Misdiagnosis Concerns: Navigating Urological Health Issues - Urology

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Was there a misdiagnosis?


Previously, I visited a gynecologist due to issues with vaginal discharge.
During my first appointment, the doctor performed an internal examination and diagnosed me with vaginitis, for which I received medication and suppositories.
At my second visit, the doctor examined me again and noted that there was still vaginal discharge, advising me to continue the medication.
I took the opportunity to ask some questions because I had noticed what seemed to be small polyps appearing just below the vaginal opening (flesh-colored, only one or two, not itchy or painful, resembling polyps, but I don’t recall having them before).
These had been present for some time (about a few months, and they had not increased in number, just one or two), and I had no discomfort.
Initially, the doctor said they were likely small skin tags, but after a while, he changed his statement to say they looked somewhat like warts.
I was taken aback and sought clarification, but he only said they looked similar and did not provide a definitive diagnosis.
He then decided to treat them immediately.

His method of treatment involved applying a medication that was not a cream but was in a dark brown glass bottle.
During the procedure, I felt a burning sensation.
It seemed he used his gloved hand to apply the medication to the affected area and then manipulated the small polyp.
Throughout this process, I was surprised and skeptical because he repeatedly stated "it looks like" without giving me a clear diagnosis.
I asked him more than three times, and he only responded with "it looks like," without conducting any further tests to confirm.

I have not engaged in unclean or promiscuous sexual behavior; I have only one partner, and we are both very mindful of hygiene, always using condoms during intercourse.
I asked the doctor if using condoms could still transmit the virus (as I found online that warts can still be transmitted even with condom use), but his response was, "That should not be the case," which was another uncertain answer that made me question his professionalism.
He is supposedly an experienced gynecologist, but I am unsure whether to trust his expertise or suspect a misdiagnosis.
He also mentioned that it could be a case of accidental infection from public places (like public restrooms or hot springs).

After the treatment, he did not prescribe any medication for warts (either oral or topical), only medication for the vaginal discharge and a small tube of cream (Miconazole cream) to apply to the small wound from the polyp removal (this cream was also prescribed during my previous visit for the discharge, and he mentioned it could be used for itching, but I did not use it then).
After returning home, I diligently researched and felt that the small polyp did not resemble warts, and the treatment process did not align with typical wart treatment methods, which usually involve electrocautery or topical medications, both of which are generally expensive.
However, I was not charged any additional fees apart from the initial consultation fee, which left me feeling confused and worried!
I considered visiting another gynecologist for a second opinion, but since the polyp has already been treated, can it still be diagnosed as warts? I also thought about getting a blood test for confirmation (because if I unfortunately do have warts, I need to inform my boyfriend and have him get tested and treated), but I found conflicting information: some say warts can be detected through blood tests, while others say they cannot.
I am truly feeling quite troubled and anxious.

I would like to ask the doctor: Is my condition really warts? Since it has already been treated, can another gynecologist still diagnose it? I genuinely do not know whether to trust that doctor or my own doubts.
Please give me some advice.
Thank you very much!

Lü Chá, 20~29 year old female. Ask Date: 2007/03/18

Dr. Xu Weikai reply Urology


Green tea: Hello, I appreciate your detailed description.
In fact, many people, especially those who are health-conscious, can relate to this.
Cauliflower is actually a colloquial term for genital warts, which typically appear on mucous membranes, such as in the genital area, and can grow quite large in severe cases.
They usually occur in multiple lesions rather than as a single wart, and they often have a finger-like appearance with a deep brown color.
Diagnosis is generally straightforward and relies on the physician's experience; a trained eye can often identify it with over 95% accuracy.
For lesions that appear atypical or raise suspicion, a biopsy may be necessary (blood tests are usually not required).

As for treatment, I believe you have researched various options and have some understanding: the most commonly used methods include local electrosurgery, cryotherapy with liquid nitrogen, chemical ablation, and surgical excision.
Since the virus can sometimes remain dormant, it typically requires 2-3 treatment sessions for complete resolution.
Furthermore, if no new lesions appear after 8 weeks post-treatment, it can generally be considered a successful outcome.

Regarding whether the physician at the medical facility misdiagnosed or if your lesions are indeed unusual, I cannot ascertain.
My recommendation is that if new lesions develop within the following 8 weeks, it would be prudent to undergo a biopsy to confirm the diagnosis and to examine the entire vaginal area for any deeper lesions.
As for whether to inform your boyfriend, I believe it would be best to share your current situation with him (this is my personal opinion) to avoid any future disputes; after all, honesty is the best policy.

In men, genital warts are easier to examine because, unlike women, they do not sometimes grow inside the vagina where they are not visible.
The diagnosis and treatment process is generally much simpler for men.

Note: 1.
General clinics typically do not have a pathology department, and if they do not have a contract with a larger hospital, they usually will not perform biopsies.
(The following is just my personal perspective and can be disregarded.) 2.
Currently, the National Health Insurance Administration may impose various difficulties on medical facilities.
For example, if a medical facility treats your genital warts and charges you for special medications, reporting this to the National Health Insurance Administration could lead to punitive measures based on "technicalities" (usually, patient reports are taken seriously, and the explanations from medical facilities often do not mitigate the situation, as they are also under scrutiny).
If the National Health Insurance Administration deems the situation serious, they may suspend the facility's contract for 1-3 months.
Therefore, many medical facilities often absorb such costs to avoid complications and direct out-of-pocket charges to patients.
This is a unique situation arising from the current healthcare system where the payer and the supervisory body (both are the National Health Insurance Administration) are the same entity, which I personally believe is not necessarily beneficial for patients, as it prevents them from accessing new medications or treatments when the National Health Insurance Administration has not yet established a contract.

Sincerely,
Dr.
Hsu Wei-Kai, Head of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2007/03/18

More Info


Navigating health concerns, especially those related to urological and gynecological issues, can be quite stressful, particularly when faced with potential misdiagnosis. In your case, it appears that you have undergone treatment for a condition that may or may not be accurately diagnosed as genital warts (often referred to as "cauliflower-like" growths due to their appearance), and you have valid concerns regarding the diagnosis and treatment you received.

Firstly, it’s important to understand that genital warts are caused by certain strains of the human papillomavirus (HPV). While they can be transmitted through sexual contact, it is also possible to contract HPV through non-sexual means, such as shared surfaces in public places. However, the most common transmission route is indeed sexual contact, even with the use of condoms, as they do not cover all areas that may come into contact with the virus.

The uncertainty you experienced during your consultation is concerning. A definitive diagnosis typically requires a thorough examination, and in some cases, a biopsy may be necessary to confirm the presence of HPV or to rule out other conditions. The fact that your doctor was hesitant to provide a clear diagnosis and instead used vague language like "it looks like" can understandably lead to confusion and anxiety.

Regarding your treatment, the method used to remove the growths may not align with standard practices for treating genital warts. Common treatments include cryotherapy (freezing), laser treatment, or topical medications specifically designed for warts. The method of applying a caustic agent to burn off the growths, while it can be effective, should ideally be accompanied by a clear explanation of the diagnosis and the rationale for the chosen treatment.

Since the growths have already been treated, it may be challenging to obtain a definitive diagnosis from another healthcare provider. However, it is still possible for a new doctor to assess the area and provide insights based on the appearance of the skin and any residual effects from the treatment. If there are any new symptoms or changes, these should be communicated to the new provider.

As for testing, blood tests for HPV are not routinely performed because there is currently no FDA-approved test for HPV in men or for most types of HPV in women. However, if you are concerned about potential HPV infection, discussing this with a healthcare provider is essential. They may recommend a Pap smear or HPV test if you are due for routine screening.

In light of your concerns, I recommend the following steps:
1. Seek a Second Opinion: Find a reputable gynecologist or urologist who can provide a thorough examination and discuss your concerns. It’s important to feel comfortable and confident in your healthcare provider.

2. Document Your Symptoms: Keep a record of any changes or symptoms you experience, including the appearance of any growths, discomfort, or changes in discharge. This information can be helpful for your new provider.

3. Discuss HPV Testing: While routine blood tests for HPV are not available, your new provider can discuss appropriate screening methods based on your health history and current symptoms.

4. Communicate with Your Partner: If you are diagnosed with HPV or genital warts, it is essential to have an open and honest conversation with your partner about potential risks and the importance of regular check-ups.

5. Mental Health Support: Given the anxiety surrounding your health concerns, consider speaking with a mental health professional who can help you manage stress and anxiety related to your health.

In conclusion, your health and peace of mind are paramount. Seeking clarity and reassurance from a qualified healthcare provider is essential in navigating these concerns. Remember, you have the right to advocate for your health and seek the answers you need.

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