Confusion Over HPV Diagnosis: Urology vs Dermatology Insights

The urine test for warts (condyloma) was negative, but the dermatologist still diagnosed it as warts. Thank you, doctor?

Last year, between September and October, I had unprotected sexual intercourse three times with three different women.
Then, around early November, I discovered a small lump near the junction of my abdomen and penis, about the size of a typical mole.
Since it was in the pubic hair area, I was unsure if it was something I had before or if it had developed later, so I went to see a urologist.
The urologist diagnosed it as genital warts and prescribed me antiviral oral medication and a topical ointment (Podophyllotoxin).
That same day, I also had blood tests for STIs (HIV, syphilis, HSV-1, HSV-2, chlamydia, and DNA (PCR) for gonorrhea).
When I returned the following week for the results, all tests were negative.
After using the ointment for three weeks without any signs of reduction or improvement, I decided to have a wart test.
The urologist used a hard bristle brush to collect samples from the wart area, glans, and the sulcus of the penis.
A few days later, the results were also negative.
The urologist then suggested that what I had might not be genital warts but rather common viral warts.
However, I found that genital warts are a type of viral wart, which confused me because the doctor said it wasn't.
To be cautious, I consulted a dermatologist.
I explained the situation to the dermatologist, who examined it under a magnifying glass and confirmed that it was indeed genital warts.
I subsequently underwent five cryotherapy treatments, and the scabbed areas have fallen off.
Now, the wart-like lesions are no longer visible to the naked eye.
My questions are as follows:
1.
If the dermatologist confirmed it was genital warts, why did the urologist's tests come back negative?
2.
The area where I applied the ointment has been itchy and red.
Is this a side effect? Did I apply the ointment incorrectly by covering it directly without spreading it out? If the itching persists, should I stop using the wart ointment?
3.
I asked the dermatologist if I should get the HPV vaccine.
The doctor said it is advisable, but the HPV vaccine only protects against the more common strains and is not effective against every virus.
Is this true?
4.
If I later see the urologist and say I have healed, will I still need to continue using the wart ointment to prevent recurrence? Thank you for your patience in answering my questions.

Xiao Shan Xia, 30~39 year old female. Ask Date: 2023/01/28

Dr. Chen Jiansheng reply Urology

Please seek medical attention.

Reply Date: 2023/01/28

More Info

When it comes to HPV (Human Papillomavirus) and its associated conditions, such as genital warts (commonly referred to as "cauliflower" due to their appearance), there can be considerable confusion, especially when different specialists provide varying opinions. Let's address your questions systematically.

1. Discrepancy in HPV Diagnosis: The fact that your urologist's tests returned negative for HPV while your dermatologist confirmed the presence of genital warts can be perplexing. It's important to note that not all HPV tests are created equal. The urologist may have conducted a test that was not sensitive enough to detect the specific strain of HPV responsible for your warts. Additionally, the presence of visible warts does not always correlate with a positive HPV DNA test, as some strains may not be detected by standard testing methods. Genital warts are typically caused by low-risk HPV types (like HPV 6 and 11), which may not always be included in broader HPV screening tests.

2. Side Effects of Treatment: The itching and redness you are experiencing after applying the topical treatment could indeed be side effects of the medication. It's crucial to apply such treatments as directed, ensuring that the area is clean and dry before application. If the medication is causing significant irritation, it may be wise to stop using it and consult your healthcare provider for alternative options or to confirm that you are using it correctly. Over-application or improper application can lead to skin irritation, which may exacerbate your symptoms.

3. HPV Vaccine Efficacy: Your dermatologist's advice regarding the HPV vaccine is accurate. The HPV vaccine is designed to protect against the most common and high-risk strains of HPV that are associated with cervical cancer and other anogenital cancers. However, it does not cover every strain of HPV, particularly those that may cause warts. Therefore, while vaccination can significantly reduce your risk of developing HPV-related diseases, it is not a guarantee against all HPV infections.

4. Post-Treatment Care: After undergoing treatment for genital warts, it is essential to follow up with your healthcare provider. If your urologist confirms that the warts have resolved, you may not need to continue using the topical medication. However, it is crucial to have regular check-ups to monitor for any recurrence, as HPV can remain dormant in the body and may lead to new warts in the future. Your healthcare provider will guide you on the best course of action based on your individual situation.

In summary, navigating HPV-related diagnoses and treatments can be complex, especially when different specialists provide differing opinions. It is essential to maintain open communication with your healthcare providers, seek clarification on any discrepancies, and follow their recommendations for treatment and follow-up care. Regular monitoring and preventive measures, such as vaccination, can significantly contribute to managing HPV and reducing the risk of complications. Always prioritize your health and well-being by staying informed and proactive in your healthcare decisions.

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