[Question #3370] Dr HHH; Skin Tag/ HPV anxiety

39 months ago
Hello, Dr.

I'm a 20 year old male with serious STD anxiety. I was vaccinated for HPV at 18 after my third sex partner and every partner I've had I always get tested for Chlamydia, Gonorrhea, syphilis, both types of Herpes, and Hep B and C 6 and 12 weeks after exposure. I've had 7 partners, and always tested negative for the above but did have a molluscum infection early 2017 that lasted a few month's which was treated with cryo by my dermatologist. I'm really careful about this sort of thing so when I see any red bump down there I make an appointment with my derm or Planned Parenthood to make sure its not an STD. Recently after months of abstaining from sex after the molluscum infection, I was seduced by this 22 year old girl and we had protected sex twice over the span of 3 days 8 weeks ago. I tested at 6 weeks and everything was negative. However, a few days ago i was grooming myself and saw what looked like a small white wart to me on my lower shaft where the shaft meets the scrotum. I freaked out and went to the derm the next morning and he looked at it and said it was a skin tag and froze it off. I asked him if it was HPV related and he said probably no and that they're caused by skin rubbing. I can't seem to find reliable information on skin tags and am scared it was actually a genital wart. This is causing me serious anxiety and I am having trouble getting past this. I don't know what to do or what to disclose. Please help. Can I assume this isnt warts and move on?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome back to the forum. FYI, I scanned your recent discussion with Terri and agree with all she said.

I'm completely unaware of skin tags being caused by friction ("rubbing"); if there are such data or consenses with dermatologists, I am unaware of it. In any case, skin tags should not be viewed as abnormal. They are simply a normal variation on normal skin. They are not warts and would almost never been confused with warts, so you can rely on your dermatologist's diagnosis of skin tag rather than wart. Skin tags are not sexually acquired or transmitted. You should not say anything about it to current or future sex partners. Also, HPV vaccination is 100% effective agains the two HPV types that cause almost all genital warts.

Second, it seems to me your obsession with STD risk doesn't just hint at OCD. Clearly you are experiencing an STD-centered form of germophobia, which is a common manifestation of OCD. And although I am not a mental health expert, I think you have a rather severe case and should seek professional counseling about it. Notwithstanding Terri's comment about many people have OCD in regard to herpes, the level of fear you express and your compultion to be tested after every new sexual encounter go way beyond normal. As you may know, OCD in general and germophobia in particular can be early signs of serious disability. For an excellent example of where it can lead, see The Aviator, the film biography of the "eccentric" (i.e. very disabled) billionaire Howard Hughes. (It's an excellent movie too, with Leonardo DiCaprio and Cate Blanchett.)

I'm not saying your sexual lifestyle is zero risk for STDs. Indeed, you can assume you have or have been infected with genital HPV, since 90% of people acquire it within their first three lifetime patners. Your risk is lower than that, because of being immunized, but the vaccine only protects against 9 types of genital HPV among over 100 types that exist. Even with vaccination, having genital HPV should be viewed as a normal, expected consequence of human sexuality. In any case, your STD risk is sufficiently low for any single encounter that testing makes no sense, except to consider routine testing for selected common STDs (gonorrhea, chlamydia, syphilis, HIV) once a year or so; or of course if you learn a partner had an active infection.

I hope these comments can help serve as a first step in moving toward a healthier and happier sexual future. Let me kow if anything isn't clear.

HHH, MD

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39 months ago
Dr,

Thank you for your response. It's made me feel tremendously better already. I guess what my dermatologist meant is that they're said to most commonly appear in places with folds or where there's friction such as eyelids, armpits, groin area, etc. 

I am aware of the prevalence of HPV and I do realize that I may already have a silent infection or have had a past infection that has since been cleared. But based on what you told me, saying that skin tags aren't sexually acquired or transmitted, I can assume this skin tag isn't at all an indication of genital warts and move on from this, correct? I just want to make sure. I'm going to University this fall hoping i find the girl of my dreams and some of the articles on the internet  talking about how skin tags may be caused by HPV fueled this anxiety. 

I am also aware that I need to find some psychological help regarding this issue. I feel a lot better now though. And I'll check that movie out. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Your dermatologist undoubtedly knows more about skin tags than I do, but his views make sense to me.

No, skin tags are not "an indidcation of genital warts". Anyway, you can be very confident you'll never develop GWs, given the 100% effectiveness of the HPV vaccine against the two types (HPV6 and 11) that cause almost all genital warts.

I'm still hopeful you will follow through with counseling, but glad this discussion has been helpful in the meantime.

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39 months ago
Dr Handsfield,

Thank you for all that you do. I can assure you that I'm going to do my best to just stop worrying about all this and listen to the doctors rather then trying to diagnose myself. Im retrospect its ridiculous that i went to both planned parenthood and my dermatologist and still wasnt convinced and thought it was a wart because i am by no means a medical professional. I think you hit it right on the head with this Germophobia thing. I know that this anxiety I'm experiencing and my frequent medical visits do show signs of OCD and I'm going to see to it that I speak to someone about it.I'm done with it interfering with my daily life and causing me to isolate myself and cope by smoking, drinking, and drugs. I'm also going to abstain from sex until I find someone I love and trust enough to be intimate with, even though it seems theres no reason at all to abstain. It's usually when i sleep with a girl i dont know very well that triggers this anxiety. Whats weird too is as soon as I got this Skin Tag (which is now completely gone) my worries changed completely from Herpes to HPV, as you can see from my conversation with Terri. Im gunna take it easy from now on. Again I can't tell you how grateful I am to have received this advice from you. Although it'll be my last post, thank you for all the sound medical advice and it was a privilege to converse with you. God Bless.
39 months ago
I'm going to move on and be successful and not let my irrational fears bother me anymore. Wish me luck in college !
39 months ago
I guess the only other question I have is say if i got HPV before i was vaccinated at 18 as I had only got vaccinated after my 3rd partner, would the vaccine still prevent genital warts 100%?  and since im 20 now and its been 2 years, if i was infected with HPV wouldnt any infection acquired before vaccination have cleared or become dormant? And any encounter after i was vaccinated i was completely protected from strains of HPV that cause genital warts? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Thanks for the thanks. I'm glad my comments so far have been helpful.

The vaccine has no effect on established HPV infection, so if you acquired HPV 6 or 11 before then, it is conceivable you could have genital warts someday. However, although late recurrence like that is quite uncommon, and once you received two doses of vaccine you were and remain at little or no risk from new partners. So you're very well protected, but not 100%.

Best luck in college, both academically and romantically. But don't delay the obviously necessary mental health counseling until then. That you are getting support from alcohol and drugs is a bad sign, indicating the seriousness of the problem. Finally, I would caution you against making unrealistic pledges to yourself, such as no sex until "love and trust" is in the picture. Most such pledges fade quickly as circumstances arise. Better to be realistic and be prepared (condoms, lower risk partners, etc).

That concludes the two follow-up comments and replies included with each question and so concludes this thread. Best wishes.
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