[Question #7641] GW on Scrotum?

16 days ago

My overall question is, how often to genital warts show up on your scrotum? I know they can, but I know it's a slightly rarer location.

For context, 3 months ago I was diagnosed with GW, and had them treated; so I know I probably still have it. But recently I noticed a lesion on my scrotum (nearish the bottom), and then I remembered that I actually first noticed it many months ago (maybe even a year) and well before I was officially diagnosed with HPV. I think I just wrote it off and forgot about it because it didn't look like the traditional look of GW. It was very small but it looked more like a flat flap on my skin. 

I just got it checked out at my dermatologist, he said it could be a wart, so he's going to do a biopsy. My question in the meantime is what are the chances that I've been walking around with a GW and not known it? 

If it provides any additional context: I told all of my recent partners when I was first diagnosed, and I didn't transmit to them. And some of them I'd been with multiple times with the scrotum lesion. 
Edward W. Hook M.D.
Edward W. Hook M.D.
16 days ago
Welcome to the Forum and thanks for you questions, some of which you have, in large part, answered for yourself.  I’ll confirm those statements where appropriate.

There are no precise measures of the proportions of warts which occur on the scrotum as opposed to the penis or other locations.  The certainly occur but are far less common than warts occurring on the penis.  Further, in that the friction of sexual contact plays a role in enhancing HPV transmission, it is reasonable to assume that scrotal warts are somewhat less likely to be transmitted than warts occurring on the penis.  Equally important is that there are many different dermatological problems which might mimic scrotal warts.  If it is really important whether or not this lesion is a wart ( see below) I think you should be sure that it is a wart that you’ve found.

Congratulations on telling your partners about your genital wart diagnosis.  While this is always a desirable practice, we do not feel strongly that it is necessary because, in general, HPV is a relatively minor infection I suggest you read some of the many other discussions on the site where the issue of HPV disclosure has been discussed by both Dr. Handsfield and me.

If any part of this reply is unclear or there are further questions, please use your up to two follow up questions for clarification. EWH 
9 days ago
Hello Dr. Hook! 

Thank you for your reply. I have an update to this that I was hoping I could get your opinion on.

So I went back to my dermatologist and got the results of my biopsy. Basically the biopsy couldn't tell whether or not it was  GW or something else.  My doctor said to just assume it was a GW since I've had them before, and to freeze the remainder off. 

But when we looked down at my scrotum, we couldn't find anything left. We couldn't find any evidence that it was ever there. So he just applied the freezing solution to any off color spot on my scrotum (which was just so much fun let me tell you). Also I do remember that at one point there was a small scab where he did the original biopsy, but it's no longer there.

So my question is: given that the biopsy results were inconclusive, it was in a place that GWs don't usually show up, and everything else I mentioned, would you think it was a condyloma? Again, my dermatologist assumed it was a GW since I had one in November. But I figured I'd get a second opinion.

Thank you!
Matt VandenElst
Edward W. Hook M.D.
Edward W. Hook M.D.
9 days ago
Your dermatologist has advantages that I do not including the facts that he/she was able to examine you and has seen the biopsy results directly.  I find myself wondering why the biopsy was non-diagnostic.  The microscopic findings of HPV on biopsy are pretty distinctive.  Further, if the lesion that was biopsies was a wart and was not entirely removed, then there should have been residual lesion present if it was HPV.  As you point out, the location is unusual for a wart and as I pointed out there are many dermatological conditions that can mimic HPV.  Finally, I am not a fan of “just in case” treatment in most situations.  Personally, I would not assume that it was a wart unless there is more supporting evidence.  EWH ---