Sexually Transmitted Diseases/HPV Warts or Swollen Anatomy?

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QUESTION: I had what I recently thought was a recurrent yeast infection. Discharge, swelling, itching, etc. My doctor did a bunch of STD tests and found nothing, including Yeast or BV. She put me on terconazole and most of the symptoms went away, but I still have slight irritation and swelling. Around the time this all began happening, these tiny bumps appeared right under my vaginal opening. I showed my doctor who dismissed them due to being too small. I had a second opinion where they performed an aceto-whitening test, and nothing turned white. However, I am still concerned. Do these bumps look like possible HPV warts? Should I push for a biopsy for confirmation? Or could these be normal anatomic variations brought out by inflammation?

ANSWER: Hello Lauren,
The tiny bumps you speak of are squamous papillomatosis, a normal variant of the vulvar anatomy, sometimes brought about through a mild inflammation. They are NOT related to warts or HPV. You are correct!!  Nothing to worry about. Absolutely no biopsy is needed based on these images.

Good luck!
--mark


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QUESTION: Thanks! A follow up: As irritation continues to grow, I've also noted these small bumps on my vaginal entrance itself. Are these concerning? (red arrow)

Also, is it okay that the blue arrow bumps are a little clumpier than the ones on the other side? Is this still possible for squamous papillomatosis?

ANSWER: Hello Again, Lauren,
Both the red and blue arrows point to normal variations in the vulvar skin.  Treat the irritation and these little things may not be as apparent. In other words, inflammation may play a role in their evolution.  

Good luck!
--mark


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QUESTION: I have an appointment with my gynecologist in just a couple of days to hopefully put this matter to rest, but I have one further follow up question which will help me be informed during my visit.

I was told that no acetowhite changes occurred at my doctors office, however there was no use of a colposcope. I performed an at-home acetowhite test, and found this diffuse acetowhitening to occur around my entire vulva, including the area over where my concerning bumps are. Can diffuse, non-specific, symmetrical acetowhitening such as can be seen in the pictures be normal? Or is this something I should push my doctor about at my visit?

Answer
Hi Again, Lauren,
Good observation.  Yes, indeed, the very nonspecific and diffuse acetowhitening you observe is a normal consequence of applying vinegar. If certain areas turn really white in comparison to surrounding areas, than THAT may be due to HPV/warts. A colposcope is just an instrument designed to magnify areas and allow observation with a bright light and a green filter, all of which designed to make abnormal lesions easier to see.  

Good luck!
--mark  

Sexually Transmitted Diseases

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Mark P. Behar

Expertise

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!

Experience

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.

Organizations
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)

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

Education/Credentials
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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