[Question #6067] HPV wart?

19 months ago
I have (what seems like) a strange formation at the back of my vaginal opening.  I have a lot of scar tissue from three births, so nothing looks exactly normal.  But this one area, I noticed several days ago has me afraid it could be a wart.  I went to my Dr today and she examined me, told me nothing looked like warts, then I ask are you sure not even that one spot and she says well, it could be a condolyma and looked at her computer and then was convinced that's what it was and prescribed Aldara.  I read that can't be used internally and her DX didn't seem completely assured.  My concern is....I have had unprotected sex with two different men one in July and one end of August.  I am still with the second man and my symptoms didn't start until after I was with him. First guy assured me he's never had an std and when asked about warts was very indignant that he's never had them. Second man is coming out of a ten year marriage and says he's never noticed anything either. I only started having symptoms after the second man.  Started with watery discharge and an itch vaginally, but nothing terrible. I used boric acid suppositories a few nights and that seemed to help.  But then it came back and I decided to look with a mirror, then convinced myself what I was seeing was a wart.  It's just a small, maybe the size of an eraser head, oblong formation, doesn't seem to look too much like cauliflower, although I can't tell for sure.  It just looks odd, but I don't know if that's because I am looking and never had or I've made it angry, or if it's something. To add to this, I tried to put vinegar (undiluted) on it and the surrounding area to see if it turned white and ouch.  I made everything completely raw and inflamed.  So then I really started to imagine the worst.  Dr said she didn't see anything else and I'm wondering how sure I should feel about this DX?  I have another appointment with a gyno in about a week, but I'd like to have an opinion on what else it could be?  Sho
Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
Welcome to our Forum.  I'll do my best to help.  Your question raises a number of issues.  I'll try to address the one's I note.  As an FYI, we provide up to three responses to each client's questions so that after this response you may have up to two further responses for the purpose of clarification.

1.  The "formation".  Thanks for your description of this lesion. Determination of whether this may or may not be a wart can be quite challenging and I endorse your decision to see a second opinion.  Although genital warts are common, there are also an enormous number of other dermatological conditions which also occur in the genital tract and can be difficult to distinguish.  If it turns out to be a wart, the question becomes, is that important?  The fact is that nearly all unvaccinated, sexually active adults acquired HPV infections at some time during life, that visible warts are almost always cosmetic nuisances only and do not progress to cause complications.  When people develop warts it is almost impossible to know how long it has been present or who it came from.  Warts take months to develop after infection starts.    

2.  Your partner's reaction.  Given what I have said above, I think he is over reacting and may not know much about HPV infections. The sponsor of this forum AHSA has an excellent HPV section on their website which may provide you and, should you care to discuss it with him, him useful information.  

3.  Your symptoms. Typically, warts are asymptomatic.  There could be another cause of your vaginal discharge.  Many causes of vaginal discharge are not due to STIs and may represent changes in the bacteria normally present in the vagina.  

4.  As you found out, vinegar can be VERY irritating.  Further the so-called "vinegar test" is non-specific and misleading.  That your lesion turned white does not help things - the lesion still may or may not be a wart.  

I hope that these response are helpful to you.  EWH  
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19 months ago
I have some more concerns and just wanting more information in general.  I am so thankful for this forum. I believe that I may be having some obsessive, anxiety driven thoughts about this due to my guilt and other life situations being very complicated.

Am I correct in my statement that Aldara should not be used on internal, opening to vagina skin?  If it is determined this is a wart by visual exam of another DR, is there a way to biopsy and know for sure?  Is there a way to test for the HPV strain that causes warts to know definitively? What would a good plan of treatment be? 

After looking at it more, I just don't think it is a wart, but again I'm no expert.  If it is a wart, is it normal to just have one?  As much as I've messed with it, would it spread in a day or two to other parts of my vagina?  It's only on one side and honestly looks like scar tissue with a bit of an odd shape formation at one end....almost pointy but not exactly.  Is it possible that having sex with the new guy could have irritated some tissue and made this skin take on a different shape?  Sex with him is a little painful, due to position and size. Would a dermatologist be a better option to have it looked at?

If it is a wart, you said they take months to appear....first guy was in mid-July and it's now end of September.  Would this be enough time?  Up until this first man, I was married for 16+ years....with no other sexual partners besides my husband.  As for going forward, the new guy is trying to be supportive (probably shouldn't have said anything until I knew for sure) but what does it mean going forward?  Of course, the thought of getting warts is less than appealing to anyone.  Would he be likely to get warts if that is what this is?  And I've read the virus can go away, but how do you know and is this the case for the wart causing strains?  Or is it a lifelong infection?

Also, in regards to the discharge....the DR did look at it under a microscope and said it doesn't look like yeast or BV...doing a test for Trich....but I keep having it and am spotting right now for my period (which is minimal due to IUD) but it is kind of like really small clumps, whitish, no smell, some are blood tinged of course. This discharge is definitely irritating everything and still causing an itchy sensation which makes me notice everything going on down there.  Would yeast be a possibility based on this description?  

Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
Straight to your questions:

One of the side effects of Aldara treatment if local inflammation. This can be quite irritating when it occurs at a mucosal site and for that reason many providers prefer alternative therapy such as liquid nitrogen, laser or removal in the context of a biopsy.    Biopsy specimens are the most specific way to make a diagnosis and HPV typing can be performed on biopsy specimens.  

There is substantial variation in clinical expertise but either a GYN or a dermatologist should be able to make a helpful visual assessment.  A dermatologist might be a bit more likely to perform a biopsy.  

Sex is about friction. Particularly with a new partner size and positive could lead to local irritation which in turn may have called your attention to this spot.  Going forward, use of a lubricant might help this.  

Glad to hear that your partner is being supportive.  Yes, the interval between July and late September is long enough for a wart to appear.  With regard to going forward, IF it is a wart you have both been exposed.  I would certainly try not to let a wart in any way interfere with your relationship, including sexual contact.  Also, remember, most people already have HPV- having had a wart should not make you less desirable.  Finally, yes HPV infections do go away on their own although this make take several years. Treatment accelerates the clearance.  

Regarding the discharge, what you describe could be yeast.  your doctor did the right thing by looking under the microscope but sometimes this can miss things.  The most common causes of vaginal discharge of the sort you describe are either yeast of a disruption in the normal bacteria in your vagina, called bacterial vaginosis.  i would suggest that you give your doctor a call and let him/her know that the discharge is still  present and is problematic.  

Hope this helps. EWH.  
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18 months ago
I just wanted to provide an update....went to gyno and it was NOT a wart!  It was explained to me that it was part of the hymenal ring and scar tissue, etc, that was irritated from sex and a BV infection.  Anyway, based on that news, would you say someone who is 42 would benefit from the HPV vaccine?  I had only been with my husband for the last 17 years and then these two men after.  The vaccine is expensive, so would it be of benefit in my situation?  And do I need the three doses or just two?  If I'm planning to be with the same person in a monogamous relationship from here on out, does it see worth it?

Also,  completely separate topic, but where do you fall on disclosure of HSV1 status when you aren't sure if it's genital (if so it would be 20 years old) and if it was oral it would date back to your teens (25+years ago) with no recurrence in any of that time?  Does disclosure seem necessary to you in this instance?

Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago

Welcome back to the Forum and thanks so much for the follow-up. Follow-up of this sort helps us to provide better advice.  The HPV vaccine is now approved or men and women up to age 45 so you are in the appropriate age group.  The vaccine is expensive, costing $400-600.  If you have health insurance, it may pay for it.  Worth checking.  In my opinion, there would be value to getting the vaccine as you re-enter the dating scene.  if you are in a relationship that is monogamous, there is less reason for getting the vaccine but I would still recommend regular reproductive health checks.  You indicate you have had just three lifetime partners and may be exposed in the future.  If you choose to receive the vaccine, it is recommended that you have three doses.  The two dose regimen is recommended only for females in their early teenage years. 

Regarding HSV-1.  I presume that you assume you have it due to a blood test result.  In most adults with HSV-1, they have acquired the infection as a child and the location of the infection is usually oral in location.  Further, future sex partners, like you, are more likely than not to also have HSV-1 (about 60% of adults do).  Thus, unless you get frequent cold sores, while I do endorse regular exchange of information about past STIs and sexual history. I do not feel strongly about disclosure of a positive blood test for HSV-1 for a person in her 40s.  Of course, there is no "right" answer to this and open exchange of information is almost always a good thing.

I hope this information is helpful to you and thanks again for your follow-up.  As per Forum guidelines, as this is now my 3rd response, this thread will now be closed.  Take care.  EWH

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