hpv or lichen planus...doctors don't know

i recently saw both an infectious disease doctor and dermatologist at the same time. i did something sexually risky 7 months ago and there is now a bump in my urethra and redness and irritation on the penis head that has been there for months. the infectious disease doctor thought it was hpv, but the dermatologist thought it was lichen planus. is there any way to tell between the two. would hpv cause redness around the head? i was treated with desonide cream a while back for lichen planus, but it did not help. they said lichen planus can be caused by trauma to the area, but would it take a month or two after the incident for it to show up. i noticed symptoms about 6 weeks after the incident. any input or advice would be appreciated..

[Bhupinder Kaur, MD]

Hello,
I agree with the dermatologist that it can be lichen planus. HPV warts present as small cauliflower like protuberance or masses and they are not associated with any redness or pain. Lichen planus affects the mucosa and may present as papules or bumps. Desonide is a low potency steroid and if you are not benefitting from it, then some other treatment like oral steroids, retinoids, immunosuppressants, tacrolimus and aloe vera need to be prescribed. Please discuss about these treatment options with your dermatologist.

I hope it helps. Take care and regards.

[jon309]

can lichen planus present itself as a bump in the urethra? ..the bump looks different from the redness on the head. the infectious disease doctor suggested that hpv can present itself as flat along the skin, and that the bump alone could be hpv while the rest could be lichen planus. but, the dermatologist thought because of the redness it lichen planus. do you think a bippsy on the bump is necessary? that is what they are considering for my next visit...thanks a lot.

[Bhupinder Kaur, MD]

Hello,
Penile lichen planus presents as papules and may present as a ring around the penis but it can present as shiny, flat-topped, firm papules involving the mucosa. The important point to be remembered is that it can be due to an abnormal immune reaction provoked by a viral infection and so HPV also needs to be ruled out. You can go ahead with the biopsy that the dermatologist has planned for you because then a clear cut differentiation can be made.
Hope it helps. Take care and regards.

[jon309]

thank you for your help. can lichen planus also be cause by trauma to the penis during sex instead of an abnormal immune response?? i believe that is what the dr said.