[Question #2131] HPV Symptoms Questions

88 months ago

I am a 50 year old male. Three days ago I discovered a small circular spot on my glans. I'm sure it's new, as I check myself out almost daily. It's flesh colored, clearly defined, not red, no pain, maybe about the size of a “period” made by a sharpie. The skin inside the dot is dry and smooth, and seems to have more of a flat and shiny “tissue paper” surface, as opposed to the normal soft and “textured” surface of the rest of the glans. It's flat, neither raised nor indented, and cannot be felt at all if I run my finger across it. It hasn't changed for the better or worse since I've noticed it.

The majority of the information I've read and pictures I've seen on the internet suggest that genital warts are, most of the time, raised at least somewhat, and tend to be firm, and have some kind of texture, from a little rough, to cauliflower-like. However, other sites suggest they can take different forms, but they're all vague on what that means.

In your experience, how do genital warts present? I know they can be hard to see sometimes, but this thing is not. Can they be, and if so, how often, are they like what I'm experiencing? Based on my description, do you suspect genital warts, or something else like a fungal infection or some kind of abrasion or...?

I've read very many of the posts on this forum, and in them you've said more than once that new cases of HPV are uncommon in people over the age of 26. I was wondering if you could clarify that statement. Why is this so?

H. Hunter Handsfield, MD

88 months ago

Welcoem to the forum. Thanks for your question. I'm happy to help. (Your question arrived just before I logged in. Most users shouldn't expect nearly real-time replies!)

First, new genital warts are uncommon at your age -- the large majority occur under age 30. That's true even if at risk for new STDs, e.g. multiple sex partners or a new partner. Age 26 often comes up because that's the age after which HPV vaccination is not recommended and usually not covered by health insurance; which in turn is partly because new HPV infections are uncommon. The reasons are complex, but have to do with lower likelihood of exposure to infected partners and because after 25-30, so many people have been infected with HPV already that they can't beneift from a preventive vaccine.

Second, a "small circular spot" is not typical for genital warts. Your description from your online research is correct. And there are plenty of other conditions that could cause something like this, mostly not at all serious. As I type this, the bookshelf at my left side has a book titled Genital Dermatology Atlas, with a little over 300 pages filled with photos and descriptive text. Of those 300 pages, only 15 deal with STDs. That tells you that the large majority of genital skin problems are not STDs. Those conditions include both genital-specific skin problems and garden variety skin problems that happen to involve the genital area. As only one example, psoriasis or eczema in men often involve the penis. Without mroe description, I really can't judge what this might be.

As for what this might be, and for the appearances of typical warts, it sounds like you've already searched online for photos of genital warts. Also try googling "gential skin conditions pictures"; I just did it and it found too many websites to count. Give it a try. The vast majority of genital warts are as you describe in paragraph 2 of your question. However, I would caution you not to try to diagnose yourself in any definitive way. And also don't be concerned if you find photos of "flat" warts or other subtle warts that might look something like what you have. It still probably isn't a wart or related in any way to HPV. If the problem persists, see a doctor -- your own PCP would probably be fine, unless s/he refers you directly to a dermatologist. But in the meantime, stay mellow. This probably isn't serious.

I hope this has helped, but let me know if anything isn't clear.

Best wishes-- HHH, MD

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88 months ago

Hi Doctor. Thank you so much for your very quick, professional and thoughtful reply earlier. I wanted to thank you much sooner, but also to save my follow-ups for further questions. This service is invaluable.

Day 7. Between day three and last night, my spot became a reddish brown color, and transitioned to something I could feel if I ran a finger over it. Still a small dry patch though, and still totally flat, just a little rough.

I tried to “stay mellow” as you suggested and wait to see if this would begin to heal or if I should see a doctor, but couldn't stay off Google. What I have doesn't look like warts or herpes, even in mild pictures. And there's still no pain or redness surrounding the spot at all.

I had tried putting antifungal cream on it, and hydrocortizone 1% cream to see if those would have any effect, but they didn't appear to right away.

The closest thing I found that resembles my condition is Lichen Planus, but there aren't a lot of good photos available that show mild cases as it presents on the glans. The few that there are look more like what I have than HPV or herpes pics.

Last night, I decided to put a small band aid on it with neosporin underneath. This morning, the spot was still there, but smaller, and indeed in the shower, the top layer of dry skin sloughed off leaving flat, intact new skin underneath... Still shiny, but looking like it may heal?

I know this is beginning to leave your area of expertise, but, thoughts on these latest developments?

H. Hunter Handsfield, MD

88 months ago

Given your description of "shiny", I agree lichen planus might be a possibility. But as I said above, this is not a diagnostic service and I will not speculate on what might be the cause -- except I'm confident it isn't HPV, for the reasons discussed above. See a doctor if it continues and/or you remain concerned about it.

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