[Question #7462] Penile Papule or Wart?

2 months ago
Hello

I am a 31 YO male and I had 1 genital wart at the base of my penis in my pubic area in May 2019 that was frozen off. Since then, I have not seen any re-occurrence. I asked a question earlier this year regarding what "clearing" the virus means, which Dr Hook answered quite well for me (thank you).

I do have another question. About three months ago I did notice something new on my penis that my family doctor said he is "pretty sure" is not a wart but probably a penile papule, but said it might be a good idea to speak to a dermatologist to make sure. Unfortunately, due to COVID  derm clinics in my area have decided to stop seeing wart patients for now. The one I went to originally to freeze my wart off is in the same boat.I am uncircumcised and I have always had penile papules as long as I can remember. I have a lot of them along the ridge of my penis, and they are all very small, barely perceptible, smaller than 1mm. About three months ago I noticed a much larger and newer Penile Papule along that same ridge. It is one single papule in the middle row of my papules, but it is much larger in comparison to the rest of the ones I already have. It has the exact same appearance and size of a small zit one might have on their face as a teenager: a white color and dome shape, about 1-2 mm. It is soft like the rest of my papules, and sometimes after masturbation or touching it it does feel a bit irritated. I didn't think too much of it initially, but since I read online that papules aren't supposed to generally change and only occur after puberty, I started to wonder if this new appearance has any chance of being a wart. 

While I have become generally guarded about anything you can read online, I can't help but wonder a few things:

1) Does this sound like a penile papule, ie can a wart ever take an appearance such as this?

2) This may be out of your expertise, but can uncircumsized men experience new papules later in life, or papules that change or grow in size? 

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

Welcome back to the forum and thanks for your questions.  I'm saddened that dermatologists in your location have reduced their services for persons with HPV. Perhaps if you described the lesion as a recently noticed penile bump and went so far as to explain that you're confident that its not a wart (see below) you can get them to take a look which is, by far, the best course of action. 

My sense is that this is not a wart.  I say this based on the fact that the location id quite different from your prior wart, the "company" it is keeping (i.e. the other papules- papules can certainly vary in size on the same person), and the fact that you have now been vaccinated against HPV.  Based on the difference in location, this is unlikely to be a recurrence of your previously treated infection.

Regarding your second question, I do not know enough about the nature history of penile papules to provide a confident answer.  Sorry

The one thing I would urge you not to do is to seek treatment before an expert had seen the lesion.  Treatment of penile papules is typically not effective and there are side effects.  It's a "rabbit hole" you do not want to go down.

In addition, in the interval until you can get this sorted out, I would urge you not to worry and to not feel the need to modify your regular sexual activities. 

I hope these comments are helpful. EWH


---
2 months ago
Hi Dr. Hook

Thank you for your response.

Your comments to reassure me, and they mirror similar thoughts that I have had. I agree that it is best not to treat the papule. I have read claims online of them being re-movable and it seems a controversial topic. So long as they are benign I see no point in taking any unnecessary measures, especially if it could cause scarring. One followup question for you: who/where could I go to for subject matter expertise on papules in your opinion? Is this something a urologist would know more about? Or should I stick with Dermatologists? I'd still like to get an understanding on what I can do to reduce its irritation it causes me, as well as understanding why a new one might appear/grow larger.
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago

Good questions.  My personal bias would be to seek dermatological advice.  With all due respect to urologists, their training is typically surgically focused, dealing with the bladder and urinary collecting system. 

I also totally concur with your sense that it is best not to seek intervention until you have more information and can make an informed decision.  EWH

---
2 months ago
Thanks Dr Hook for your time and responses. Please stay safe and have a good day