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Sexually Transmitted Diseases/Is this HPV or Squamous Papillomatosis?


QUESTION: I am a 24 year old female with Hashimoto's Disease, which has also caused a hormonal imbalance.  When I was diagnosed with the disorder 6 months ago, I had significantly low estrogen, testosterone, and progesterone. Since then, I have been on 50mg progesterone pills taken twice daily, and thyroid medication.

I have never had sexual intercourse, but I have had oral sex with 3 individuals.

3 months ago, I gave and received oral sex ONCE with an  individual.  A week or so later, I came down with the flu and then started suffering from what seemed to be a yeast infection. I have never had a yeast infection before.

I experienced extreme itching and burning around the entrance of my vagina and lower half of my vulva, but no discharge. I immediately panicked and thought that I had contracted an STD.  Upon inspection, I noticed finger-like growths around the entrance of my vagina.  I'm not sure how long they've been there, but I'm almost 100% certain they are new.  The yeast infection medicine seemed to work, and I tried to ignore the finger-like growths, hoping they would eventually disappear.  

Fast forward 3 months, and I looked at my vulva again because I could still feel the growths. Now, I have numerous growths that are significantly larger in size.  I'm really scared that I have HPV warts, but I'm hoping it's squamous papillomatosis.  If this is indeed squamous papillomatosis, I do not understand why I've suddenly gotten them.  Could it be caused by my hormone fluctuations?

I have attached 2 pictures of the growths that were taken last night.  I have zero pain or itching associated with the growths, now. I have an appointment with my gynecologist in a few months, but until then, can you please give me know your honest opinion? I'm freaking out!  Thanks!

ANSWER: Hello Rebecca,
As far as I know, Hashimoto's has NOTHING to do with the normal vulvar skin variation known as "squamous papillomatosis."  The closest variant in men is the "pearly penile papules," although I'm not 100% certain that they are anatomically homologous. There is some degree of controversy as to the role of HPV in squamous papillomatosis (SP). However in order for HPV to be a causative agent, then it must be found in all cases of SP, which is not so. Many attempts at isolating HPV from SP have failed to find it in 100% of all cases. Some people, such as yourself, have never had penile vaginal sex, and studies have failed to isolate the virus. Of course it is uncommon but not impossible to acquire HPV from non-traditional sexual means (i.e., oral sex, use of dildoes, contaminated wash cloths/underwear, etc.). But these are not likely!

Now that does not mean there are therapies that may help remove or minimize them, although some may view them as unnecessary cosmetic procedures. But the bottom line is it is not likely to be HPV!!

Good luck! Find a gynecologist to examine you and do the tests to reassure you.

---------- FOLLOW-UP ----------

QUESTION: Thanks for the quick reply, Mark!  I just have a quick follow-up question.  Does it look like any STD you've seen before?  Thanks again!

Hello Rebecca,
No,  it does not look like any other STD, although squamous papillomatosis is often confused with venereal warts and "hairy leukoplakia," which infrequently occurs on the tongue inside the mouth, which IS associated with HPV and herpes simplex in immunosuppressed people. HP does NOT occur in the vagina or vulva. I'm almost certain that the photos show SP, and they are NOT related to HPV.

Good luck!

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Mark P. Behar


Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!


Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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