40 yr/old circumcised male married and in a faithful relationship for 14+ years.  Prior to this marriage, after a divorce, I went through a period of multiple sexual encounters with CSWs and causal sex.  I know at least one of these encounters included unprotected intercourse.

6 weeks ago, I noticed 4 pink spots under my circumcised for skin on the underside of my penis near where the foreskin attaches to the penis (although I think I've seen them before and wrote it off as nothing).  One is 1/4 pencil eraser size...the others are much smaller.  They are not raised but are circles, smooth, and sometime shiney.  Sometimes they look like they are healing and harder to see, sometimes really pink/red and easy to see- especially after sex or masterbation.

I've seen 2 dermatologist.  1 who nonchalantly said it looks like mild psoriasis, use hydrocortisone.  The other said i think it's psoriasis but if it doesn't respond to hydrocortisone we should treat it as GW.  But "it's not screaming GW" This still freaked me out- and confused me based on my sexual history.

1.  Is it possible I got GW 15+ years ago and never have noticed them or They've come and gone? 

2.  Is it possible one of my wives gave them to me even and it's just now presenting?  (though they were both intercourse virgins when we married.  They both had oral sex and genital to genital foreplay, just not intercourse.)

3.  Should I be worried to keep having sex with my wife?  Or if I've had it unnoticed or dormant all these years does my wife for sure already have it?  Why has she not presented?

I'm so confused and afraid to talk to my wife about it. Any observations, insights would be appreciated.

From your description, I very much doubt you have genital warts. I'm not sure why the second dermatologist raised that issue. In my home office is a book title Genital Dermatology Atlas. As the title implies, it is filled with photos of various genital skin conditions. Of the 300 pages, only 15 are devoted to STDs, including warts. That tells you a lot:  there are a large number of highly varied, non-STD skin conditions of the genitals. Some occur more or less exclusively in the genital area; many others are common skin conditions that can occur anywhere and happen to affect the genital area, such as psoriasis. But the notion that all penile skin problems must be either psoriasis or warts is nonsense -- and I doubt that's what the second dermatologist intended to imply.

Having said that, it certainly is possible to have genital warts regress and seem to be gone, and then reappear or become more prominent years later. However, 15 years is an awfully long time for this. Everybody gets HPV, usually several times; it's a normal, expected, and more or less unavoidable aspect of being sexually active. Given your past sexual history, you can be sure you have had HPV. But I strongly doubt HPV has anything to do with your current penile skin condition. Now to your specific questions:

1. Possible but very unlikely.

2. As noted above, you can be sure you have had HPV. However, it is rarely possible to know when and from whom any particular HPV infection was acquired. If your former wives' sexual histories are accurate, then it is unlikely they were the source of HPV in you. Your multiple CSW and other casual sexual exposures were more likely.

3. Even if your current problem is due to HPV, there is no point now in changing your sexual practices with your wife. If you have warts, you have had the HPV infection causing them for at least a few months, and maybe for years -- so your wife has been repeatedly exposed and almost certainly infected. Changing you sexual practices now won't have any benefit. That horse is not only out of the barn door, but galloping over distant hills.

So my advice is to keep working with your dermatologist -- or maybe get yet another opinion about it.

I hope this information has been helpful. Let me know if anything isn't clear.

HHH, MD

I did see another dermatologist today who said it doesn't look or feel like warts, which offered some mental/emotional  relief (I told them before the exam "I'm sure you are going to say this is GW").  They gave me some PX level creams.  If it is Psoriasis, will it definatley respond?  That's what concerned me about dermatologist #2 "if it doesn't respond to hydrocortisone, we will treat is as GW."

That being said, if it was HPV warts, how likely is it that one partner presents warts and the other doesn't?

One other thing that wasn't clear in my original post was that there was a 5 week difference in dermatologist #1 visit "mild psoriasis" and dermatologist #2 saying "i think is paoriasis...it's not screaming genital warts."  

I have taken pictures of the penile area to document for myself.  A month ago, one of the lesions appeared worse (bright pink/red), that now it is so small (hard to see without a pen light)  and dry but you can feel it, I think I'm feeling the edges of it.  But the one that is most prominent and largest now, was less red a month ago, and doesn't seem raised...I can't feel it with my finger but can see it because it's bright pink/red and sometimes has an oozy film on top that comes off if you touch it.

I think I've convinced myself that all these are the slow, gradual onset/growth of hpv GW.

Really appreciate any perspectives and expertise.  

The acetowhitening test ("vinegar test") is never used to diagnose visible growths. Almost any visible skin growth will turn white, not just warts. The main purpose of the test is to look for possible HPV lesions not visible with the naked eye, sometimes called "flat warts". That is, white patches on otherwise normal tissues often indicate HPV. The main use of this technique is when gynecologists are treating women with abnormal pap smears:  puting acetic acid on the cervix can help guide where to biopsy. But use of this test on external skin is simply a terrible test, with lots of white spots not being warts at all, and some warts or HPV spots not turning white. While some trained dermatologists use it in this way, it's especially unreliable in the hands of medically untrained persons.

So you don't have warts. Continue to follow your dermatologists' advice about further evaluation and treatment. Good luck.

Thanks for bearing with me and for this service.

But this indeed is irrelevant, since you don't have warts. Time to move on -- and that concludes this thread. Best wishes.