[Question #3004] Unclear HPV diagnosis/disclosure concerns

39 months ago
Hi, I'm a female with a couple questions. 

In May 2015, my PA found a couple bumps when examining me and thought they could possibly be molluscum. They were sort of near the area between the vagina and anus. She wasn't sure, so I scheduled another appointment with a doctor the next day. The doctor wasn't sure either. She thought they could just be ingrown hairs, molluscum, or even a mild form of HPV, but she couldn't tell for sure. I had her freeze them off because I was paranoid (I have diagnosed OCD). She never offered to do a biopsy. I asked her at the time if I needed to inform future partners or doctos and she told me no. I've also never had any further complications. 

I have never informed partners about this instance and when asked if I'm clean, I say yes. 

In April 2017, I talked to that doctor again because I had some new anxiety about it. When I was talking to her, I got a little upset. To calm me down, she said something like "Oh, you seem savvy and discerning. When you get to that point, just explain." And then I had to explain to her that I was pretty sexually active and had not said anything to anyone because she said I didn't need to. By the end of the appointment, I said "I would feel better not telling because I don't want someone to freak out about a hypothetical infection." And then she just said "I think that is well reasoned." So I left equally confused. 

My gut tells me that the bumps were probably ingrown hairs for several reasons. First, I am prone to get them. Second, the PA and doctor couldn't be sure and it seems like they should have been about warts. And third, I had only been with 2 partners at the time of the May 2015 examination. One was a male that I had been with for years with no issues. The other was a woman that would have told me if she had any issues. 

My question is if it is okay for me to just assume the bumps were never warts and continue telling partners I'm clean. I get regular check ups. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome to the forum. Thanks for your question.

Based on your description, I agree wit hour "gut" understanding. (I don't think it's your "gut" speaking: this seems a very rational, "left brain" analysis!) In addition to the reasons you give, as you describe the lesions, a couple of years ago, they don't sound like warts. (They also would be very atypical for molluscum contagiosum. I've never seen genital area MC that had only two lesions. 10-20 is more common. In addition, your age may be against it:  I don't know how old you are, but genital MC is uncommon after age 20.) Warts also do not appear as red bumps, notwithstanding your doctor's mention of that possibility.

I trust and hope you understand that you are at risk for and likely have (or have had) genital HPV, probably more than once. That's based on your statement that you are (or at one time were) "pretty sexually active". Virtually all sexually active persons acquire HPV by the time they've had 3-4 lifetime sex partners. And even consistent condom use barely dents the chance of catching or transmitting HPV. Most infections cause no symptoms and are never apparent; only a minority cause warts or abnormal pap smears. At any point in time, up to 50% of sexually active persons are carrying one or more HPV types, so being exposed (and exposing one's partners) is pretty much unavoidable and should be considered a normal aspect of human sex. Therefore, people with past HPV (and often even with a know current infection), there is generally no need to inform partners:  doing so does not modify their risk of catching HPV or having a warts, abnormal pap, etc.

In summary, for sure you have no ethical or practical obligation to inform partners of your past genital bumps. You would not need to do so even if they had been confirmed warts.

Final advice:  If you are not yet 26 years old, you should speak with your health care provider(s) about being immunized against HPV. The vaccine is 100% effective in preventing the 9 types that collectively account for 90% of genital warts and almost 90% of cancers and pre-cancerous lesions like pap smear abnormalities. (No protection against any of those 9 types you've already had, but most people like you remain susceptible to some of the vaccine covered types.)

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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39 months ago
I want to clarify a few things: 

I don't think the bumps were red. I remember seeing them myself. They were flesh toned, but not particularly warty. I think I thought they were just the result of like dry skin or something before the PA pointed them out again to me during the examination.  

I think was like 3, rather than 2. I know I said a "couple," but I don't think that changes your response. 

I think at the time the reason I was hesitant to believe they were DEFINITELY  ingrown hairs is because it had been a while since I shaved that area. But I also didn't just check out that area very often, so I have no idea how long they could have been there. 

I'm 27  and I've had my gardisil shot. I got it after the 2015 examination. 

I know I probably have or have had HPV. From reading your responses on medhelp, I knew that disclosure was sometimes a merky area and a little different if you had warts rather than an abnormal pap. I'm not worried about my health related to HPV. I just don't want to give someone warts and I want to be honest with my partners. 

Thanks for your initial response. It fits with my own self-analysis of the situation, but my OCD takes over and makes me get anxiety about it. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Thanks for the feedback (which arrived while I was logged in -- most users shouldn't expect nearly real-time responses!) Glad to hear you've had the HPV vaccine, but I trust it was more than just one shot:  at least two and preferably 3 doses are needed to be fully effective.

I really can't say more about the likely cause of the genital lesions a couple of years ago. But regardless of color, warts still seem unlikely. Also glad I (sort of) to hear you've been diagnosed with OCD. The situation suggested that possibility, but not enough to mention. Anyway, I'm inclined to agree that indeed this is all or most your OCD "taking over".

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39 months ago
Just to clarify, I've had all 3 shots! 

It seems like your advise about disclosure of past warts has changed over the years to lean more toward no disclosure. Is there a reason for that? Better research or something? Just wondered. 

Thanks again for your help! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
I don't think my advice about HPV disclosure, with or without warts, has changed significantly, unless you go way back, before HPV immunization was available (?), i.e. 10 or even 15 years ago. If more recently, I suspect you saw advice to specific questions that are not entirely analogous to yours. Certainly disclosure is and was the wisest choice in some cases. But for sure I would never have told someone in your situation, i.e. worried about but never diagnosed with warts, and over 2 years previously, that it is necessary to inform her current or future partners.

Thanks again for the thanks. That's why we're here, and I'm glad to have helped. 
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