Dr:

In the past, I have battled genital warts, both on my penis and around my anus. I have had surgery twice to remove large patches around the rectum. I am heterosexual, and my doctor wrote it off to promiscuity. I have had a couple of the warts near the rectum return in recent years, but they have not spread like before. This brings me to the problem. I was looking inside my mouth after a recent battle with the flu and noticed some wart like bumps at the very back of my tongue. There are several, and they look like warts, although they are the same color as the tissue of my tongue. I have used smokeless tobacco for years (I know, I'm trying to quit), and mouth cancer is a concern. While reading your answers, you mentioned "circumvallate papillae". Could it be that, or should I be concerned?

What you have described sounds very much like circumvallate papillae, which are a normal part of the anatomy of the tongue. Since you have a history of HPV and smokeless tobacco use, I strongly suggest that you visit a dentist who is experienced in oral pathology/medicine for routine check-ups.

We have recently completed a study, and submitted abstracts to both the International Oral AIDS Conference and International AIDS Conference concerning the increase in the presentation of oral warts we are seeing. I will say that of the 36 cases we diagnosed last year, only a few had oral warts present on the tongue and for the most part they were in the anterior 1/3 of the tongue.

Other background information: Human papillomavirus (HPV) is the most common sexually transmitted disease (STD), with 5.5 million cases occurring in the United States every year. Additional information about the virus can be obtained by calling the American Social Health Association's HPV Hot Line at 1-877-478-5868, or by visiting www.ashastd.org on the Internet.

Hope this helps!

DR