Conflicting Medical Opinions: Navigating HPV Treatment Options

Every doctor has a different opinion?

Thank you, doctor, for reviewing this information.
I am originally from Japan and was diagnosed with genital warts at a small clinic in Taichung in early June.
The doctor, who has experience in traditional Chinese medicine, directly recommended electrocautery or purchasing very expensive medication.
Later, I visited a traditional Chinese medicine clinic for gynecology, and they also suggested electrocautery.
Additionally, they prescribed a Candida suppository.
After that, I went to another clinic, Happiness Gynecology, where I received a topical ointment called "Kedou Ning" (similar to this name).
The doctor mentioned that there were also warts inside and said it was serious, but after applying the ointment, the external warts almost disappeared.

In July, I returned to Japan and continued to see the same gynecologist at a hospital who said my genital warts were not very severe and surprisingly stated that there were no warts inside, advising against electrocautery.
Instead, they prescribed a topical medication, which was very irritating and painful.
I later switched to medication to boost my immune system, but after two weeks of application, the condition worsened.
Initially, the warts were on the left side of the labia, and according to the Taiwanese doctor, there were warts inside as well.
Now, I feel that there might even be some on the upper part of the labia.

I have also undergone various detailed STD tests, including a Candida test, which came back negative, but the color and texture of my discharge still seem unusual.
I apologize for the lengthy description and would like to ask the doctor: 1.
Each doctor has given different opinions; what should I do? 2.
Is surgery necessary? Is it very expensive? 3.
Can Candida be undetectable?

A, 20~29 year old female. Ask Date: 2018/08/15

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In early June this year, I was diagnosed with genital warts at a small clinic in Taichung.
The doctor, who had experience in traditional Chinese medicine, directly suggested electrocautery or purchasing very expensive medication.
Later, I visited a traditional Chinese medicine practitioner specializing in obstetrics and gynecology, who also recommended electrocautery and prescribed a Candida suppository.
After that, I went to another clinic, Happiness Obstetrics and Gynecology, where I received a cream called "Kew Ning" (similar name).
The doctor mentioned that there were also warts inside and said it was serious, but after applying the cream, most of the external warts disappeared.

In July, I returned to Japan and continued to see the same obstetrician who said my genital warts were not very severe and surprisingly claimed there were no warts inside, advising against electrocautery.
Instead, I was prescribed topical medication, which was very irritating and painful.
Later, I switched to medication aimed at boosting my immune system, but after two weeks of application, the condition worsened.
Initially, the warts were on the left side of my labia, and according to the Taiwanese doctor, also inside, but now I feel there may be some on the top of my labia as well.
Additionally, I underwent various sexually transmitted infection tests, including for Candida, which all came back negative, but the color and texture of my discharge still seem unusual.

I apologize for the lengthy description and would like to ask the doctor: 1.
Each doctor has given different opinions; what should I do? Answer: Choose someone you trust.
2.
Is surgery necessary? Is it very expensive? Answer: Trust the person you choose.
3.
Can Candida be undetectable? Answer: It requires specific equipment to detect.

Reply Date: 2018/08/15

More Info

Navigating the complexities of HPV treatment can be challenging, especially when faced with conflicting medical opinions. Your situation highlights the importance of understanding the nature of HPV, its treatment options, and the implications of various medical recommendations. Here’s a comprehensive overview addressing your concerns.

1. Conflicting Medical Opinions
It’s not uncommon for different healthcare providers to have varying opinions on the treatment of HPV and related conditions. This can stem from differences in training, experience, and the specific circumstances of each patient. For instance, some doctors may prioritize immediate intervention, such as electrosurgery, especially if there are visible lesions (like warts), while others may adopt a more conservative approach, suggesting topical treatments or monitoring the situation before proceeding to more invasive options.

When faced with conflicting opinions, it’s essential to consider the following steps:
- Seek a Second Opinion: If you feel uncertain about the recommendations, consulting another specialist can provide clarity. Look for a healthcare provider who specializes in HPV and related conditions.

- Discuss Your Concerns: Openly communicate your worries and preferences with your healthcare provider. This dialogue can help tailor a treatment plan that aligns with your values and health goals.

- Research: Educate yourself about HPV and its treatments. Understanding the condition can empower you to make informed decisions about your care.

2. Is Surgery Necessary?
Surgery, such as electrosurgery or cryotherapy, is often recommended for visible warts or lesions that are causing discomfort or have a high risk of progression. However, whether surgery is necessary depends on several factors:
- Severity of the Condition: If the lesions are extensive or causing significant symptoms, surgical intervention may be warranted. Conversely, if the lesions are minimal and not causing issues, a watchful waiting approach may be appropriate.

- Response to Topical Treatments: If topical treatments (like the one you mentioned, possibly referring to imiquimod or similar) are effective, surgery may not be needed. However, if these treatments are causing irritation and not yielding results, discussing surgical options with your doctor may be necessary.

- Cost Considerations: If surgery is recommended, discuss the costs with your healthcare provider. They may offer payment plans or alternative treatment options that are more affordable.

3. Can Candida Be Undetected?
Candida infections can sometimes be tricky to diagnose. Standard tests may not always detect a Candida infection, especially if the fungal load is low or if the sample collected is not representative. Factors that can contribute to a negative test result include:
- Timing of the Test: If you were treated with antifungal medications before the test, it might have suppressed the Candida, leading to a negative result.

- Sample Collection: The method of sample collection can affect the detection of Candida. If the sample was not taken from an area where the infection was present, it may not show up.

If you suspect a Candida infection, consider discussing with your healthcare provider the possibility of empirical treatment, which involves treating based on symptoms rather than relying solely on test results.

Conclusion
In summary, navigating HPV treatment requires careful consideration of conflicting medical opinions, understanding the necessity of surgical intervention, and recognizing the complexities of diagnosing infections like Candida. It’s crucial to maintain open communication with your healthcare providers, seek second opinions when necessary, and stay informed about your condition. Ultimately, the goal is to find a treatment plan that effectively addresses your health concerns while aligning with your personal preferences and circumstances. Always prioritize your health and well-being, and don’t hesitate to advocate for yourself in the healthcare system.

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