[Question #283] Wart

35 months ago
Hi. Thanks for your advice in advance. 

I noticed a very small spot 3/4 of way up penis which seems to be close to a vein. It appears to be a very small spot and almost looks like it could be a gland (can glands be on this location)  but does have some distinctness. It is also flat and skin colored. I sometimes have trouble finding it again but in the end I can. 

I went to a std clinic and the doctor said it wasn't a wart. However I keep looking at it and I had something like this before and a dermatologist said he didn't know and "let's just freeze it" as there was no harm to do so. I feel like if I went back to him he would say the same. An everyday person would probably never even notice this, but I have always had some anxiety with this stuff. 

The only exposure I had was protected sex once about 6 months ago. And penis to breast exposure (i did notice some sort of pimple on her Brest plate) if that makes sense. But was probably a pimple. 

This std Doctor also offers a hpv test for males where they take a swab type sample but with a harsher material than just a tip. Supposedly one of the only places that offers this for males. However he said it wasn't necessary. 

What do the warts usually look like and does this sound like anything to be concerned with. My partner has already had gardasil 5 years ago. 

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome to the fourm. Thanks for your question.

Of course we cannot diagnose anything and wouldn't try, based on verbal description. But this doesn't sound like a wart. More important, the direct exam by a physician experienced in STD care is very reliable. Further, the majority of skin problems of the genitals are not warts or other STDs. (My bookcase contains a 300 page atlas of genital dermatology. Only about 15 pages deal with STDs.) And it sounds like your previous dermatologist also didn't really think the previous problem was a wart

I'm also inclined to agree that it shouldn't be tested for HPV. I'm unclear on your sexual history; the last sentence suggests you have a regular partner, but previously you speak of your "only exposure". Those particular events carried little risk for HPV (zero for the penile-breast event), but if you're under age 30 or so there's up to a 25% chance you have a genital HPV infection. A positive test would not tell whether it was actually the cause of the spot on your penis. And the kind of test the STD doctor is offering misses many HPV infections, so a negative result would not guarantee you aren't infected.

So from all you say, I think it very unlikely this is a wart. But if it continues to bug you, the only option is to get another opinion, perhaps from a different dermatologist. But from all you say, if I were in your situation, I'm pretty sure I would't do anything more about this. I would also suggest you stop examining your penile skin.

I hope this has been helpful. Best wishes--  HHH, MD


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35 months ago
Hi Doctor HHH,

Thanks for your note. I mean my only exposure as it was the only time I had been with anyone else and am positive the current partner does not have anything. Also the lady with the breast exposure was at a massage parlor so I'm assuming this isn't the first time that has happened to her to still zero risk?

Also, I will make note that this other experience with this dermatologist was about two years ago. 

In any case my current partner has gardasil so in the event that it was a wart (which we are thinking it's not) that she would be 90% protected, correct? Does this include oral exposure as well? And what are the chances of Oral warts for my own knowledge. Also how long is gardasil active for. 

Another side point. I was offered gardasil and am in the early 30s. Is it still safe to take then? 

Thanks a lot
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Thanks for the additional information. However, none of it changes my judgment of risks or advice. You can't talk me into believing you have any significant HPV related health problem. 

"Positive the current partner does not have anything" is meaningless. Since 90% of all sexually active people have or have had HPV, and 10-50% have it at any point in time -- and since these data are the same in people with only a few vs over 100 lifetime sex partners -- there is no way you can be "positive" your partner isn't infected. I am absolutely confident my wife and I have been faithful and monogamous for 30+ years. But I'm not positive she doesn't have HPV.

Even if someone is infected with HPV, there is no chance it involves the breast. If it did, I cannot imagine a transmission risk.

Your partner's level of protection is 100% against the HPV types represented in Gardasil. Since 90% of warts are types covered by the vaccine, 90% protection is about right, if you have a genital wart. However, as discussed above, you could well have other types instead or in addition -- against which she may or may not be protected. Whatever protection she enjoys, it applies equally to oral and genital exposure.

Gardasil is entirely safe at age 30 and probably effective. However, it has not been studied beyond age 26, because it is unlikely to be beneficial. New HPV infections with the vaccine types is rare beyond that age, which is why it isn't recommended (and usually not covered by medical insurance). But it certainly would not be harmful if you decide to get vaccinated and are prepared to pay about $500 out of pocket. But of course it has no effect at all against HPV infections already acquired -- so in the unlikely chance your penile lesion is related to HPV, vaccination won't help.
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35 months ago
Hi Dr HHH

Thanks for your comments again. Would you mind if I shifted gears a bit and asked you a different question. 

This time relates to herpes. I guess in general I have been having some anxiety with stds. For about 3 months I had convinced myself that I had herpes. Also didn't help that the doctor I was consulting said it could take a while for antibodies to show up and kept testing me (std clinic doctor said not to continue but guess I wanted to keep getting tested too). Long story short I had the exposure I mentioned to you before (breast exposure and protected sex) and also went to a massage parlor where the masseuse may have kissed my back side once and she touched her hand to my penis (unsure if she touched herself first). 

In any case. I had multiple hsv tests and the last one was 17 weeks from the last exposure and it came back negative for hsv1-.04 and hsv2-.11. I also had a couple swabs of lesions on my buttocks which came back negative.  The only problem is that I have been getting a constant tingling sensation in my buttocks for 3 months now and keep associating this with herpes but have been better at trying to get it out of my head due to these test results. But hearing your opinion on this may help me. Also I wouldn't be able to contract it from an in inanimate object such as an examining table in a clinic that the sterile paper may not have been replaced from the patient before,correct?

Lastly was wondering if you do in person consults and/or phone consults. 

Thanks for everything and your time here. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I agree with your self diagnosis of excess anxiety regarding STDs. There isn't the slightest reason to be concerned about herpes in this situation. The transmission risk from the exposures described is nearly zero, and your blood tests prove you weren't infected. And the symptoms you describe are not at all suggestive of herpes. Initial genital herpes occurs only at the sites of friction during sex, and therefore virtually never involves the buttocks, so you and your doctor overreacted there. You probably have seen herpes symptoms on line that include thingling, etc, but you missed the fact that tingling by itself is never due to herpes. Herpes sores may tingle, but symptoms like yours are never caused by herpes. And no, herpes (or HPV or any other STD) is not transmitted by contacting contaminated surfaces. Whatever the cause of the tingling, it isn't herpes. (I suspect a psychological origin.) Finally, you have the negative blood test results. So for sure no worries about herpes.

I would advise you to take a holiday from searching online about herpes, HPV, or other STDs. Like many anxious persons, I suspect you're being drawn to information that inflames I am retired from direct patient care and don't provide direct care. But I can assure you that in person care woudl be very unlikely to change my perspectives on your risks or possible infections.

If despite this reasoned, science-based reassurance (which you probably recevied from your own doctors as well) you continue to find yourself anxious about HPV, herpes, or other STDs, professional counseling about it might be a consideration. Your fears are beyond a rational level and it sounds to me that they may be significantly affecting your life. I suggest it from compassion, not criticism.

That will end this thread. Thanks for the thanks. Best wishes.

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