[Question #2439] HPV warts and recurrence?

45 months ago
I had one wart at the base of my penis for approximately one year (no sexual contact in that time) about one and half months ago I went to my GP to have it treated. He gave me aldara to try and said we may have to freeze it off.  After about 10-12 days I noticed some slight inflammation and reddish marks around the circumcision line. I went back to GP who did STD checks (all clear) and stated they don't look like a reccurence of warts (marks are slightly  raised and flattish along line of circumcision and some dark spots). These new marks don't resemble the one I Had previously. He gave me a corticosteroid and antifungal. After one week of use I didn't see any or much change so he suggested I see a dermatologist. The dermatologist stated it was warts. In retrospect it seems his synopsis was hasty as he didn't look much or touch around to look. He prescribed me veregen. I asked for a biopsy and he stated he didn't want to cause scaring and it was too late. I had a follow up with a urologist who stated it was definitely not warts as skin pigment can change and it looked like excess skin.  I also asked for a biopsy and he said there was nothing to biopsy (adding it's a small cut and wouldn't need to worry about scaring as biopsies are simple process). 
I do not have any pain or itching. I did have slight tickling in my scrotum for the past month what the urologist likened to epididymis may be inflamed from how I sit or exercise. 
Extremely distressed as what to do next if I should start veregen or go see another dermatologist or gp with particular attention to warts

I also did try acv and tea tree oil prior to first visit to treat but that was in a different location then the new marks and weeks prior. 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome to our Forum.  I'll try to help.  Did you initial wart respond to treatment?  That you experienced some inflammation is not a surprise as part of the way Aldara works is through inducing some inflammation. 

As far as your newer lesions are concerned, it is not clear to me that they are warts.  It is unlikely that I will be able to add much to the experienced clinicians who have already examined you.  There are many cutaneous bumps and other irregularities that can be mistaken for warts to less experienced clinicians and both your GP and urologist do not feel this is HPV.  Further both your lack of response to tea tree oil (which is closely related to Veregen) and that the lesion does not look like your prior wart also suggest that the lesion you are worried about is not a wart.  I would believe them and not worry.  Time will tell you whether this is HPV or not since if it is HPV the small lesion that you describe will likely enlarge gradually, over a period of months.  My suspicion is that it is not HPV. 

I hope you will find my comments helpful.  If some part of my response is unclear or there are additional questions, you are permitted two follow-up questions.  EWH
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45 months ago
Thank you for the response. 

The aldara seemed to make it go down a little and then revert back on the off days. My GP told me it might not work and we elected to freeze it off as this was a little bit bigger. 
I thought the Aldara might have been suspect but they are not in the same area. As the initial wart was at the base left of the penis. And the new marks are around the circumcision line and I have now been off the Aldara for nearly three weeks.  What is the extent of inflammation and marks Aldara can create (in skin roughly 3 inches apart from applied site)? Also aldara didn't seem to inflame specific part I was applying to. 
I am more concerned this is a new outbreak on a larger scale and that they don't resemble the other wart because this is the starting phase before they fully grow out. The new lesions seem to be basically located only and around the ring of skin that separates the forehead and shaft. And if it is a new case to try to start the treatment as soon as possible to battle it before it gets worse. 
Is there any test I could ask to determine it (i.e. Acetic acid? I've also seen mention of putting vinegar will confirm if it turns whitish)
Is it worth going to another doctor to check out to demand biopsy as well?


Thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
The acetic acid test is not reliable.  The location that you describe is an area where "pearly penile papules" frequently occur and can be mistaken for warts and they do appear as "bumps".  What you describe sounds like this. 

I am not sure I see much to be gained by seeing another (4th I believe) doctor.  EWH
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