'I'm pre-op trans woman in her early 30's. In 2019, I noticed a small bump on my penis after shaving, and had it looked at by a primary care physician. I assumed it was an ingrown hair,  because I have sensitive skin. It presented as round, non-characteristic of the cauliflower shape that seems so pervasive. He said it was a genital wart, and prescribed me podofilox. It appeared to more or less dissipate. A year later, I had my primary care look at it, and he referred me to a dermatologist. The dermatologist was a bit puzzled by it, thinking it to be a cyst or something else. He sent it for biopsy, and it tested negative for HPV but he told me it was still probably an old genital wart, based on the previous primary clinicians visual diagnosis. 6 months later, I saw a bit of growth and went to another dermatologist for a second opinion. He said it was suspect, and took another biopsy. No HPV detected, and was diagnosed with benign keratosis. It appears to be happening in the same location, and I'm honestly curious if there is an ingrown hair that never came out, that may be causing the issue. When I asked the most recent provider if there is an explanation for this, he said he couldn't confirm if it was HPV or not. The uncertainty is sort of killing me, because I have the added complexity of a potential STD on top of transitioning, and I'm feeling a bit disheartened. I'm now vaccinated against HPV. Little bit of my history - I was with a partner monogamously for 3 years prior to being symptomatic. I've actively practiced safe sex almost entirely,  except unprotected with 2 partners. I've also been tucking (wearing tight underwear) for about the past decade, and have constantly battled body hair. Do you have a perspective of the likelihood I actually have HPV, and how I should communicate these findings to future partners? I don't want to unnecessarily scare people off it's nothing. 

I encourage you not to be "disheartened" at all. It seems most likely that you do not have a genital wart and never did. But even if the original lesion was a wart, biopsies are conclusive:  what you have now is a benign keratosis.

That said, you can assume you have been infected with HPV and could still have a continuing but inactive infection. At least 80-90% of all sexually active people acquire genital area (including anal) HPV at least once, and somewhere around 50% of all people acquire HPV within their first three lifetime sex partners. The frequency probably is not significantly lower in people with consistent safe sex practices:  condoms reduce the transmission risk for any single exposure, but probably only by 60-70% (mostly because of skin contact above the condom). Therefore, over multiple exposures and/or partners, condoms are not very protective against HPV; and research studies have reported pretty much equal frequencies of HPV in people who do or do not report consistent condom use. Fortunately, the large majority of infections remain subclinical, i.e. never causing warts, pre-cancer, or genital cancer itself. The universality of HPV, regardless of sexual lifestyle, is why all women (speaking now anatomically, i.e. cis-gender females) need routine Pap smears periodically to prevent cervical cancer. 

Because everyone (i.e. all your potential sex partners in the future) has HPV, in general there is no need to inform partners of past infection. In other words, all sexually active persons should understand that sex with a new partner always carries some risk for HPV. This, of course, is why immunization is available and recommended. Although most infections cause no harm, there is always some risk of warts, and genital, anal and throat cancers; and the vaccine prevents infection with the 9 HPV strains that cause 90% of these problems. So I would encourage you to get vaccinated -- but I would also suggest that with or without immunization, you need not mention your past possible genital wart to prospective partners. (That said, many people discuss past STIs with prospective partners, especially when a relationship may have promise for ongoing mutual commitment. But this is more in the realm of demonstrating respect and commitment, not prevention of infection.)

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

HHH, MD