[Question #4018] HPV

33 months ago

Hello Doctors,

I apologize in advance for the length of my question here. Just a bit of background. I am in my late 20’s, have had two full sexual partners in my life in monogamous relationships for 3+ years each and then after these had brief hand-genital contact with a third woman. I have been dealing with OCD and anxiety related to HPV and some bumps I had in my genital area for quite some time now and I was hoping I could post here my specific situation and get some feedback from Dr. Handsfield or Dr. Hook because I have yet to find another situation like mine online.

                A little over two years ago, I got a full-panel of STD tests with everything coming back negative and then had a doctor (either an NP or PA) at a sexual health clinic look at a purple spot on my scrotum and then also do an examination of the entire genital area for any lesions that could be HPV-related and she found nothing to be concerned about. About 2 weeks after that, I discovered two bumps on the shaft of my penis that I was concerned with. I will call these bump #1 and bump #2. Bump #1 was slightly larger(about the size of a grain of rice) and had about 8-10 tiny bumps surrounding it in the folds of skin. Bump #2 was smaller (about half the size of a grain of rice), itched slightly and had redness around it and had a tiny bump right next to it.  I went to a GP in internal medicine to have these bumps checked out. She said that she did not know what they were but that they could possibly be HPV and said she would give me a referral to see a specialist if they did not go away and still bothered me. I then went back to the sexual health clinic and had one of the doctors there examine these bumps under light and magnification specifically (as I believe they were new since last time I had visited the clinic) and she told me “we see HPV everyday in this clinic and I really don’t think that this is HPV,” and assured me not to worry about it.

                I was unable to weigh everything in my mind and move on from this, so I found online that you can put apple cider vinegar on skin and the skin will turn white if it is thickened (which I found out later can be thickened from HPV or other non-sexually transmitted conditions that thicken skin as well). When I applied the apple cider vinegar to about a square inch of skin on my penis (including the area with the bumps), nearly the whole area turned white. Bump #2 turned whiter than the surrounding skin and little red lines (almost like veins) became visible around it. With so much confusing information thus far, I kept testing the skin for days and was also trying to see if the bumps would go away with the application of the apple cider vinegar. Eventually the skin turned black, bump #2 got “burned” off and some other spots of skin without any bumps “burned” off as well, leaving little holes in the first layer of skin in these spots. Within a couple of days, these spots healed and bump #2 that had “burned” away CAME BACK but was missing the tiny bump next to it that had been there before (so the main bump was still there, but the appearance was altered slightly after it got burned off and came back). Bump #1 did not burn off but may have changed appearance slightly. Although with the way my mind works, I am unsure if I was noticing a change or just making something up in my head to scare myself.

                I then decided that taking the situation into my own hands was not helping so I went to a dermatologist. I got bump #1 (the larger of the two) biopsied only to find out it was just a skin tag (NEGATIVE for HPV). I have since had two dermatologists examine the 8-10 tiny bumps around bump #1 and tell me they are not HPV. The dermatologist also examined bump #2 and told me he was not worried that it was HPV. I was able to let this go for a while but held off on any kind of sexual relationship for over 2 years and counting. In the meantime, I had several other spots on my penis and scrotum examined by several different dermatologists, only to be told that they were nothing to worry about. About a year after I first did the “vinegar test” on myself and got the first biopsy done, I did the vinegar test again on bump #2 (the one that “burned” off and came back) and the skin did not turn white this time. I went to a different dermatologist and got bump #2 biopsied and that test came back NEGATIVE for HPV as well. At the time, I wasn’t sure if the “vinegar test” was relevant, so I forgot to tell this dermatologist (who biopsied bump #2) about the fact that the bump had “burned off” and come back looking slightly altered. Either way, he biopsied it, and it came back negative for HPV.

                It has been a year since the biopsy of bump #2 and over two years since the biopsy of bump #1. In that time period, no new concerning bumps have shown up on in my genital area and I have seen other dermatologists only for them to examine tiny bumps or discolored spots that have been there for a long time. For example, the redness that I had around bump #2 is still there and a dermatologist told me that this redness is just a normal variation of skin. Also, it has been nearly 3 years since I last had any kind of sexual contact.

I realize this was lengthy, just to recap:

1. I had two bumps on the shaft of my penis that a GP said she wasn’t sure about but could possibly be HPV, but an STD clinic told me on examination were not HPV.

2. Applying apple cider vinegar to the bumps and surrounding area turned the skin white. After having applied the vinegar for several days on and off, Bump #2 “burned off” and came back looking slightly altered. I am worried that this test may have screwed up a potential diagnosis of bump #2.

3. After having applied the vinegar, I had bump #1 biopsied only for it to be identified as a skin tag. This dermatologist examined bump #2 and said he thought it was not HPV.

4. A year after having bump #1 biopsied, I had a different dermatologist biopsy bump #2. This biopsy came back negative for HPV as well.

5. I have had dermatologists examine any other bumps that may have come up in the meantime and none of them have said they are HPV.

 

My questions are the following:

1.       I realize that HPV is very common and that many people do not worry about it, but I am wondering, does this whole experience mean that I should worry more than the general population that I have or had HPV? The biopsies and exams kept showing no HPV, but should I put weight in the vinegar test I did that maybe I did have it? My dermatologist told me that acetic acid in vinegar will turn any thickened skin white (which can potentially be thickened for many reasons NOT HPV-related), but I have read online (even on the websites of reputable medical organizations) that the test helps doctors identify potential HPV.

2.       I fear that I may have screwed up a potential diagnosis of bump #2 by doing the “test” with the apple cider vinegar(and burning off bump #2 only for it to come back looking slightly different). Do you think the biopsies were an accurate test of whether or not these bumps were HPV-related?

3.       This question is will be slightly redundant of the last one: I moved during the couple of years this was all happening and went to a new dermatologist. I forgot to tell the new dermatologist that biopsied bump #2 that I had applied the apple cider vinegar to it a year before and it had “burned off” and come back. While the biopsy did turn out negative for HPV, do you think this biopsy was an accurate test of whether bump #2 was or was not HPV-related?

4.       It is impossible to get your entire genital region biopsied, so what is the best way to make sure that you have gotten all suspicious bumps sufficiently checked out? (I have heard HPV can lurk in normal-looking skin as well).

5.       Is there a point when no new bumps arise that I can assume going forward that I did not/do not have HPV?

Thank you very much for taking the time to answer these questions for me. I have been dealing with the anxiety related to this through therapy.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Welcome to the forum and thanks for your confidence in our services. But unfortunately, there is a reason for the character limit, which you apparently have overridden by writing separately and pasting into the question field above. The moderators cannot be expected to take 15 minutes just to read the question. On quick scan, I am confident the important information above can be compressed to a maximum of 1,500 characters (about 300-400 words). Please do that, post it in the follow-up window below, and I will be happy to respond. (FYI, in nearly 15 years on this and my previous MedHelp forum, I've never had a question that could not be posed within these character limits; indeed usually 200 words is sufficient.) 

In the meantime, on superficial scan I am pretty confident you do not have genital warts at this time. Bear in mind that we cannot and do not try to diagnose anything. Do not expect a conclusive answer about whether or not your bumps are warts or otherwise related to HPV.

I look forward to your edited question.

HHH, MD
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33 months ago

Late 20’s, 2 lifetime sex partners.

3 years since last sexual contact.

Background: Had 2 bumps on penis shaft, appeared 2 years ago.

Bump #1: Size grain of rice, 8 tiny bumps surrounding it.

Bump #2: Half size of grain of rice, had a tiny bump next to it, redness surrounding it.

Went to GP, she said she wasn’t sure, but that the bumps could be HPV.

Went to a Sexual Health Clinic, the NP or PA told me after examining with light and magnification “we see HPV everyday and I really don’t think you have HPV”.

I applied apple cider vinegar to skin at home (identifies thickened skin, which apparently can be thickened from non-STD reasons or HPV).

Bumps + square inch of skin turned white after application of vinegar. Bump #2 turned whiter and got little red lines (almost like veins) around it.

I kept testing the skin for days for acetowhitening and was trying to see if bumps would go away. Skin turned black, bump #2 got “burned” off along with some other spots of skin. After healing, bump #2 CAME BACK and remained until biopsy but was now missing the tiny bump next to it.

Dermatologist biopsied bump #1, skin tag, no HPV.

Dermatologist examined bump #2, told me not worried it was HPV.

Different dermatologist examined 8 tiny bumps around bump #1, told me not worried about HPV.

1 year after vinegar “test” on bump #2, did test again and bump #2 did not turn white. Then new dermatologist biopsied bump #2, negative for HPV. Forgot to tell new dermatologist about bump #2 “burning” off and coming back. Redness around bump #2 still present, but another dermatologist told me normal variation of skin.

Should I be worried about HPV?

Should I trust biopsies even after vinegar "test"?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Thanks very much for the abbreviated version.

Perhaps the first thing for you to know is that almost all warts look like, well, warts. Visual diagnosis by an expert, especially a dermatologist, is highly reliable. Since two dermatologists and an STD expert agree these things aren't warts, that's my opinion as well. Second, your description doesn't sound typical for warts. Third, biopsy is conclusive:  no HPV on biopsy means no HPV, period. Fourth, warts almost never last 2 or more years; even without treatment, warts would be gone by now. Finally, that a particular skin lesion returns after biopsy or surgical removal does not mean it's a wart. Many other things (fibromas and others) can return, especially if biopsy or surgical removal leaves some of the original tissue behind. 

It was a mistake for you to use the acetowhitening (vinegar) test at home. Experts in STDs, and most dermatologists, never use it because it is highly unreliable, even in highly experienced hands. Self testing by a lay person probably is little better than a coin toss. Some HPV infected tissues do not turn white, and many things other than warts or HPV may do so. Those results can and should be ignored entirely.

Another factoid may interest you:  the large majority of genital skin problems are not STDs. My professional bookshelf includes a title Color Atlas of Genital Dermatology. It has 300 pages of photos of penile and other genital skin problems. Of those 300 pages, only 15 (5%) deal with all STDs.

Do even though I can make no diagnosis from this distance, I am highly confident you do not have genital warts. If you are sexually active or might become so, you need say nothing at all to your partners and from a genital warts standpoint need not worry about infecting them.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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33 months ago

Hello Dr. Handsfield,

Thank you.

You explained: "that a particular skin lesion returns after biopsy or surgical removal does not mean it's a wart. Many other things (fibromas and others) can return, especially if biopsy or surgical removal leaves some of the original tissue behind."


1. My main concern was different from above. I applied the vinegar to bump #2, it turned white, and then after multiple applications it "burned off," leaving a hole. Bump then came back but it was missing the smaller bump that had been next to it before. The remaining bump remained consistent for a year.  After a year, I did the vinegar test again, the bump did NOT turn white. Then I got it biopsied, which came back negative for HPV. Main concern is that I might have screwed up biopsy and diagnosis of bump #2 by applying the vinegar and having the bump burn off and come back, because it turned white before it had burned off and did not turn white a year later when I got it biopsied. 
Should I worry about this?

2. I forgot to tell the dermatologist that did the biopsy of bump #2 that I applied the vinegar a year earlier and bump #2 had "burned off" and come back. Would his biopsy process have likely been different or should I still trust his biopsy of bump #2?

3. Would there be HPV material related to these bumps that wasn't caught in the biopsy that I should worry is still present in my skin? It's impossible to get your entire genital region biopsied, what is the best way to make sure that you have gotten all suspicious bumps sufficiently checked out? 

5. Is there a point when no new bumps arise that I can assume going forward that I did not/do not have HPV?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
You're missing my main point, that it is very unlikely you have (or had) genital warts.

1) I commented earlier on the futility of vinegar testing. These comments do not change my opinions or advice.

2) Vinegar will not "burn off" warts. Most likely he applied one of the standard chemical treatments for warts, also used for other kinds of skin lesions. Maybe bi- or trichloroacetic acid (chemically related to vinegar, i.e. acetic acid, but must stronger). Ask the dermatologist.

3) In treating warts, biopsy or surgical excision is intended to remove visible warts, and NOT to cure HPV. Think of HPV like an iceberg:  the area of skin involved with the virus is often more extensive than the visible wart.

5) It is already quite certain you do not have HPV. If it was, it is generally believed that it is safe to assume the infection is gone if warts do not recur within 6 months.

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33 months ago

Thanks Dr. Handsfield,

I might not have explained questions 1 or 2 well enough. The dermatologists never applied any chemical treatment, they only did surgical biopsies. The only time bump #2 “burned off” and came back was after I had repeatedly applied the apple cider vinegar to it.

Sorry if this is redundant but here is my main concern and series of events as they happened:

A GP said she isn’t sure but bumps could be HPV. A sexual health NP or PA said “we see HPV everyday and I really don’t think you have HPV”. First, I applied the vinegar and bump #2 turned bright white with little red lines visible in it. Alternately, bump #1 turned more of a dull white with the application of the vinegar. After repeated application of the vinegar, bump #2 turned black and “burned off” leaving a little hole in the skin for a few days. After skin healed, bump #2 came back but was missing the little bump it originally had next to it. Dermatologist said bump #2 did not look like HPV. A year later, I applied the vinegar to bump #2 again but this time it did not turn white. I forgot to tell the new dermatologist that I had applied the vinegar a year earlier and bump #2 had burned off and come back. The new dermatologist did a biopsy of bump #2 and it was negative for HPV.

Main concern is that by applying the vinegar, bump #2 “burning off” and coming back and me not telling the dermatologist the bump had burned off and come back a year before the biopsy, I somehow screwed up an accurate biopsy of bump #2 and I should still be concerned there is undetected HPV around bump #2. Should I be concerned about this?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Thanks for the clarifications, but I understood most of this, including the important parts. None of this changes my opinion or advice. I remain confident the problem isn't (or wasn't) genital warts. Vinegar would not clear a wart or make a biopsy negative for wart tissue or detection of HPV and the biopsy remains solid proof. And you have two or three expert health care providers who agree, after direct examination. I suggest you stop worrying about all this, stop overthinking the situation, and move on with your life. 

That concludes the two follow-up comments and replies included with each thread and so concludes this thread. I hope the discussion has been helpful.
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