[Question #1688] Conflicting opinions from Specialists

76 months ago
Hello Drs.,

I believe I had asked 2 questions regarding a certain exposure on this forum in the past. 
Since then, I have seen another lesion near the previous one, and the previous one has grown SLIGHTLY so that it looks like a little
shiny, pink spot that sometimes has skin flake off. The new lesion is much less visible but shares the same shiny and pink qualities with a distinctive border.
I went to a Planned Parenthood clinic and the Nurse Practitioner said that these didn't look like warts, but could be the very early stages. She thought it might be a "blemish" but seemed to refer to a picture with someone with a severe case of warts (maybe 50 in all that protruded quite prominently from the skin) as the typical case. 
I later had a "visit" with a dermatologist through teledermatology and the Dr examining the photos diagnosed them as genital warts. He did not prescribe anything but urged me to seek treatment despite conceding a reasonable degree of uncertainty. My only real question is:
this main lesion that looks the most like a wart would have been covered by a condom during the exposure I am concerned about. And it first began to appear about 22 days after the exposure although has not healed since then and has grown just slightly. How atypical is this exactly? There are no lesions of any kind on the areas of skin that were NOT covered by the condom, so I have a hard time believing that these can be warts, especially considering that only 2 lesions of any suspicion have appeared in 2 months, and that they were both certainly covered by a condom. I would imagine that if I did contract HPV from this encounter, I would also have warts on the exposed areas. Do warts not always appear where the virus was massaged into the skin? 
What are your thoughts? 
Thank you.
Edward W. Hook M.D.
76 months ago

I'm sorry to see that you have not been able to control your anxiety despite your pledge to not return to the Forum for at least a year.  Clearly you remain anxious and feel guilty about the very low risk exposure you had about two months ago.  The lesion you describe, its appearance (flat, flaking, not raised) and the timing of its occurrence (too early), as well as the fact that the affected location was under the condom all make it very, very unlikely that this is a wart.  On this Forum we do not look at pictures because they are all too often misleading.  On the other hand, when you seek opinions of health care providers saying "could this be HPV/wart" it is easy for that person to say yes, there is a chance.  Both of the providers you mention seemed to feel that the chance that the lesion you described was a wart is very small, as do I. 

Warts typically occur at sites of direct contact, thus while there may be a VERY small risk that a wart might occur in an area not covered by a condom, there is even less chance that a wart would occur in an area covered by a condom. 

As before, I sincerely doubt that this is a wart.  What you describe (a flat, slightly scaly lesion" might be a non-STD dermatitis or a fungal infection.  it does not sound like a wart and it certainly does not sound like something you should be worrying about.  Your repeated questions are now entering the realm where we will be forced to stop answering questions.  Please try to get over your guilt and move forward without further concern.  EWH

76 months ago
Thank you Dr. Hook. I am sorry I broke my pledge, but I was a bit alarmed by some of the NP's statements regarding genital warts (would grow significantly within a month) and subsequently was not inclined to trust her knowledge. I was further alarmed by the Dermatologist I consulted online and his diagnosis of condyloma acuminata. He said he believed the diagnosis was correct, but I asked if it was possible they weren't warts and he said it was possible.  

The area I'm located in is a bit far from any universities or large cities, so I have limited access to expert knowledge from professors/doctors such as yourself, and it seems that providers in my area have limited knowledge about genital warts/HPV. This is why I reluctantly came back to this forum. 

I suppose the reasons I'm concerned are the diagnosis by a dermatologist (albeit from pictures only, and as you mentioned they can be very misleading), the appearance of a nearby similar lesion, I have never seen such lesions on my penis before that haven't healed promptly, and the coincidental timing after a sexual exposure. 
But your logic is sound and you have answered my question, it appears that warts would only appear on areas that were not covered by a condom. And even if they did appear on the penile shaft, this would be several months after other warts appeared and the infection spread to the shaft (perhaps by shaving or scratching the area). With all of this clarification, you are still confident this is nothing to worry about? I kindly request an answer and then you may close the thread. I will have no further questions. 

Edward W. Hook M.D.
76 months ago

You have summarized my earlier replies accurately.  The lesions you describe are most unlikely to be warts related to your encounter about two months ago. 

In my opinion, your anxiety and guilt is causing this problem, leading you to repeatedly inspect your penis and then when you find any sort of variation, asking and asking again until someone says "sure, this could be HPV".  My advice is to not repeat your questions in the way you are doing.  If anything, my advice would be to seek counseling to help you address your anxiety and guilt.  I say this because I believe that you are harming yourself through your current actions.  I wish you the best.  This thread will be closed tomorrow.  EWH