[Question #5643] HPV Question

21 months ago
Hi Doctor,

Thanks for this awesome resource. For about six months now I have had vulvar itching and irritation which has recently been affecting the internal area as well. Hydrocortisone cream calms it down, but I always know its there. My friend who has also been dealing with the same symptoms as me, through a vulvar biopsy was diagnosed with genital warts, though no warts she or her gyno can see  are present and she suggest I do this as well. Though she says her gyno tested her for all infections, I can't help but wonder if a different infection or condition is causing these symptoms? Do you think a biopsy would be helpful for me or not worth it? It seems that for most people, they do not deal with irritation and such, the warts just appear. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Welcome to the forum and thank you for your kind words. Unfortunately, I don't think I can help much. I wish I could.

Vulvar itching or pain -- often termed vulvodynia -- is a common and difficult problem, for both patients and their doctors. (The fancy term doesn't really mean much. Vulvodynia is just Latin [or Greek?] for vulvar pain.) The causes are unknown, but as best we know, HPV doesn't cause it. Up to half of all people age 20-50 have detectable HPV in genital tissues, so it stands to reason that some people with vulvodynia also have HPV. But that doesn't mean HPV is the cause. So most likely this is the situation with your friend. Since this problems isn't an STD, I really can't say much more. When patients with this problem come to the STD clinic, all we can do is test for common STDs like gonorrhea, chlamydia, trichomonas, syphilis, HIV, and sometimes herpes, and check for non-STD vaginal infections, like yeast and bacterial vaginosis. When those results are negative, as they usually are, we refer the patient to a gynecologist, preferably one with particular interest in vulvar itching and pain.

As those comments imply, your own closing statement is exactly right. Genital HPV causes no symptoms other than growth of warts. As far as we know, they don't itch or feel irritate. (Extensive warts can get irritated and infected, and may itch. But that's not what we're talking about here.)

If you have been at possible risk for STDs -- e.g. if you're a typical single woman with a handful of different sex partners over the last few months or years -- it would be reasonable to be tested for common STDs, and of course follow standard recommendations for pap smears from time to time, which may include HPV testing. But it is unlikely HPV or any other STD explains your itching. Find a gynecologist you trust and take it from there.

Sorry I can't give you a more conclusive answer. But let me know if anything isn't clear.

HHH, MD
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21 months ago
Gotcha, that makes sense thanks. Just to follow up, is itching a symptom of vulvodynia? And is it true that hpv hides in hair follicles? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Itching and vulvodynia aren't necessarily the same thing. Some women describe such severe itching that they consider it painful. I'm not an expert in this area -- there's some overlap, but I'm not aware of specific criteria that define vulvodynia.

HPV is not concentrated in hair follicles or "hide" there. Most HPV infections cause no visible abnormality, but that doesn't mean the virus is "hiding" anywhere. It just doesn't cause visible changes in skin, except when warts appear -- which happens only with certain HPV types.

Have you had the HPV vaccine? If so, at what age and how many doses? How old are you now?

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21 months ago
I got the first dose at 17, 2nd at 18 (both before sexually active) and forgot about the third, which I got at 20. 

I feel that what you were saying makes sense. I talked to my friend and she went to PP to get another opinion, she was given yeast medication and she said some irritation went down, she still has some redness on her labias. So like you said, it seems like it could be something else. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
I agree your friend's improvement on yeast treatment strongly supports that diagnosis and not HPV. I didn't think to say it above, but yeast indeed is the most common cause of genital itching in women; my comments about vulvodynia etc assumed you ahd been evaluated medically and no specific cause was found. I also was assuming this is a long term problem. If recent onset and you have not been professionally evvaulated, you definitely should do that.

You are fully protected against the 4 or 9 HPV types in the vaccine (depending on whether you were vaccinated within the last few years or earlier), which together account for the large majority of genital warts and cancers -- not counting any types to which you might have been exposed before vaccination, if you were sexually active before the first dose. Most likely you'll never have warts, abnormal pap smear, or any other HPV related problems.

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