[Question #5419] Genital Wart or Something Else?

73 months ago

To whom it may concern,

I am a 21-year-old male, and a little over a week ago I noticed a small bump on the underside of my foreskin (the side that touches the scrotum). For reference, I was vaccinated for HPV before I became sexually active. The bump is (usually) a darker pink, about a millimeter or a little over in size, is slightly raised, oval-ish and smooth. I cannot tell if it is just inflamed skin, because I (unfortunately) keep messing with it. It is also located at a point of higher friction, where my fingers grip while masturbating. I have felt a slight sting/burn/pain in the general area, but this may be caused by friction burn. At this point, it is difficult to tell if the bump is changing in size. As far as I can tell, this is the only such bump.

Clearly, I am worried this is a genital wart, but my internet and comparative image searches have not exactly helped clarify what is occurring. The Australian Family Physician journal article from 2013 was recommended online as a good resource to delineate warts from non-warts. Most of the pictures on the internet and in the image bank linked in the article do not look exactly like mine; not only does mine not exhibit the “cauliflower” appearance, it is also appears completely smooth (it doesn’t resemble “cobblestone” or “fine dots”).

Does this sound like a wart? If not, what else could it be? I am hopefully going to get it checked out but am worried about a misdiagnosis.

Thank you for any help.

Edward W. Hook M.D.

73 months ago

Welcome to the Forum and thanks for your confidence in our service. Congratulations as well in getting the HPV vaccine. The vaccine is highly effective and will prevent over 90% of visible genital warts. Of course that means that there is still a slight risk for getting a wart due to an HPV type not contained in the vaccine. The lesion you describe does not sound like a wart however. The location that you describe is a place where there are naturally occurring "bumps" and glands and would be an unusual place for a wart. Of course since I cannot examine you I cannot say more than what I've mentioned above.

Does your sexual history suggest that you may have been exposed to a partner with warts? Typically warts take several months after exposure to appear.

The best way to determine if the lesion you have noted is to have a trained clinician who has done lots of genital examinations to take a look. I would not want you to be seen someone who is not familiar with examinations of this sort since all too many inexperienced clinicians simply treat any genital lesion that they see. In the meantime, please do your best to stop repeatedly examining yourself- this will just confuse things.

I hope these comments are helpful. Please remember that even if this is a wart (which I tend to doubt), it is just not that much of a big deal. Over 80% of unvaccinated sexually active persons have HPV and the infection is of consequence to the health for less than 1% of those infected persons. I would also encourage to look at some of the many other posts on our site that have been answered by Dr. Handsfield or myself. This posts may provide useful information and perspective. EWH

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73 months ago

Thank you so much for your prompt reply, and for your help in this. To answer your question, I have never been with anyone that I was aware had warts, though I did have unprotected sex with someone who I don’t believe had the HPV vaccine.

I have a few follow-up details to add/questions to ask, if that’s okay.

Just to clarify my original post, this bump is fairly close to that ridge that runs on the underside of the penis, a on the upper half of the shaft. I’m actually not sure if the bump itself touches the scrotum, but it’s on the side facing it. The bump kind of just feels fleshy, and I don’t think it contains any fluid. It might actually be two millimeters, I’m not sure about the size exactly. The texture of the bump just sort of looks like the surrounding skin, only raised. I know you said that warts don’t usually appear in this area, but I thought I would add some additional info in case that changes anything.

Would the smooth appearance of this bump suggest it’s likely not a wart, or is it more the location that suggests this?

Could this bump be an inflamed gland? It is sort of in an area with Fordyce spots, so I wondered that too.

Lastly, the doctor I was planning on seeing is a family physician who I believe has been practicing since 2003. I know this is a limited metric, but is this enough experience to get a handle on what this is? Should I see a clinic like Planned Parenthood?

Thank you again.

Edward W. Hook M.D.

73 months ago

Thanks for the additional description of this bump. Your detailed description only serves to make me more confident that this is unlikely to be a wart. Both the location and its smooth appearance, as well as your own vaccination status and limited number of sexual partners contribute to this assessment. As to what the bump may be, as I said above, I cannot say and suggested you have a knowledgeable clinician examine you directly. Among the possibilities are pearly penile papules, Fordyce spots, and benign cutaneous cysts.

Regarding whom to see- presuming that your family doctor has been doing genital exams for the 16 years he/she has been in practice, that will probably be fine. You may want to print out this exchange and take it with you as a point of reference.

Hope this helps. BTW, you are permitted one additional post for additional questions or clarification. EWH

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