[Question #2500] Genital Warts

97 months ago

About 2 months ago I noticed a flat, shiny lesion on my glans about 0.5 cm above the corona on one side. It's about 0.5cm across with an irregular border. A couple of smaller patches have since appeared around it (1-2mm diameter), I've also had a couple of shiny "domes" appear on my corona which are in the vicinity of the initial patch. The lesions are flat, very shiny when viewed from the side, do not itch, and are not painful. I am wondering about the possibility of genital warts. I have to wait one month to see a doctor. I have not had unprotected intercourse with anyone other than my wife in the last 15 years however I have received unprotected fellatio a few times and have had protected intercourse a few times. I understand that oral transmission of HPV is rare, and it's my understanding that warts typically show up at contact points. With a condom I would expect these to occur at the base, not the glans. I'm just wondering if you can give me an idea of the risk of continued intercourse with my wife while I wait to see a doctor. Thank you.

H. Hunter Handsfield, MD

97 months ago

Welcome back to the forum.

As I'm sure you understand, it isn't possible to diagnose anything by written description -- and in any case, this forum is not a substitute for direct health care (as described in the introductory materials and FAQs). However, from your description, I doubt you have genital warts. The large majority of penile or other genital skin rashes and other abnormalities are not warts or any other STDs. From your descrition, I wonder whether you have lichen planus, psoriasis, or some other garden variety penile skin condition. (Since you describe the patches as "shiny", you might google lichen planus and see if the many images availabe online look like what you have.)

You say nothing about sexual risks that might increase the chance you have genital warts. But from the information available, I doubt it. Probably it is entirely safe to continune unprotected sex with your wife. (And even if you have warts, the HPV infection causing them would have to be present for several months. In that case, your wife has already been repeatedly exposed, and stopping sex now obviously would make no difference in her risk.)

You should follow through with plans to see your doctor, ideally a dermatologist. Probably you'll learn that you don't have warts, more likely some relatively unimportant and non-transmissible condition.

I hope these comments have been helpful and reasuring. Let me know if anything isn't clear.

HHH, MD

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97 months ago

Thank you Doctor. I think I'm at a bit higher risk as the few unprotected oral and protected intercourse events outside of my marriage have been with escorts. The most recent being about 10 months ago. Intercourse was always with a condom. It does look very much like lichen planus to me and I've sent pictures to an online dermatologist today who suggested the same thing. I was just concerned as I had read that often flat genital warts can be mistaken for lichen planus and vice versa.

I'll take some comfort in your response but one quick question - how likely would it be to get warts on the glans from condom protected intercourse? Or if they were warts would it more likely be from unprotected fellatio?

Thanks again for this great service you provide.

H. Hunter Handsfield, MD

97 months ago

Although lichen planus and flat warts "can" be mistaken for one another, that's very unlikely for any reasonably experienced clinician. I don't recall that any of the innumerable LP cases I have diagnosed over the years turned out to actually be warts. You can rely on your online dermatologist's diagnosis. Also, new genital warts rarely present with only a single lesion; usually there are several warts simultaneously.

So I think the issues of your sexual history really aren't relevant. However, warts rarely result from oral sex, and condoms should effectively prevent new warts on the head of the penis. That said, if this were a wart, there would be no particular reason to attribute it to your most recent sexual exposure. It could go back a lot longer. It's rarely possible to know when and from whom any new HPV infection is acquired. But really, I think all this is irrelevant. I would advise following the dermatologist's treatment advice, probably a corticosteroid cream. If that doesn't help and the dermatologist rethinks the diagnosis, cross that bridge when you come to it.

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

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