[Question #13276] Follow up Question 11592
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25 days ago
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Dr. H:
I had been happy to accept your response to my previous question. However, going through my medical records, I saw that my former dermatologist had put in my records a diagnosis of verruca vulgaris (VV) on the first biopsy on 7/11/22. (At our appointment, my former dermatologist said the pathologist was unsure whether it was a VV or a seborrheic keratosis (SK).) Since I have no access to the pathologist or my former dermatologist, I asked Grok (AI) for an interpretation of the pathology reports, and it said that the first lesion was a HPV wart because of the presence of the koilocytes. The samples of the other two lesions did not mention koilocytes and Grok agreed with the SK diagnosis. I know that Grok is not a doctor, but this information is troubling me, which is why I'm back here. Is Grok correct on this and does it change your original response?
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Edward W. Hook M.D.
25 days ago
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Sigh. GROK like other Internet sources is unreliable. Kiolocytes may or may not indicate HPV. Your obsession with this is unhealthy. No change in our assessment or advice. You need to move on. EWH---
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18 days ago
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I understand. I'll ask my follow ups anyway.
Does HPV sometimes cause a rash? On 5/10/22 I went to the dermatologist for a red, peely, and itchy rash in my groin area. Their notes: "diagnosis
Groin: erythematous patches c overlying, sharply demarcated scale at periphery,
favored Tinea Cruris." I went back on 5/16/22 because the econazole cream they gave me wasn't really helping - so maybe it wasn't Tinea? They gave me a steroid cream that helped in conjunction with the econazole. Then the rash flared again around 6/16/22. I used the topicals again and they helped. I must have noticed the growth at around this time and had it biopsied on 7/11/22.
Since these things occurred at the same time, I wonder if they are related.
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Edward W. Hook M.D.
18 days ago
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HPV does not cause a rash of the sort described. What is described sounds nothing like HPV or other STI. You may need different treatment. You should go back to see the dermatologist who saw you originally. EWH---
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11 days ago
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OK, Dr. Hook.
My new dermatologist diagnosed my rash as intertrigo, and recommended keeping the area clean and dry - that seems to do the trick.
I'm honestly afraid to research koilocytes or rashes and their relation to HPV warts, so I will not and will trust your advice.
I read the ASHA publication HPV: What men need to know, which raised some questions. My sexual history.: virgin before marriage (> 20 years ago). Wife had a few sexual partners before me (male and female), including one MSM (she didn't know he was doing that). I had an affair with a woman in 2015 that involved 3 events PIV w/ condom, although there was once unprotected oral sex for both of us. Another woman in 2016 - 3 events, PIV w/ condom, once unprotected fellatio. Once there was some condom slippage. Then the escort event in 8/21 - protected oral from her and PIV. I didn't notice condom breaking but I didn't see my semen deposit in the condom when I took it out.
- If you can't see your semen deposit in the condom, does that mean it failed? I didn't see obvious tears, but maybe I missed them?
- What is the likelihood of me or my wife having high-risk HPV / cancer developing going forward?
- Can you only get HPV throat cancer from oral sex, or can you catch HPV from intercourse that can infect the throat?
- If my wife had an abnormal pap smear in the future, that would be from me, right, given the length of time we've been married?
- How late in life do women need pap tests? Should my wife test longer given my recent extramarital events?
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Edward W. Hook M.D.
10 days ago
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As you know, these will be my final responses. Your other recent questions have been deleted so there is no way to review those interactions. After this response there is little more that we can do to help and you should not return with further anxiety-driven questions. They serve no purpose and will not be answered.
I feel like I have put us at risk and want to make sure we catch anything that could crop up early.
- 1. If you can't see your semen deposit in the condom, does that mean it failed? I didn't see obvious tears, but maybe I missed them?
No, you may have missed it, the amount of ejaculate may have been small and on some occasions there is no visible ejaculate.
- 2. What is the likelihood of me or my wife having high-risk HPV / cancer developing going forward?
- Because you and your wife have both had other partners and are unvaccinated, you both probably have HPV, The likelihood that you will develop cancer is less than 1% and virtually zero if your wife get's regular check up (PAP smears or HPV tests)
- 3. Can you only get HPV throat cancer from oral sex, or can you catch HPV from intercourse that can infect the throat?
- For all practical purposes, throat cancer due to HPV occurs only in persons who have had oral sex. HPV does not spread within the body to other sites.
- 4. If my wife had an abnormal pap smear in the future, that would be from me, right, given the length of time we've been married?
- No, not necessarily. HPV can present years after the infection has been acquired.
- 5. How late in life do women need pap tests? Should my wife test longer given my recent extramarital events?
- Your casual encounters are no more risky than your wife's prior partners, particularly if one of them was a MSM. If PAP smears are recommended for women up to age 65 or, if they have ever had an abnormal PAP smears for 10 years after an abnormal one.
Your concerns are far from unique and your guilt is getting the best of you. Both you and your wife have had other partners. Your risk (both of you) is minimal and with routine health care you should have no problems. I urge you to stay of the internet and address what appears to be unwarranted guilt.
This completes this thread. EWH
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