Pearly penile papules are small raised nodules (bumps), usually 1-2 mm in size, which are located around the rim of the penis head in the form of string of pearls.  Usually developing during adolescence, they have been reported in up to 35% of males. Uncircumcised men are more likely to have pearly penile papules.  Very often these lesions are confused with genital warts, although there is no known link between warts and pearly penile papules.

Pearly penile papules are NOT cancer and are NOT spread via contact or sex. Most men with penile papules do not seek medical treatment.

Men do not need to have them removed but some men feel uncomfortable having spots or dots on the penis.  Some men are worried that a partner my not have sex with them because they look like warts or other sexually transmitted bumps such as herpes.

Many treatment methods have been tried, including circumcision and freezing. But these methods had proven to be either ineffective or have side effects.

Until recently,burning and carbon dioxide laser were considered the most effective treatment options.

Radiofrequency surgery was introduced into dermatology, it became a great option to remove unwanted papules effectively, safely, and with no scarring or bleeding.  Originally used to remove papules on the nose or other small bumps radiofrequency removal is an effect technique.   Because radiofrequency uses radio waves and not electricity, there is less damage to surrounding tissue and its small and light hand-piece allows for more precise and complete removal.

Usually one treatment is enough to remove all penile papules.

Treatment area is numbed with lidocaine cream making the area not sense pain or heat.   The skin takes a week to ten days to heal.  Patients can resume daily work activities that same day but we encourage no sexual relations until the healing process is finished

In a previous post, we discussed penile pearly papules.

Lichen planus can also cause bumps on the penis.  This condition is an inflammatory condition - NOT an STD.

Classical lichen planus is characterized by shiny, flat-topped, firm papules (bumps) varying from pin point size (‘guttate’) to larger than a centimetre. They are a purple colour and often are crossed by fine white lines (called ‘Wickham’s striae’). They may be close together or widespread, or grouped in lines (linear lichen planus) or rings (annular lichen planus). Linear lichen planus can be the result of scratching or injuring the skin. Although sometimes there are no symptoms, it is often very itchy.

Lichen planus may affect any area, but is most often seen on the front of the wrists, lower back, and ankles.  They are also commonly found on the penis.

Sometimes it may be necessary to take a skin biopsy to confirm the diagnosis.  One of the best treatments for lichen planus on the penis are injections with cortisone.

Penile warts are diagnosis that a trained doctor can make without a biopsy.  If patients have many warts or ones that look suspicious for other lesions like cancer I often biopsy a representative sample and freeze (with liquid nitrogen) or burn (electrocautery) or laser (C02 or YAG) the rest.  If a patient has warts on the foreskin and wants a circumcision I sent the tissue for biopsy. 

If your doctor didn’t send a biopsy and it didn’t come back that’s fine.  If it keeps coming back and there was never a biopsy ask your doctor to sent a piece to the lab or make sure they are convinced its not cancer.

I hope this post is helpful.  Go to our find a physician tab if you need an evaluation

Thanks,

Dr. A.

Peri-anal warts are a serious condition – with multiple treatment options.  There is a significant risk of developing anal cancer if these are not treated.  In fact, this risk may be greater than the risk of developing cervical cancer (which is what PAP smears check for.)  Though we typically do not test for the presence of HPV on the penis, it is very important to check for HPV in and around the anus in patients at risk (ie: those who have had anal sex).

Since it is difficult to examine yourself in this area, it is most important for you to get examined by a physician if you feel any growth, bump, roughness, or experience any bleeding from the area.

Treating penile warts presents several problems to the patient and to the treating physician.  The ideal treatment would be non-invasive, non disfiguring, quick, painless and it would eliminate the risk of any wart recurrence.

The ideal treatment does not exist.

Most treatments offer some sort of balance between expedience, invasiveness, and recurrence.  The correct treatment really depends on patient preferences, patient medical history, and the doctor’s experience.

Treatment options include:

• Imiquimod: This is a form of immunotherapy.  Is not invasive and non-disfiguring but requires 16 weeks of therapy.  Dermatologists seem to like to use it, but urologists like Dr Schoor, who have had extensive experience with imiquimod, have not found it useful for his male wart patients.
• Podophylin: This is another form of immunotherapy.  Like imiquimod, it is non-invasive and non-scar producing.  Podophylin takes approximately 4 weeks to work and is very effective on penile condylomas.  Recurrence rates are low with this approach.
• Cryo therapy: This means freezing off the warts, usually with liquid nitrogen.  This is a great treatment that effectively gets rid of the lesions without scar formation or marks and has very low recurrence rates.  It is painful and requires at least 3 to 4 applications over a 6 to 8 week period.  Dermatologists like this form of treatment for their patients.  Urologists don’t too so much of it, however.
• Cautery: Effective though invasive and scar producing.  It does require that the doctor give a local aneshtetic prior to the procedure.  Recurrence rates are higher than for the other treatments, but the results are immediate.  Perhaps the worst aspect of this approach is that the cautery smoke may contain vaprized though live viral particles that can be inhaled by patient and staff alike.  To prevent this occurrence, special masks may be worn.
• Excision: 100% effective but 50% or greater recurrence risks when used alone.  It does leave a scar but the result is immediate, which most men want.  Another advantage is that it allows for pathologic confirmation of the lesion, which on rare occasion can be a penile veru
  

  Using crythherapy to treat disease

  cous cancer.  Recurrence risks can be minimized by cauterizing or freezing the base after the excision or by having the patient apply podophylin or imiquimod after the wart has been removed.

• Laser therapy: This procedure is done in the OR with a CO2 laser.  It is very effective over the short and long term, non-scar forming, and immediate.  It is very expensive and best reserved for patients with extensive disease, such as in the immunoscompromised population.

We hope readers find this useful.

Genital Warts are among the most prevalent sexually transmitted diseases, but people lack the right information to help prevent or treat this condition. Clear, correct, updated information regarding human papillomavirus (HPV) and genital warts is difficult to find. The result is that a lot of myths and misconceptions regarding genital warts abound. In some cases, these mistaken beliefs may even do harm. Inaccurate information may have several physical and emotional ramifications on the sufferer. For instance, he/she may suffer from severe anxiety over his/her condition, doubt the faithfulness of his/her partner, undergo an expensive and painful treatment that could otherwise have been avoided, or worst of all, neglect having his/her condition treated and risk his/her health.

This article tackles the most common misconceptions and busts these myths in order to make more people understand genital warts and HPV better.

Myth: Only women can carry HPV and have genital warts.

Fact: The chances of men and women having HPV and genital warts are more or less equal. However, the symptoms of genital warts appear more on women because their anatomy provides a better breeding ground for the virus. The warm and moist environment of the vagina makes it an attractive location for the virus to reside in and multiply.

Myth: I can only get genital warts by having unprotected sex.

Fact: It is no doubt that having unprotected sex increases your chances of getting HPV. HPV can also be transmitted by direct skin contact. Thus, some forms of protection like condoms won’t guard you against some STDs because they don’t cover the entire genital area. It can also be passed on through oral sex, resulting in warts in the mouth and throat. Moreover, some studies have shown that HPV can be spread through contact with infected objects such as contaminated medical equipment and bath towels.

Myth: If I don’t see genital warts, it means that I don’t have HPV.

Fact: HPV, when passed on, can be in a latent or incubation phase that can last for a few weeks to even several years. Thus, symptoms of genital warts won’t manifest right away. A carrier may never know that he/she has the virus. In fact, experts estimate that only around 1 percent of all Americans who are sexually active have visible warts. 

Myth: Genital warts appear only on the head of the penis.

Fact: Genital warts can appear anywhere – on the head, shaft, scrotum, or even the thighs or lower abdomen.  Here are some warts on the shaft.

Penile pearly papules are tiny bumps on the rim of the glans or head of the penis.  It is common for young men to be concerned about the dots because they look like warts or other growths.  They are usually very small a couple of millimeters in diameter and are clear or pearly in appearance.  If you have these don’t be alarmed.  A note of caution just because you have pearly papules doesn’t mean you can ignore other bumps or lesions on your penis.  Everyone who is not practicing safe sex and notices lesions that are suspicious should seek medical attention.

Venereal warts are very contagious, most often spread by sexual intercourse. It is believed that two out of three individuals that have sexual contact with a partner with condyloma will get lesions within 3 months. If your sexual partner(s) is known to have venereal warts, protective measures need to be taken by the use of condoms until both you and your partner are free of warts

Warts on the penis can be embarrassing – but should be treated.  If untreated, you can spread them to your partner or develop into cancer.