[Question #2027] Fordyce or HPV

46 months ago
Dear Doctors,

Earlier this year, I went to the doctor for what turned out to be molluscum. 

I was tested for HSV, HIV, Syphilis, Chlamydia and Gonorrhea with negative results, except for HSV IgM (1.3 low index positive). HSV IgG and PCR were negative, IgG remained negative at 6 weeks. Terri was kind enough to address a number of my concerns and I'm fairly confident I don't have HSV 1 or 2. 

During this time, I noticed some clusters of bumps around the very end of my foreskin (on the outside), along with a small whitehead on the frenulum. I'm uncircumcised and over the years avoided retracting the foreskin due to discomfort, so these clusters could've been there for a long time without my knowledge. As it stands, I've seen them there for over 1.5 months, no change, no spread, no pain. The clusters are only visible when the skin is stretched and look like the fordyce spots people have on their lips. 

I was seen by the Physician's Assistant at the dermatologist's office and she seems at a loss. She initially thought they could be HSV. After the negative IgG, she thinks maybe HPV, maybe nothing at all. She advised me to keep an eye out for changes and to ask my PCP for her opinion. 

My primary care doctor thought it could be HPV when I described it to her, but once she examined me she said I had nothing to worry about. 

I would like to be conscientious for the sake of my future partners, and I was wondering if you have any ideas about what these bumps could be. I do have oily skin and a tendency for acne, so I thought the whitehead on the frenulum could be a sebaceous growth of some kind, while the clusters around the foreskin look like fordyce. I've always used condoms for vaginal intercourse, but have had unprotected oral sex before. I've been abstinent for the last 2 months while sorting this out. 

Any thoughts or input would be appreciated, and thank you again for offering a space where we can get informed answers to our questions.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome back to the forum. Thanks for your question and for your kind comment about our services.

I reviewed your discussion with Terri about herpes and your molluscum contagiosum a few weeks ago. I agree with all she said, including her comments about the HSV IgM antibody test.

While I cannot make a specific diagnosis based on your description, I am certain this problem isn't herpes and very doubtful you have genital warts. Fordyce spots sounds like a good bet, probably inclluding the one on fhe frenulum. As you see to know, these are entirely normal, simply prominently visible sebaceous glands, usually most obvious on the genitals and lips. Indeed, the possible "sebaceous growth" terminology is consistent with the one of the frenulum simply being a more prominent fordyce spots than the others.) Your situation is a good lesson in the importance of the time course of genital skin bumps (and many other conditions) rather than examination only once; and also a warning about seeking repeated medical exams or opinions. While it is conceivable the Fordyce spots or similar skin bumps might make a doctor think of herpes, for example, herpes lesions always would either clear entirely or worsen (becoming obvious blisters, sores, scabs, etc) with a few days; unchanging appearance over time proves herpes isn't the cause. As for warts, they rarely show up with multiple bumps all looking more or less the same:  warts are almost always irregular and random in their distribution. 

My advice is to just accept your genital anatomy for what it is, stop examining yourself, and stop seeking professional opinions about it. Whatever is going on, for sure it's not an STD and nothing else likely to be harmful to you or future sex partners. I wouldn't even mention it to them, nor do you need to mention your past molluscum.

I hope this has been helpful. Let me know if anything isn't clear. Best wishes and stay safe!

HHH, MD

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46 months ago
Hi Dr. Handsfield,

Yes, that's extremely helpful and on the whole, this experience has been tremendously educational for me. I appreciate your time and consideration.

One last note, I was considering getting the HPV vaccine since I'm in my 20s and my insurance covers it. Does this sound reasonable?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Yes, I strongly recommend HPV immunization for those who qualify. The highest priority is for younger persons, i.e. pre-teens and teens -- but everyone up to age 26 should be vaccinated.

Thanks for the thanks; I'm glad to have helped.

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