[Question #5287] Multiple symptoms since 15-16 months

24 months ago
Hello Doctors,
Male 29- Incidents .  1. Had couple encounter with CSW (unprotected oral) .  2. And couple of massage events - naked rubbing against each other completely naked (no penetration) ***Symptoms 
1. Initially I noticed tiny white shinning dots on my penis shaft (skin) - Visited a derm, who confirmed nothing to worry. This was in between the 2 events mentioned above.
2. Oct/Nov 2017 noticed variation on my penis head (pin head multiple soft inflations), started feeling tingling sensation in and around penis/groin area. Scheduled appnt with my GP, who ordered STD panel including HSV - All neg. As my discomfort/sensation continued, my GP referred me to Urologist who did physical and confirmed not to worry. He ordered another round of panel test and all came back neg.
3. Feb-2018 penis/groin irritation re-starts, this time with greater intensity. Frequent urination, burning sensation and constant irritation. Went back to urologist and dermatologist. Test re-ordered all neg. Doctors said my anxiety might be causing the sensation. Flat multiple white bumps increased on my penis head.
4. April/May 2018 - Observed 2 wart like bumps on my groin, went back to doc and they did biopsy and it came back normal
5. Now Mar-2019 bumps on my penis spread to foreskin - I am circumcised and I could see similar multiple white/yellowish dots on my foreskin. Dermatologist ordered biopsy by taking sample from my foreskin, as sample can't be taken from penis head (Fordys spot vs condyloma) was ordered are result was Lichenoid dermatitis. 
Questions
1. Is it STD/STI because of which I am having flat dots on penis head, shiny dots on penis skin and irritation in/around penis (as explained above). Even now I can feel the discomfort. I mean not normal, sometime I feel tingling sensation in my legs. If yes what specific infection it could be?
2. How does HPV wart look like - Does multiple flat, soft pin head bumps on penis head indicate HPV infection. It is there for more than 15-16 months now?
3. Can biopsy result be applied to bumps on penis head?
4. Since I noticed these bumps I have not had intercourse with fear I might infect others. Please suggest best way to diagnose my issue and figure out the cause?
5. General question - if HPV +ve person donates blood will the recipient gets infected with HPV?
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Welcome to the forum.  I'll be glad to comment.  Before I address your specific questions, please let me make a more general comment.  My sense from your detailed description (thank you) is that it sounds like you had several low risk exposures over a year ago which have caused you to worry.  That worry has led you to repeated evaluations, tests and even a biopsy but your worried continue.  The symptoms you describe are not suggestive of a specific STI and are the sorts of symptoms we hear of from clients whose anxiety causes them to become aware of normal sensations which are more typically overlooked.  Such symptoms can be increased with anxiety.  With that general statement, let me comment on your specific questions:

1.Is it STD/STI because of which I am having flat dots on penis head, shiny dots on penis skin and irritation in/around penis (as explained above). Even now I can feel the discomfort. I mean not normal, sometime I feel tingling sensation in my legs. If yes what specific infection it could be?
These dots to not sound like an STI. there are many normal dermatological conditions which may be mistaken for STIs- these include Fordyce spots, pearly penile papules, lichenoid dermatitis and many other processes.   

2. How does HPV wart look like - Does multiple flat, soft pin head bumps on penis head indicate HPV infection. It is there for more than 15-16 months now?
HPV can be highly variable in appearance HOWEVER, you have been evaluated by multiple trained health care providers and had a biopsy, all of which idciate that you have nothing to worry about and that this is not HPV.  the lesions you describe do not sound like HPV.

3. Can biopsy result be applied to bumps on penis head?
yes

4. Since I noticed these bumps I have not had intercourse with fear I might infect others. Please suggest best way to diagnose my issue and figure out the cause?
You have no reason to worry.  Believe your doctors.  there is nothing you had reported that suggests any need to abstain.

5.  General question - if HPV +ve person donates blood will the recipient gets infected with HPV?
No, HPV is not transmitted in blood or blood products.

I hope these comments are helpful to you.  If you continue to have problems, my suggestions would be to seek the assistance of a mental health specialist who can help you address your unwarranted concerns,  EWH
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24 months ago
Hello Doctor,
Thank you! Follow up question.
1. I visited a dermatologist today to get my penis bumps examined. He said it is very difficult to conclude anything (that these bumps are contagious or not) without performing biopsy on it. As my previous biopsy was done using sample from foreskin which had developed white dots much later than the ones on penis head, a separate biopsy must be done for penis head. Please note that now those bumps or dots have spread all over my penis head.
I have asked for a days time to confirm on getting biopsy done. 
Could you please suggest, if I get this biopsy done will the result conclude the cause of it? In which case I would like to get it done , as it will help determine what I have.
2. Also dermatologist said sometimes Hepatitis might also cause such bumps, should I get that test also done?
3. I can ignore biopsy and move on, but what if these warts are contagious and I pass it on. This is the main doubt making me consider biopsy.
4. In case I get the biopsy done, it will not cause any complications other than a small scar correct? Also hoping it will heal fast.

Thanks a lot for your expert advice.
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
You have asked my professional opinion and while I am not your doctor, I do think you are over reacting  Major STIs have been ruled out.  If you have HPV it is typically of little or no consequence (please verify this by reviewing the many other posts on this site in which we have counseled others regarding HPV and the (very little) risk of HPV transmission when present.  In your case, your evaluations so far do not suggest HPV.   Addressing your follow-up questions:

1.  This is between you and the dermatologist.  If I were you  I might see another dermatologist before I got another biopsy.
2.  A hepatitis blood test is easy to do.  The rash of hepatitis is relatively rare and from what you say, you have no other signs of hepatitis.
3.  See my comment about warts/HPV above.  I would estimate that over 25% of the questions we receive deal with HPV.  I suggest that you take a look at some of the other posts.  To summarize our stance, for most people warts are nothing more than a minor nuisance.  Further, the spreading dermatologic process you describe is nt typical of HPV.
4.  Correct.  A proper punch biopsy should not cause complications other than a small scar.

EWH.
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