Bumps/growths on foreskin and pelvic region

[SuperSpanky]

For a while now I've had these almost perfectly circular, flesh colored/slightly darker, bumps/growths on the foreskin of my penis near the hair line (about halfway down) - one on each side, another one right at the base of the penis/pelvic region, and then two more where my pubic hair is, nearing up towards my belly.  I won't lie, I picked one off a few months ago with a tweezers and it bled, pretty badly, and it was painful.  The one went away after I did that, but it seems to be coming back now.  Furthermore, I have crohn's disease and take remicade, so I understand this makes me more suceptible to viruses such as HPV.

I would say that these have been here for well over a year, they have stayed the same size, and I don't think they have spread or multiplied.  They are maybe 2-3 mm in size, raised maybe 1 mm, and they are flat on top. They don't cause me any discomfort, and I don't notice they are there unless I touch them.  At first I thought it may just be a mole or something to do with hair folicles, but I started looking at them closer the other night and part of me thinks they may be warts.

I did the white vinegar test (however effective that is, I don't know), and they didn't turn white.  I kept pouring vinegar on a rag and holding it to these bumps for a few minutes, and they never changed color.  So if that test is true, and these are warts, then they should have turned white, correct?  And if they are warts, shouldn't my touching my penis cause them to spread?  Furthermore, I don't have any of these on the head of my penis or when I pull back my foreskin and reveal the shaft of the penis.  Perhaps these are normal growths?

I have an appointment with a dermatologist, but he can't take me till next week. I know you can't diagnose anything over the internet, but I figured I'd check here first since I hate waiting.

So, do these sound like genital warts?  I've looked at pictures online, but can't find anything exactly like this.

Thanks.

[H. Hunter Handsfield, M.D.]

I'll try to help, but the definitive answer is going to come from the dermatologist.  If there is any difference between my guesses and what the dermatologist says, you need to rely on the latter's judgment, not mine.

I'm confused by your description of the location on the foreskin, which is at the tip of the penis, nowhere near the pubic hair line.  Leaving aside any lesions actually on the foreskin or the head of the penis, and focusing on those near the base of the penis, pubic area, and/or lower abdomen, I am suspicious you have molluscum contagiosum.  Typical lesions are pink and shiny, often smooth, but often with a dimple in the center.  And as you describe, they tend to bleed briskly when the lesions are removed or the white core is expressed.

MC is a minor viral infection, most common in young children, where it is acquired from other kids through saliva and most commonly occurs on the face; it is especially common in toddlers and can be transmitted in day care and similar settings.  In adults, MC often appears in the pubic area and is usually sexually acquired -- but there probably are exceptions to sexual transmission.

The main atypical aspect in your case is that most MC cases clear up on their own in a few weeks or months; persistence for a year or more is uncommon.  To my knowledge, infliximab (Remicade) has not been reported to increase susceptibility or prolong resolution of molluscum lesions, but it's an immunosuppressive drug and this might be possible.  Your dermatologist is likely to know more about this than I do.

I could be entirely wrong about molluscum; this could be something entirely different.  But I doubt you have genital warts, even though warts and MC sometimes can resemble each other.  The vinegar test isn't helpful; it is a lousy test -- that the lesions didn't turn white is at best weak evidence against warts.

Please return to the forum and report back after you see the dermatologist.

Best wishes--  HHH, MD

[SuperSpanky]

Thanks for the quick reply.  You are right, it's not on the foreskin, they are towards the base of the penis, just on the side.  Sorry for the mix-up with my terminology.  Every bump is where there is pubic hair.

I looked at molluscum contagiosum, and it looks a little bit different than what I have.  Mine seem darker colored and they don't have a dimple in them. Although I do remember a couple years ago that I had little "pimple" type bumps in my pubic region, and they would bleed when popped, and I think it's quite possible that those little bumps turned into these.  I just thought those were infected hair folicles. I don't know why I didn't pay more attention to this.

I was in a committed relationship for two and a half years, and I'm virtually positive these came about when I was with her. We pretty much always used a condom as well, but sometimes we wouldn't.  She didn't show any signs of anything, however.   I've only had sex a couple times since then and was with a condom.  

The fact that these are raised, flat, and somewhat flesh colored are what make me think they could be warts.  It is reassuring to hear that you think that isn't the case though. They almost look like moles to be honest. It's just odd that I can't find anything on the internet that looks the same as this (small, circular, raised, flat top, skin colored/dull).

I will report back in a week after I see the dermatologist.

[SuperSpanky]

Follow up - I did the vinegar test again and I think one of them turned whitish.  I kept the Vinegar on for a while though (5+ minutes), but I know it's not an accurate test.  

So my question is - do warts bleed a lot when you pick them?

[H. Hunter Handsfield, M.D.]

Warts may or may not bleed, but I am skeptical that a wart could actually have been removed at all, whereas MC lesions are quite superficial and easily scraped away.  Not all things that turn white with vinegar are warts, and not all warts turn white -- which is why painting skin with vinegar or acetic acid is never done in STD clinics.  It is simply a useless test, except in very specialized circumstances and in expert hands.

There is no point in speculating further; dermatologists are experts in both warts and MC and that's where the answer will come.

[SuperSpanky]

Thanks again for the follow up.  I found a dermatologist who could see me tomorrow, so I'll report back once I meet with him.

[SuperSpanky]

I just got back from the dermatologist, he said they were warts and he lasered them off.  

He seemed very laid back about it, as if it's some common occurance.  Said not to worry about it anymore since they were now dead, and to only come back if I see more of them.  

He said it could have been transmitted sexually, but it was possible that I shook someone's hand and then went to the bathroom, and it transferred that way.  

I wish I could pinpoint when this happened, but I just don't remember.  So does this mean I have HPV and can give it to someone else?  

[H. Hunter Handsfield, M.D.]

While MedHelp prefers that its moderators try to avoid overtly disagreeing with questioners' own health care providers, either you misunderstood your dermatologist or he is simply wrong about genital warts being acquired by the indirect route you describe.  That is a theoretical possibility only and very rare if it occurs at all.  Different types of HPV cause warts of the hands and feet (mostly HPV-1) versus genital warts (90+% HPV-6 and -11).  The hand types are virtually never found in the genital area.  You definitely caught your warts by sex with someone infected with HPV.  (My guess is that your dermatologist knows this.  He might have responded with a theoretical face-saving explanation when you asked about it.)

Yes, this means you have HPV and indeed can transmit it, but that risk probably has been reduced by removal of your warts.  However, it likely will be a few months before you can be confident the underlying HPV infection is gone and you can no longer transmit the virus to sex partners.

You should inform anybody you have had sex with in the last few months -- since the warts first appeared -- so they can be on the lookout for warts.

[SuperSpanky]

Thanks for the clarification - I appreciate your throughness.  I haven't had sex with anyone in the last few months; I have a feeling I got these after having sex with someone back in January.  Is is possible that she didn't show any signs, but I picked up the virus?  Perhaps it was dormant in her, and with my weakend immune system I picked it up? There seems to be a lot of different opinions about HPV, and it seems not too many people know what triggers it, where you picked it up, if you are still infected, etc.  

So even though the warts are now dead, I could still transmit the infection for the next couple of months?  Is there any exact way to tell that the virus is gone?  Perhaps it could stay around longer because of my immune system?

My dermatologist didn't think it was a very big deal - he was quite laid back about it.  He told me they were gone now and I didn't have anything to worry about.  Maybe he was just trying to make me feel better. He's been in the practice for 35 years, so it is odd to see this contrasting opinion about this.

[H. Hunter Handsfield, M.D.]

The epidemiologic and clinical knowledge about genital warts has evolved rapidly over the past decade.  Also, much remains unknown.  These facts lead to lots of variable knowledge levels and advice.  It is true that it often is not possible to know when, where, and from whom warts were acquired.

Sometimes warts may resolve but leave behind a scar in the form of heaped up but non-warty tissue.  If that is what you dermatologist found, then perhaps you are no longer infectious.  However, I suspect the dermatologist would agree that's a judgment call, not a definitive diagnosis.  You'll have to clarify it with him. My routine advice to patients is that if a bump/wart is present, so is the virus.

Many wart infections are asymptomatic, especially in women, who can have internal warts without ever noticing anything wrong.

That will have to be all for this thread.  For further questions, see some excellent websites, including www.cdc.gov/std and www.ashastd.org, and consider starting a dialog on the HPV community forum.