[Question #7378] Wart anxiety!

3 months ago
Hi Docs. I have noticed a few bumps on my penis which are circular in shape and very hard to see unless carefully looked at. These bumps are slightly raised and are  either flesh coloured or white(quite hard to tell due to the size). They are also <1mm-1mm in size and located on the foreskin or at least very close to the foreskin. There are multiple bumps that are adjacent to each other and almost form a straight line(maybe slightly curved) if you drew a line connecting the bumps. Have had one unprotected sexual experience in the past multiple years ago(like 7/8 years ago). There is a general slight redness in the area near the bumps but it has been like that ever since I noticed the bumps. These bumps are not tender to touch or cause discomfort. I have noticed these bumps ~ one year ago but I have totally forgot about it until 2 months ago when I read something about genital warts and became anxious. They may have been there longer than a year but I just never noticed. They are still here to this day. I have consulted a dermatologist and she said it was fordyce spots however due to the small size I am worried she didn't see it properly or just couldn't see it. My questions are 
1. Does this sound like warts to you? I have seen the standard pictures on the internet and the appearance does not seem similar however I heard they don't always look the same as the internet images.
2. Can warts be this small in size? (Barely noticeable unless inspected closely)
3. If it were fordyce spots, how come these fordyce spots look very different to the other fordyce spots on my genital. 
I know I am being overly paranoid but I really hope you can reassure me so I can put this behind me. 
Thank you very much for your service!

Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Welcome to the forum.  Thanks for your questions.  I'll be glad to comment. 

1. Does this sound like warts to you? I have seen the standard pictures on the internet and the appearance does not seem similar however I heard they don't always look the same as the internet images.

One of the reasons we decline to look at photos on the site is that they are so unreliable and misleading.  My advice would be to seek examination by a clinician with experience examining genitalia.  All too often inexperienced clinicians mis-identify genital bumps, including Fordyce spots as warts and treat them unnecessarily.  What you describe do not sound like warts and could be pearly penile papules, Fordyce spots or some other non-STI genital dermatologic process 


2. Can warts be this small in size? (Barely noticeable unless inspected closely)

It would be uncommon for a wart to be this small and remain that way for a year.


3. If it were fordyce spots, how come these fordyce spots look very different to the other fordyce spots on my genital.

As mentioned above, numerous other genital condition can cause irregularities on penile skin.  the first step is to find out what the spots you've noted are.  Whatever they are, they are unlikely to represent a serious problem.

A side note.  you do not mention your age but if you are under age 45, the HPV vaccine is available and highly effective for prevention of most HPV infections, including visible genital warts.  If you are worried about warts, this is worth investigating.  EWH

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3 months ago
Thank you for your response. 
1. I have already consulted a dermatologist who said it was fordyce spots and said they can come in a range of different sizes., however I was just worried they didn't see it properly due to the size. Is this considered as a clinician with experience in examining the genitals? Should I trust their opinion or go see another doctor?
2. Are warts usually circular in shape and arranged in this kind of pattern where if you drew a line connecting the bumps, it would form a straight line?
3. You said "It would be uncommon for a wart to be this small and remain that way for a year." How exactly do they act rather than remaining that way for a year.
4. Would there be any need for future examination or does this not sound like it is a concern at all? I am really ready to put this behind me. 
Thank you

Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Thanks for the additional information:

1.  In general, the assessment of a trained professional (your dermatologist) who has had the opportunity to examine you is a better assessment than I can offer you on-line.  I do agree that Fordyce spots can be quite variable in appearance.  I would trust his/her opinion.

2.  Not really,  Warts are often single.  When multiple they are irregularly clustered, not linear in appearance. 

3.  Once warts appear they tend to get a bit larger with time.  If your bumps are stable appearing this too is not suggestive of recently acquired genital warts.

4.  At this juncture I would accept the diagnosis of your dermatologist and move forward without concern and without the need for additional evaluation.

Hope this helps.  EWH

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3 months ago
Thanks for your response.
I also forgot to mention the unprotected sexual encounter did not involve penetration but rather a lot of genital to genital rubbing/contact (rubbing our genitals together and grinding their genital against my penis) and also mutual masturbation. I was worried that I had these warts for a long time and have never noticed it till now  since I am inspecting the area more but maybe they are perhaps fordyce spots.
1. Does this change your opinion?
2. Is there a risk for transmission from this encounter or basically none? 
Hopefully I can stop worrying about this issue. Thank you!
3 months ago
Sorry I forgot to add in a question to my previous response.
3. I also have an area where it's slightly red and hurts on my genital area but whenever I take a hot bath or go to a hot spring(super hot environment) or steam room, the pain is temporarily relieved. My question is,  when you put hot water over a HSV sore or submerge the area in a hot water environment/or are in a hot environment, is it possible for the pain to essentially go away or be heavily relieved or will it actually feel worse as I suspect this is some other problem-non-std related? I am convinced this pain is something else as there appears to be no sore there and when inspected by a clinician, everything appears to be fine besides slight redness. 

Many thanks for your time and the wonderful service you provide!
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

thanks for the additional information on your exposure. 

1.  This does not change my opinion or advice.

2. There is a theoretical risk for HPV/wart acquisition bit without penetration there is no risk for other STIs such as chlamydia or gonorrhea.

3.  The discomfort you describe does not suggest herpes.  To my knowledge, the discomfort of genital herpes does not go away in hot/warm  environments. 

This is my 3rd response to these questions. Thus, as per Forum Guidelines, this thread is now complete and will be closed shortly without further response.  I hope the information I've provided has been helpful.  Take care.  Please don't worry. EWH

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