Lesion

[jann20]

I had a non healing lesion or 'vesicle' as my physician called it inside the opening of my vagina.  It was there for 4years and never healed.  I got several opinions and no one ever thought it was worrisome.  It was tender to the touch.  Finally a physician said we could biopsy it and it came back a genital wart.  My physician was surprised because it was by itself and didn't manifest as a typical wart.  Whenever i see pictures of veneral warts they look nothing like this and there are usually more than just one.  Have you ever seen a wart like this?  Does this mean I have some strange strain of HPV or could this be a typical strain that just manifested itself differently on me?

Also, if warts don't show up on someone with HPV, where does the HPV virus go?  Does it stay in the vaginal secretions?  Where exactly does it dwell if someone has it but doesn't have warts?  My local news channel talked about oral and espophageal cancers and said one risk factor is HPV.  How is HPV detected in these cancers if it they are strains that don't cause warts.  I've always been told it's very rare to even have oral HPV unless you are immunocompromised, but is this no longer the case?  
  

[Edward W Hook, MD]

Yes, you understoo what I said.  The best example is women with so-called "flat warts" in which there is no visble abnormality but biopsy shows HPV. This is a very common occurrence.  EWH

[jann20]

Thanks that is helpful.

To be clear, you say "HPV infections can be present in normal appearing tissue without forming a wart".  Does this mean that hypothetically you could biopsy a normal appearing area of tissue, and if HPV is present it will actually show this on the biopsy?  Or will it only show up if the HPV has progressed to dysplasia?  

[Edward W Hook, MD]

Welcome back to the Forum.  What you describe would certainly be a most unusual presentation for a wart or other manifestation of HPV infection, as your doctor has told you.  I certainly have not encountered such a presentation in my own practice or in my reading of the scientific literature.  In this situation my approach would be to discuss the biopsy result with the pathologist who studied the biopsy tissue.  A possibility that I would ask about would be that what was there was a cyst or other structure which then became infected with HPV rather than the possibility that the lesion that had been there for the past 4 years has always been a wart and nothing else.  Perhaps the pathologist would have another explanation.

HPV infections can be present in normal appearing tissue without forming a wart.  In such cases the skin cells become infected with HPV but do not grow in the heaped up fashion that results in what we call warts.

HPV is associated with esophageal and oral cancers however these are very rare cancers an typically occur in persons who have other risk factors such as smoking as well as oral HPV.   Even with both factors are present, most people do not win up with these sorts of cancers.  When present it is detected by biopsy and special studies.

Hope these comments help.  EWH