the pubic region. It was very small. This concerned me so I went to a dermatologist.

The dermatologist said both, my first spot and this second were likely warts. I was confused because my last sexual encounter was a year ago. He seemed like he didn’t find it useful to give a confident diagnosis and instead wanted to just treat them. When I mentioned my vaccine he said these are likely not genital warts since they’re not on my penis. But they are HPV nevertheless.

I got them frozen and went back a month later. The spots were not fully gone so he froze them again but this time he said the lower spot is a molluscum. I’m pretty confused at this point, since his answers are inconsistent. Do you think I should get a biopsy for confirmation? I don’t have any other lesions. These two are it.

In your experience, do you think these are HPV warts? I honestly feel like it’s unlikely given my vaccination status, sex over a year ago, and warts not on penis. I’d love to hear your perspective.

H. Hunter Handsfield, MD

16 months ago

Welcome. Thank you for your confidence our forum.

Glad to hear you were immunized. You are free of risk the four HPV types covered by the vaccine. That means you are 60-70% protected from HPV related cancers snf 90% protected from genital warts. That makes is quite likely that your genital area skin bumps are not warts at all; or if they are, that they are not typical genital-type warts. It is true that genital warts in men usually involve the penis and not nearby areas.

As you have learned from personal experience, diagnosing skin bumps is not a precise science; even experienced dermatologists often cannot be certain or make mistakes. The way to know 100% whether your continuing skin bumps are warts is to have them removed or biopsied, as you suggest yourself. On the other hand, freezing might have destroyed the wart tissue and biopsy might not be accurate any more.

In summary, I have no way of judging the diagnosis, but it seems to me that it's unlikely you have standard genital warts. My guess is your sex partner(s) are not at risk for catching HPV from contact with the bumps.

Interesting that at least one lesion apparently is molluscum contagiosum. This is an unusual situation: I've never seen or heard of MC appearing as only a single lesion; usually they are multiple. And how old are you? MC is increasingly rare beyond young adulthood. You might have a further discussion with one or both dermatologists about how confident they are in that diagnosis.

Sorry I don't have clearer answers -- but the forum is not intended for actual diagnosis of any particular problem. We do not attempt to provide direct medical care in that way. But I do hope the discussion has been somewhat helpful.

HHH, MD

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16 months ago

Thank you Dr. Handsfield.

I am 28 years old. I also think it's unlikely to be molluscum but I will likely seek out another opinion if the spot continues to persist.

I know this is difficult to answer and you dont offer diagnosis, but one of my bumps, the one closer to my lower abdomen was kind of flappy i.e. I could play with it by moving it with my finger. In your experience, do HPV genital warts manifest like that? I know they should generally be cauliflower like. This was the same growth my primary care said was a skin tag and my derm said was a wart.

Also, now that I can't really do a biopsy, should I be concerned about giving future partners HPV and potentially warts or cancer? This is my most important concern.

H. Hunter Handsfield, MD

16 months ago

It it was molluscum, peculiar it wasn't removed. Most dermatologists would have removed it, curing that lesion. It takes about 10 painless seconds.

"Flappy" is far more suggestive of skin tag than wart. There's a bit of controversy in the dermatology research literature about whether skin tags are sometimes (often? usually?) due to HPV. Perhaps your dermatologist believes that. I don't.

I think there is almost no chance you have sexually acquired or transmitted HPV, and even if you did, I never advise precautions to protect partners. They're all infected or will be anyway; any single exposure never materially increases anyone's risk of having or getting genital HPV someday, so what's the point?

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16 months ago

Thank you. They did actually freeze it off so that’s good.

I appreciate your perspective on this matter, that makes sense.

I have one more question. I was examining my penis today and found another very tiny bump near the base on my shaft. This is very hard to see with the naked eye but with my phone camera zoom I can see the details. It’s round, has some cauliflower like lines and has a hair coming out of the side of it. There are other similar smaller bumps and they form a straight horizontal line with a few hairs coming out of them.

I will get it checked out but would love to get your perspective. Realistically I feel like I’m over examining myself but this one does eerily look similar to a wart. Could it be something else? For context my last sex was 13 months ago and I used a condom.

H. Hunter Handsfield, MD

16 months ago

As you seem to know, "cauliflower" is most consistent with a wart, but warts are not associated with hairs. Given your immunization, it will surprise me if it turns out to be a wart. But you'll need to be examined, ideally by a dermatologist. In the future, I would suggest no more self examination, especially with magnification. If there's nothing obvious on casual inspection -- like when using the toilet -- it's a pretty fair bet that nothing at all is wrong. This probably will turn out to be some minor anomaly or even entirely normal skin.

Each question includes the opportunity for two follow-up comments and replies, so that concludes this thread. I hope the discussion has been helpful. Best wishes.

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