[Question #11667] "Indeterminate" HPV Biopsy

13 months ago

Hi Doctors,

I hope you're doing well. As indicated in my previous question, I had an oral squamous papilloma removed from my tonsil region about a year and a half ago, which was not tested specifically for HPV. I had an EGD for unrelated reasons about a month ago, and they found another squamous papilloma in the middle third of my esophagus. This lesion was tested for HR-HPV (Roche Cobas 4800), and the result was "indeterminate." The lesion has been totally removed, so there's no way to conduct repeat testing. I am somewhat at a loss as to how to interpret all of this and what it means for my sex life. My GI said that they think that esophageal processes are generally not sexually transmissible. But presumably whatever caused the esophageal papilloma was the same thing that caused my earlier tonsil lesion. I have gardasil, but only the quadrivalent version.

Would you recommend disclosure of this to partners before oral sex and/or kissing? More generally, I could use some words of advice about what this means for my sexual health overall. Thanks

Edward W. Hook M.D.

13 months ago

Welcome back to the Forum. I'm certainly no expert on papillomas of the GI tract but I'll be glad to comment. Papillomas are found throughout the GI tract and are not uncommonly found on endoscopic procedures, both upper GI and colonoscopies. Gastroenterologists remove them and that's the end of things. While there have been concerns that esophageal papillomas are sometimes caused by HPV, the majority have other causes including chronic gastrointestinal irritation. As was the case with your tonsillar papilloma, there is no evidence that your lesion was due to HPV. A agree with your GI that it is unlikely that your lesions would be transmissible through kissing or oral sex- after all HPV is transmitted by direct contact and I'm doubtful that your sexual partners, no matter how vigorous the sex, are going to be directly exposed to your esophagus. Further, as before, please remember that your HPV vaccination makes it most unlikely that this lesion was HPV related AND that the lesion has been removed, possibly curing you .

I see no need for disclosure. Your good to worry about your partners but as already discussed, warning partners of something that you do not know you have is asking for trouble.

I will have little to add to these comments. I suggest that, should your concerns persist, and I hope they won't, that you discuss these problems with your GI. EWH

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