[Question #1272] HPV Anxiety / What Bumps are Normal?

47 months ago

Hello Doctor(s),

 

To preface my questions, a little background. For sexual partners, I've only been with 4 people. One was my first girlfriend, whom I started dating 9 years ago and broke up with 4 years ago. During this time I never had any symptoms of anything. Last year, I was seeing someone who was a virgin before we were together (even including oral). 3 months ago I had one brief instance of unprotected oral with a woman on a date. Shortly after, I started dating my current girlfriend, who I have had reciprocal oral with but no penetration. In addition, I have always had a small patch of evenly distributed, ~3mm fordyce spots on the side and bottom of my shaft. These have been there as long as I can remember, before I was ever sexually active.

 

In the last year, now in my late 20s, I have developed a TON of tiny, clustered fordyce spots on my lips where there were previously none. Also about a year ago, before my 2 most current partners, I developed 2 bumps on the top of my shaft. These spots don't really look wart-y, and appear to be under the first, very thin layer of skin. They are slightly raised but not rough. I have also developed a few more small spots around other parts of my shaft, and they are not as big as the original fordyce spots. Still, they don't really look like warts to me.

 

 I initially did not worry about them because I figured that based on my sexual history at the time they developed (first girlfriend was 8 years prior, 1 virgin since then), there was no way they could be an STD. I recently started dating my current girlfriend, who told me she had high risk (non wart causing) HPV. I was understanding but did a ton of research, and started inspecting myself. I got into full on freak out mode about these bumps, and went to my local planned parenthood. I was seen by both a PA and and MD, who both agreed that they were not warts or any other transmissible thing, but that if I wanted further clarification I should follow up with a dermatologist. Went to my GP for a referral, who agreed with PP. Went to the dermatologist, who said he did not think the two bigger ones were warts but suggested a biopsy to be sure. I will have the biopsy in a week.

 

Here are my questions:

1) What are the odds that these were misdiagnosed and are actually warts? I know this is crazy but I just want some reassurance.

2) I also have some spots on either side of my frenulum, in the little fold that isn’t normally exposed to air. They are only visible when I pull the skin tight, and look like very tiny little pimples, more like the Fordyce spots on my lips. Is this normal? The derm didn’t seem concerned but he was in a hurry.

3) While waiting for the biopsy all-clear, can I masturbate? If I have warts, will masturbation spread them around to different parts of my penis? I have masturbated in the past and haven’t really seen a change but I want to be sure.

4) Am I freaking out about nothing?

Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Welcome to our Forum. Sorry for the delay in replying but your question gave me pause, wondering what you would do with the information if you discovered that the lesion you had biopsied was a wart.  Would that change you or the way you interact with others?, would you blame someone?, would you embark on pursuit of treatment that most experts would tell you is not needed?  It saddened me that your concern over the possibility of having an infection that over 50% of sexually active persons with a single sex partner would have within six months of initiating sexual intercourse for the first time led you to undergoing an invasive, costly,potentially scarring procedure (the biopsy).  Not much I can do about that except URGE you to relax and consider why you are (in my opinion) over reacting and unable to accept the assessment of multiple trained experts that the lesions you describe are not warts.

In answer to your questions:

1) What are the odds that these were misdiagnosed and are actually warts? I know this is crazy but I just want some reassurance.

You have been examine by 4 highly trained health care providers who doubt that your lesions are warts.  I would have urged you to believe them and, as indicated above, would not have pursued this further.


2) I also have some spots on either side of my frenulum, in the little fold that isn’t normally exposed to air. They are only visible when I pull the skin tight, and look like very tiny little pimples, more like the Fordyce spots on my lips. Is this normal? The derm didn’t seem concerned but he was in a hurry.

This suggests that you are repeatedly and perhaps over vigorously examining yourself.  What you describe is likely to be a normal variant in the same way that Fordyce spots can be highly variable as to size, number and location.


3) While waiting for the biopsy all-clear, can I masturbate? If I have warts, will masturbation spread them around to different parts of my penis? I have masturbated in the past and haven’t really seen a change but I want to be sure.

Of course.  there is no evidence that masturbation would spread HPV infection.  Just don't traumatize the biopsy area.


4) Am I freaking out about nothing?

Yes.


Finally, I note that you do not mention receipt of the HPV vaccine.  I hope that is just an oversight.  For someone who worries so much about HPV I cannot imagine why you would not have taken the HPV vaccine.  If you have not, please do- it is safe and amongst the most effective vaccines known.  EWH



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47 months ago
Thank you for your reply. To answer your first question, finding out I had wart-causing HPV would make me feel sexually untouchable. My fear is that nobody would ever want to be with me, but I guess that's more for a discussion with a therapist, and not an STI expert. It is still stigmatized and I keep envisioning disclosing this to a new partner will cause her to end things before they begin. 

To clarify, the dermatologist recommended the biopsy without my asking, but perhaps he could tell I wasn't going to relax with his sight diagnosis. He did initially say that the bumps were "too close to call" but then later said "you know, I really think you're fine." It is the indecision that has me still worried. 

I will be going in to get the first dose of the vaccine  ASAP.

Follow up questions:
1) Should I cancel the biopsy?
2) What are the odds the biopsy gives a false positive?
3) Any other advice, other than RELAX?
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Thanks for your thoughtful reply.  I think your feeling that you would be sexually untouchable if you had a genital HPV infection is an over-reaction, understandable but an over-reaction nonetheless.  As someone whom I presume is at least in his mid-20s, what you would be doing is ruling out future relationships with something approaching 70-80% of sexually active women, most of whom would not know that they were infected.  I would guess that your reaction reflects the all too prevalent stigma related to sexually transmitted infections, most of which are acquired from people who do not know they are infected and are NOT the result of socially deviant behavior in North America and Western Europe.  My sincere advice would be to consider talking this through with a counselor/therapist who knows a bit about the epidemiology of HPV infections (i.e. that nearly all sexually active persons will be infected at some point, that most people who have the infection do not know it, and that only a tiny proportion of those with infection will suffer physically untoward consequ3nces of infection. 

Glad to hear that you will get the vaccine. A good idea for both you and your sex partners.

As for your questions:

1) Should I cancel the biopsy?
Obviously this is a judgment call but I would not get a biopsy if I were you.

2) What are the odds the biopsy gives a false positive?
Very, very low

3) Any other advice, other than RELAX?
Yes, as I said before, talk this through with a knowledgeable counselor.  A not quite as good alternate approach would be to take a look at some of the materials available on the ASHA website regarding sexual health and HPV infections.
EWH
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47 months ago
Thanks again doctor. Final follow ups:

1) Do you have any advice on finding a good counselor with knowledge of HPV? I have a regular therapist I see, but he was clueless about this. 
2) What are your reasons for canceling the biopsy? Won't it just give me definitive proof and put my mind at ease?
3) Regarding disclosure to future partners: What do you recommend? Even if I don't have warts, my current girlfriend has a (possibly cleared) non-warts causing strain that showed up on a pap. Should I tell my future partners about this?
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

I'm sorry, I do not know a counselor with that specific expertise I could refer you to.  the most direct approach would be to ask your counselor to refer you to a colleague with expertise in fields related to sexuality and perceived stigma.  I suspect he/she has some who may be right for you.

I would not go with the biopsy as I think HPV is a trivial infection which resolves on its own among most people who have it.  I would not spend the money involved on a biopsy which could cause scarring.  You have 4 different clinicians who do not think the lesions you refer to are warts.

Most experts feel that there is not a need to inform partners if one has been exposed to HPV (since whether they know it or not, most people have been) and the infection is of minimal consequence for those who have it but still carries a lot of unwarranted stigma with it (as you know).

I hope my comments are helpful and wish you the best.  This thread will be closed later today.  Take care.  EWH

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