[Question #538] How believeable are negative wart biopsy?

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97 months ago
I am in a male in my early 30s and have been exposed to at least two partners with high risk HPV and at least one requiring a LEEP procedure.  This was all several years ago, and I know that I likely acquired their infection but it is also possible that it has been cleared after so much time.

My only remaining concern was two bumps on my penile raphe that have been there for many years (perhaps forever, I simply dont remember) that were prominent.  It came into my head that what if these two bumps I had for many years were unchanging warts.  I went to my family Doctor and he say "could be" but the fact that they remained unchanged for so long argued against it and sent me to the dermatologist.

I then saw the younger Nurse Practitioner at the dermatologist and she thought they were warts, but I was skeptical as I had them for so long.  The senior Dermatologist then inspected me, and immediately said not warts and were simply normal penile papules that were prominent because they were on my penile raphe and if I recall he did not think removal or biopsy was needed, but I requested biopsy due to the mixed opinion.  Both bumps were completely excised and sent for biopsy.

 The biopsy came back negative and I was told it was all normal penile skin.  Now, I know that a biopsy is only as good as the the pathologist reading it, but are negative results usually pretty clearly negative or there often a lot of fuzzy judgement calls involved?  How accurate are negative biopsy results?

What is your advice and what disclosure protocol should I follow given my likely past (or present) infection of HR HPV and possible? infection of wart inducing LR HPV?

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97 months ago
Apologies, but my post shows as recently updated... if there was a response to my question it doesnt seem to be displaying... if it is just a fluke, no worries....
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H. Hunter Handsfield, MD
97 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

First off, I would have recommended against biopsy. Your own reasonning -- i.e. persisting skin bumps for many years with no change in appearance or size -- plus the dermatologist's opinion were sufficient evidence against warts. That said, biopsy is the definitive test for wart tissue, and the negative result is conculsive. You have misunderstood or over-interpreted information you have seen about reliability of pathology and pathologists. It may be true for certain kinds of abnormalties in the biopsy, but the distinction between normal skin and warts is an easy one that no basically trained pathologist would miss. And of course you don't have only the biopsy result:  you have that negative outcome plus the other evidence already discussed. Considered together, there is no realistic chance the bumps are warts.

Could you still have HPV? Sure. Almost all sexually active people (90% minimum) acquire genital HPV at least once, and between the ages of about 20 and 30, 20-50% of people are infected at any point in time. You're beyond that range, but there's still at least a fair chance. But if so, it depends on more recent sexual partnership, and not on your non-wart genital bumps or your past partnerships with HPV infected persons. Assuming you've had other sexual partnerships along the line, the risk you have HPV is no higher from those who were diagnosed with HPV related problems than it was from others with HPV that was never suspected or diagnosed. In any case, as it seems you already know, the large majority of genital HPV infections are cleared by the immune system and never cause health problems either in infected persons or their sex partners.

In summary, for sure the penile bumps are not warts or related in any way to HPV. And I see no need for you to be concerned about HPV at this time. For sure there is no need to tell current or future sex partners of your past concerns about it.

I hope this has been helpful. Let me know if anything isn't clear.

Best wishes--  HHH, MD