[Question #6194] HPV

18 months ago
Hello, I’m a 42 year old female who had a single episode of protected vaginal sex with a 43 year old male in November 2018.  This encounter  was outside my relationship. The other day in the shower, I could feel a couple of bumps on my buttocks right under the underwear line. They are very hard to visualize because of the location but almost look like a small group of pink pimples. I’m worried about genital warts although i examined myself and don’t see any elsewhere.  My major question is what kind of provider should I have look at it? Dermatologist, std clinic, ob gyn? Also, Does the timeframe seem likely for warts? I may have another follow up but realize we are supposed to limit posts to one.  Thank you in advance for the information. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome to the forum. Thanks for your confidence in our services.

Almost certainly the bumps you have noticed are not warts. Most important, both your description (pimple-like) and the location are wrong. Genital warts almost always make their appearance exactly where HPV was inoculated, i.e. sites of friction during sex -- in other words, in women usually the vaginal opening, labia minor, or nearby (or anal area for anal sex). Although sometimes warts appear on the buttocks, upper thighs, etc, these rarely are the only sites. As for appearance, genital or genital-area warts look very similar to common hand warts, which perhaps you had as a child -- or you can google to see photos of genital warts. They do not appear as red bumps or at all pimple-like.

The location, your mention of a "group" (cluster) of lesions, and their pimplie-like nature, suggest the possibility of herpes. I'm thinking mostly of herpes zoster (shingles), although it could be herpes simplex, specifically HSV2. Have you ever had reason to believe you have genital herpes? If not, that makes shingles more likely. Either of these will be more likely if the lesions change over the next few days to become even more pimple-like, with obvious pus, and/or open into ucers that form scabs. If it's either shingles or genital herpes, it is a reactivation of a longstanding infection, not a newly acquired one. But for sure don't worry about HPV/warts. That's clearly not what's going on.

The large majority of family medcine and other general physicians, and gynecologists, would recognize and know how to diagnose this problem; although some might refer you directly to a dermatologist, who definitely would have the necessary expertise. Either way, get seen ASAP, ideally in the next day or two. The sooner the better for accurate diagnosis, especially if the doctor recommends a swab from the lesions to check for varicella zoster virus (VZV), the cause of shingles, or HSV. And if antiviral treatment is recommended -- which definitely should happen if shingles is suspected -- it must be started promptly to provide maximum benefit.

You're not limited to one post. All questions come with two follow-up comments and replies, sometimes a few more depending on what information comes to light. Let me know if anything isn't clear -- and maybe also plan on letting me know the outcome after the problem has been professionally evaluated. In the meantime, I hope these comments are helpful.

HHH, MD
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18 months ago
Thank you Dr. Handsfield. I actually have had HSV-2 since I was 18 so I am familiar with herpes lesions even though I don't get them very much. These bumps are not at all painful (slightly itchy) and I have never had an outbreak in this location. I guess that is why my head went to HPV because the only reason I noticed them at all was just feeling that they were there.  I called providers today to attempt to get an appointment tomorrow to have it examined. Is it relevant to mention the encounter last November? Thanks again
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Thanis for the clarification. With your HSV2 history, that's a good bet for this being a mild recurrent outbreak, even if not as painful or otherwise as severe as previous ones. It is true that most recurrences occur in more or less the same spot (give or take an inch or so), but exceptions aren't rare. I'll bet that if you can see a doctor or clinic in the next day or two, when the bumps still are fresh, a PCR test from the bumps would be positive for HSV2. OTOH, if this clears up quickly and not especially bothersome, pehaps it isn't all that important for you to have a conclusive diagnosis. It's up to you!---
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
I forgot to answer your question about your sexual encounter 11 months ago. Probably this is unrelated, but a case can be made for telling your doc all potentially relevant information. If you didn't have the past HSV2 history, there would be a slight possibility of newly acquired asymptomatic herpes now recurrring. And that still could be possible, i.e. a new HSV1 infection. Also, in contrast to longstanding beliefs, in recent years it has become apparent that once in a while people with HSV2 acquire it a second time. But this is a long shot:  I'm betting HSV2 will be identifed by PCR, not related to last November's adventure. A mddle ground would be to say nothing now, but perhaps raise it later, e.g. if HSV1 and not HSV2 is diagnosed by PCR. (By the way, make sure the specimen gets an adequate sample, which will probably mean a bit of pain or unroofing one or more bumps e.g. with a needle before collecting the sample. Also, make sure the doc's lab requisition specifies typing, i.e. HSV1 vs 2 determination if positive for HSV. Some labs or docs don't do this routinely.)---
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