Possible HPV

Approximately 4 months ago I notices a few spots on my penis.

The spots were reddish in color and soft to the touch when the skin was stretched and basically unappreciable when the penis was flaccid.

Rolling the penile tissue between my fingers I was not able to appreciate any changes in penile tissue texture.

The spots form a line that is essentially parallel to the circumcision scar (but not on the circumcision scar) and total in approximately four spots.  The spots initiate exactly on the underside of the penis (center) and terminate about 1/4 the circumference around the penis (left side).

The bumps or an elevation of penile tissue can be appreciated over the spots when the skin is stretched and I when lightly run my finger over the tissue.

There is no colliflower texture to the spots (at least from my view) and they are certainly not pronounced skin tags.

The spots are clearly within the skin itself and not cysts that are underneath the skin.

From about June until Sept there has been no 'perceivable' changes in the spots.  Howevver, these spots are very obvious when the penis is erect or the skin stretched.  

I am quite sure they were not there more than a year ago.

I have had two clinical evaluations:
One was a firm no and the second a strong possible.  The strong possible accompanied a "vinegar" test (which I realize is not ideal) that failed to produce any changes when vinegar was applied to the spots on the penis (the vinegar test was repeated several times).

I realize that it is impossible for you to make a diagnosis via e-mail; however, I do seek your opinion and possible differentials.  

Questions:
Are there normal benign penile anatomy changes in the penis?  (FYI: these spots are definitely not pearly penile papules)

If there are normal penile changes, what are some examples (especially those commonly mistaken for genital HPV)?

In addition, what is the sensitivity and specificity of the vinegar test for warts.  I understand that is is not specific but is it generally sensitive to genital HPV?  Does it tend to turn 50% of real warts white? More than 50%? Less than 50%?

Finally, do warts start growing and then just stop?  

Thank you for your time and please be as honest and consise as possible (I'm and epidemiologist by trade so I can take whatever you throw at me)

[Alan Rockoff, MD]

I think they are cysts.  Cysts are within the skin, not underneath it.  They look and behave just as you describe, and are common enough to be considered an anatomical variant of normal.

The vinegar test is not very useful because it has so many false positives.  The fact that it was negative argues strongly against these lesions being warts.

I urge you to get a clinical evaluation in person so you can know for sure what you have.

Take care.

Dr. Rockoff