Accuracy of HPV DNA Testing for Diagnosing Genital Warts

Accuracy of cauliflower slice and HPV DNA testing?

Two weeks ago, I went to a gynecology clinic due to itching in my private area.
During the internal examination, the doctor diagnosed me with vaginitis and noticed something abnormal when applying medication.
It turned white after using acetic acid, and then a biopsy was performed, which shocked me! My boyfriend often travels abroad, and during our two-year relationship, we have only been intimate twice: the first time with a condom and the second time without (which happened last April).
Shortly after, he flew abroad for work! During this time, I have not had any sexual relations with anyone else, nor have I engaged in any intimate contact or come into contact with anyone's bodily fluids.
While waiting for the biopsy results, I visited two dermatology clinics, where the dermatologists suggested that I might have vestibular papillomatosis and advised me to stay calm.
I also researched the differences between true and false warts online, and what I have looks coral-like.
I initially felt reassured going to hear the results, but I was not expecting this outcome! The doctor asked if I wanted to undergo HPV DNA testing for $1500.
I agreed, but he mentioned that this test checks for cervical cancer or other lesions.
However, I really want to know if this would change the diagnosis regarding the warts! I would rather be told it’s cancer than have warts, as they carry a stigma! Furthermore, while my boyfriend is abroad, I do have desires, but I rely on masturbation to relieve them (with proper sanitation).
I am very cautious about health and would never engage in risky behavior, so this diagnosis feels incredibly unfair to me!!! I told my boyfriend about this, and he checked himself and found nothing unusual with his genitals.
He is also skeptical about the biopsy results because he has a friend whose child had a blood type that he could not have fathered, but later found out it was a Bombay blood type, leading to a misdiagnosis at the previous lab.
I have other questions for the doctor: 1.
If I have warts in my genital area, could I also have the virus in my oral cavity? 2.
My boyfriend is coming back in the middle of this month; is it safe to kiss? Can we even kiss? 3.
How can we determine when it is safe to resume sexual activity after treatment?

Tai Yuan Le, 20~29 year old female. Ask Date: 2022/08/05

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you have genital warts, which may not necessarily be present in the oral cavity.
It appears that the pathology report does not indicate warts, so it should be safe.
Wishing you good health.

Reply Date: 2022/08/05

More Info

The accuracy of HPV DNA testing for diagnosing genital warts (condylomata acuminata) can be complex and is influenced by several factors. First, it's important to understand that HPV (human papillomavirus) is a group of more than 200 related viruses, of which some are classified as high-risk and others as low-risk. Genital warts are typically caused by low-risk HPV types, such as HPV 6 and 11.
When you underwent a biopsy and the results indicated the presence of genital warts, it is crucial to understand that the biopsy is a direct examination of the tissue and is considered the gold standard for diagnosis. The biopsy can confirm the presence of warts and help differentiate them from other conditions that may appear similar, such as pearly penile papules or vestibular papillomatosis, which are benign and not caused by HPV.

HPV DNA testing, on the other hand, is primarily used to detect high-risk HPV types associated with cervical cancer and other malignancies. While HPV DNA testing can provide valuable information about the presence of high-risk HPV, it is not typically used to diagnose genital warts. Therefore, the results of HPV DNA testing may not directly correlate with the diagnosis of genital warts. In your case, since the biopsy confirmed the presence of warts, the HPV DNA test may not change the diagnosis but can provide additional information about the risk of cervical cancer if high-risk types are detected.

Regarding your concerns about transmission and the implications for your relationship, it is understandable to feel anxious. Here are answers to your specific questions:
1. Can I have the virus in my mouth if I have genital warts?: It is possible to have HPV in both the genital area and the oral cavity, especially if there has been oral-genital contact. However, not all individuals with genital warts will have oral HPV. If you have not engaged in oral sex, the likelihood of having oral HPV is lower.

2. Is it safe to kiss my boyfriend when he returns?: Kissing is generally considered low-risk for HPV transmission, especially if there are no visible lesions in the oral cavity. However, if you are concerned about transmission, it may be prudent to discuss your diagnosis with your boyfriend and consider waiting until you have more information about your health status.

3. How can I determine when it is safe to resume sexual activity?: It is essential to follow your healthcare provider's recommendations regarding treatment and follow-up. After treatment for genital warts, it is typically advised to wait until the warts are completely resolved and you have been cleared by your doctor before resuming sexual activity. Regular follow-up appointments and HPV testing can help monitor your status.

In summary, while HPV DNA testing is a useful tool for assessing the risk of cervical cancer, it is not the primary method for diagnosing genital warts. The biopsy results are definitive for warts. It is essential to maintain open communication with your partner and healthcare provider to address any concerns and ensure both of you are informed about your health. Regular check-ups and following medical advice will help manage your condition effectively.

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