Diagnosis of external genital HPV lesions is not always straight-forward. Normal papillary tissue in the vestibule of the female (micro papillomatosis) may be confused with HPV disease. Accurate diagnosis of these papillations in the female can usually be made on the basis of a single base for each projection in micro papillomatosis. HPV typically has multiple projections coming off a single base.
The vulva is optimally visualized after acetic acid application and the use of a vulvoscope (colposcope or a hand held magnifying lens). Biopsy and pathological examination should be considered in the following situations:
- Lesions that are surrounded by either thickened skin or color changes.
- Lesions that are raised, red or pigmented.
- Presumed genital warts that fail to respond to two or three office treatments.
- Vulvar changes that do not respond to medical therapy, such as squamous cell hyperplasia and lichen sclerosus.
- When any suspicion of neoplasia exists.