Dr Andy Jordan discusses the difference between papules and viral warts on the penis
Both pearly penile papules and viral warts occur quite commonly, affecting the penis with multiple lesions, and often causing great anxiety and embarrassment.
Pearly penile papules
• Are a variant of normal anatomy and may occur in 40-50% of men
• Usually develop in men aged 20 to 40 and remain for life
• Do not cause problems except when first discovered, when they are often thought to be warts or other sexually transmitted conditions – and may cause embarrassment with sexual partners
• Papules are pearly pink and smooth, (occasionally filiform) and 1-3mm in diameter – usually arranged in one or more rings around the coronal margin of the glans or in the sulcus
• More common in uncircumcised males and tend to regress after circumcision
• Affected patients require only reassurance
• CO2 laser treatment is effective at removing papules
• Do not respond to podophyllotoxin.
Penile viral warts
• Are the result of viral infection with epidermotropic human papilloma virus (HPV) – 90% are caused by HPV-6 and HPV-11
• Are the most common sexually transmitted infection
• Can occur at any age – in children, always consider abuse or inappropriate sexual behaviour, although the actual incidence of this is probably quite low
• Lesions may regress spontaneously, remain static or progress
• Are usually asymptomatic but may be uncomfortable
• May cause embarrassment
• Have a variable appearance – there are usually asymmetrically scattered warty or smooth papules or nodules, which may be flesh coloured or hyperpigmented
• It is important to consider other STIs and exclude them – there is a significant chance of infected patients having subclinical urethral lesions
• Risk factors for acquiring them are smoking, multiple sexual partners and early age of first intercourse
• Treat with the immune modulator imiquimod, or podophyllotoxin or cryotherapy.
Dr Andy Jordan is a GP and hospital practitioner in dermatology in Chesham, Buckinghamshire
Pearly penile papules are a variant of normal anatomy Pearly penile papules are a variant of normal anatomy Penile viral warts are a sexually transmitted infection Penile viral warts are a sexually transmitted infection
