[Question #7246] Hpv/male/symptoms/treatment

5 months ago

Hello,


I am a 39 yr old male, who has at least 20 partners a year for the last 5 years.  Most of those partners are strippers/escorts who are paid.  All of the encounters involve me receiving oral sex without a condom, and then sex with a condom.  I have had unprotected sex only a handful of times in the last couple of years.  I have been dealing with a growth at the base of my penis head for almost 6 weeks now.  It’s started off as a pink bump.  Ever since two weeks ago it has started drying up and the skin on top of it flakes off whenever I rub it while masturbating.  It is now grayish in color and dry and rough.  There is no pain or itching.  I have a dermatologist appointment in two weeks to get it diagnosed/treated.  My assumption is that it is HPV and I have a wart.  I have the following questions:


  1. Does my description sound typical of what a wart would be for a male?
  2. If it is a wart.  Is it moving through stages toward healing by the change I described from pink to gray?
  3. How effective is aldara?  What is the normal timeline for resolution with this product?  How likely to return after this treatment?  How long to recover from treatment?
  4. How effective is electrocautery?  How likely to return with this treatment?  How long to recover from treatment?
  5. Same for cryotherapy.
  6. Same for podofiloxin (I think that’s how you spell it).


I want to take the best and most informed decision on treatment should it be concluded that I am indeed dealing with a wart.


Thank you.

Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Welcome to our Forum.  Thanks for your question and for your confidence in our service.   The lesion you describe does not really souplike a genital wart.  Typically warts do not evolve in the manner you describe and it is unusual for warts to flake in the manner you describe.  On the other hand, accepting a diagnosis made over the internet is often fraught with challenges and the right thing for you to do is to get examined as you plan to do. ,

I will also point out that at age 39 nearly all unvaccinated sexually active Americans will have HPV.  While oral sex is lower risk for HPV acquisition than unprotected genital sex. It there is still some risk.  Further, while condoms do reduce risk for HPV, they do not eliminate it.  It is safe to presume that you have or have had HPV, even if you have not had prior visible warts.

Regarding therapy, each of the methods you describe is effective although with each, anywhere from 15-25% of warts will recur.  They work in somewhat different ways.  aldara Creates an inflammatory response which stimulates the body to fight with a wart. Published reports suggest that the recurrence rate following successful out there at therapy maybe slightly lower than with other methods. On the other hand methods like cautery, podophyllin, as well as lasers and liquid nitrogen ( cryotherapy) are all basically destructive processes which destroy the wart and infected tissue.  The different methods have different advantages and disadvantages and should be discussed with your doctor IF the lesion you describe turns out to be a wart.  

I hope this information is helpful.  Again, your first step should be to determine if the lesion you’ve noted is a wart, then to discuss therapeutic options with your doctor.  EWH

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5 months ago
Thank you for your prompt reply.  I will update this post in two weeks for anybody who may be reading this and can gain some insight about their situation.
5 months ago

Hello Dr. Hook,


I wanted to follow up on my situation.  I went to the dermatologist yesterday.  He wasn’t able to confirm what the lesion was.  He said the grey coloring of the lesion is because that is scar tissue.  I showed him some pictures of the earlier stages of it so he could see the evolution of the lesion.  He recommended that I get a blood test for syphilis, which I did and it came back negative.  He prescribed me ketoconazole cream to apply twice a day.  Saying that somehow it could be a buildup of yeast or something to that effect.  I have a follow up in a month.  I still feel like this may be HPV because the skin around the lesion appears to be swollen.  My questions are as follows:


  1. The skin around the original lesion appears to be swollen.  Could this possibly be the HPV spreading?  If it is HPV of course.
  2. Is HPV easily diagnosed visually?  Or does it get confused with other conditions frequently?  He went through every possibility of what it could be, all the way up to cancer.  Basically just as I would find doing a google search.
  3. If it is HPV, how long does it take for the body to naturally clear the infection usually?  Would it be smart to just wait for that given that it’s already been two months?


Just looking for a little more clarification on the visit.  He really didn’t provide as much clarity as I would have hoped for.  


Thank you

Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Thanks for your follow up. If a highly trained dermatologist who has the advantage of being able to directly exam and you could not provide you with the diagnosis, I cannot either. On the other hand, the fact that the dermatologist did not feel that the lesion you have noted was a wart should be gratifying and reassuring to you.  In answer to your specific questions:

1.  Swelling is not a sign of HPV infection. Any local swelling around the lesion you have noted is due to something other than HPV. If you are frequently examining yourself and the lesion, the trauma caused by ear reevaluation’s may be the cause.

2.  Visual examination is an important part of the diagnosis of genital warts. As I noted above, that the dermatologist did not feel that this was clearly a wart suggest that it was not. I think you are overreacting.

3.  If the lesion you have noted is a genital wart it is more likely than not that it will resolve over the next year or two. Such lesions would not be expected to resolve in just two months. As I have noted above however, based on what the dermatologist has said as well as your descriptions it is the unlikely that this is a genital wart. 

I hope these comments are helpful to you. I think you are overreacting. EWH
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4 months ago
Adding this for anyone who may be going through something similar.

I went to the urologist because of the swelling around the lesion that I noticed.  He took a look at the area and said it was “unremarkable”.  He prescribed me a cream that was an anti fungal mixed with a steroid.  I applied that cream twice a day for a week.  It seemed to do the trick on the swelling.  Besides some slight discoloration, the issue has reached resolution.  Whatever it was never got diagnosed.  But, I noticed that the skin on my penis had been quite dry.  I moisturize with a product that has coconut oil in it and that has helped a lot.  I believe the issue I was going through was related to the dry skin issue I am having.

I hope this helps someone going through something similar.
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
Thanks so much for your follow up.  I’m pleased that your lesion has resolved and know that your post will help other visitors to the forum.  Thank you.  EWH---