[Question #875] Scared and confused.

53 months ago
Discovered bumps on glans. Spoke to 2 dermatologists online as well as one in person. Two doctors say I appear to have lichen Planus while my doctor says it appears to be pearly penile papules.

My alleged PPP is not confined to the corona but rather it's around my urethra. In fact no bumps on corona at all.

Not sure how long I have had these. Last had sex May 31st. Worried about HSV2 or HPV.

Bumps have not ruptured or given discharge. No change in appearance since discovering them (10 days ago). Would herpes blisters stay without rupturing for this long?

If HPV/genital warts, possible this early?
53 months ago
Why is my name showing instead of my screen name? I do not want my name being shown!!! What is the point of making a screen name if my actual name is going to be shown? Please remove my name.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome to the forum. Thanks for your question.

The moderators don't have the ability to change identifying information, screen names, etc. I'll send a message to the web administrator.

The large majority of penile skin conditions are not STDs. Diagnosis of lichen planus by a dermatologist is highly reliable, probably including online diagnosis if you submitted high quality photos. It's harder for me to comment another doctor's diagnosis of pearly penile papules, but they usually are not confused with genital warts. If uncertainty remains, seeing a dermatologist in person would be a logical next step.

Herpes doesn't behave at all like this; for sure these are not blisters and that's not the problem. And genital warts typically show up 2-6 months after catch HPV, never before 6 weeks or so. I'm confident you have no STD at all.

I hope this has helped. Best wishes--  HHH, MD



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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Your username has been corrected.

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53 months ago
I appreciate the correction. I also appreciate your reply.

I did see my dermatologist and he took a look and said he was 99.9% certain it was not an STD. He also disagreed with the dermatologists I spoke to online that said it was lichen Planus.


He thinks it's pearly penile papules. It's just odd to me that the papules are around the urethra instead of the corona (none on corona at all). The dermatologist I spoke to on allexperts.com disagreed with my dermatologist and insists its lichen Planus.

It's frustrating. My dermatologist (the one I visited in person) does not want to perform a biopsy but because of scarring but the dermatologist I spoke to online insists its necessary.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Sorry, but I have no way to resolve the dilemma, except perhaps to see yet another dermatologist in person. In any case, I remain confident this isn't an STD from your recent sexual exposure. (In the off chance you have genital warts, which I cannot exclude, they go back to some other more distant sexual exposure.)

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53 months ago
Thank you again for your reply Dr. Handsfield. 

I use condoms every time. I know HPV is transmitted skin to skin. However since these bumps are on the glans is it even possible for infection to occur on a site that was not exposed at the time of intercourse?

Or say if I manipulated her clitoris with my finger during intercourse and then as I was rolling off the condom my finger briefly touched my glans, is it then possible that I was exposed in that manner if I do indeed have HPV?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
As discussed above, from your description and the different dermatologists' diagnoses, I think you can be confident you don't have genital warts. Until and unless that diagnosis is confirmed, I see no point in speculating about when and how that particular HPV infection might have been acquired. But even consistent and correct condom use doesn't completely prevent HPV, which is almost as frequent in people who do and do not use condoms regularly. I have seen plenty of patients with warts on areas of the penis that apparently were always covered. Perhaps fluids get inside because during sex the penis often slides within the condom.

In any case, I encourage you to get a realistic understanding about genital HPV. Almost all sexually active people get at least one infection, most of us probably a few of them during our sexually active lives. It cannot be prevented except by no sex at all; permanent lifelong monogamy between two people who never previously had sex with anyone else. Genital HPV should just be anticipated as an expected, unavoidable consequence of being sexually active. All people (under age 26) should be immunized to prevent infection with the most troublesome HPV types. But otherwise there's just not much to be done except be on the alert for symptoms and get examined and treated if they appear (as you are doing, although I still doubt your current problem is HPV or warts) -- and of course for women to follow standard pap smear recommendations.

That completes the two follow-ups included with each question, and so ends this thread. Take care and stay safe.
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