Concern over tiny black bump on scrotum

[PennPal]

Thank you, doctors for answering my past questions and for considering this new one.

I’ll start off with a little history:

I am a 29 year old gay male in a monogamous relationship (going on 9 months).  Although, I have had multiple partners in the past and so has he.  We use condoms during sexual intercourse, and neither of us ever had a documented STD.  Very recently, I completed the Gardisil vaccine.  I was older, but my doctor was willing to write a script.  I’d like to think I am doing everything I can to prevent STDs, particularly HPV/genital warts.

Here is my concern:

Last week, while in the shower, I felt and noticed a single, tiny black bump (pimple-like), on the scrotum, further down, facing my right thigh.  Instantly, I was worried about HPV/genital warts.  

From what I’ve seen online, it seems to look more like a skin tag, a black pimple or maybe angiokeratoma?  Upon examining with a magnifying glass, I also observed that it is NOT part of a cluster nor is there any “cauliflower.”

My understanding is that a genital wart would be something “more substantial” than this tiny bump.  

I am hesitant to visit my GP becuase I was just there last month for a genital inspection and nothing was found.

How do doctors (like yourself) rule out genital warts?  Is there a checklist?  Or some sort of online tutorial?

I am not trying to substitute a self-diagnosis for that of an MD, but I don’t want to become that crazy guy that runs to my doctor’s office each time a bump appears in a naturally bumpy area.  Thank you for sharing your educated opinion.

[Edward W Hook, MD]

Welcome to our Forum.  Congratulations on getting the HPV vaccine. We endorse this practice, even for persons beyond the "age limit" (not really a limit- this simply reflects the ages where the vaccine was studied and the ages for which insurance typically pays for the vaccine).

I also note in looking at your past posts that you tend to be on the lookout for evidence of warts and have previously been concerned about the possibility of HPV.  Please realize that the closer you look, the more "bumps" and abnormalities you will find. The genital region, in particular typically has many irregularities which are normal structures.   I also find myself wondering why the vigilance and, perhaps, concern.   Virtually

With regard to your specific questions, warts can vary greatly in size, being smaller when they initially present and then slowly growing a bit larger.  The lesion you describe does not sound like a wart, in particular because warts are rarely pigmented and do have the irregular (cauliflower) surface that you note is absent.  Obviously however I cannot make a diagnosis and to do so would take a direct examination by a knowledgeable clinician.

Warts are diagnosed by health care providers on the basis of appearance more than anything less.  Our assessments typically involve not only the appearance of lesions but also the location and other "intangibles" that come with experience.  Even the most experienced clinicians may be wrong on occasion however. Fortunately, such imprecision is typically of little meaningful health consequence.  Warts are a fact of life more than a serious illness.

I hope these comments are helpful. EWH

[Edward W Hook, MD]

I thinl that working with a counselor would be a good idea- this issue here is guilt, not warts.  EWH

[PennPal]

Hi again Dr. Hook,

My vigilance and concern that you accurately observed probably stems from guilt over a causal sex encounter with someone I didn’t know about a year ago, before meeting my partner and getting serious about a relationship.  

My fear is that a revelation of an STD will ruin the relationship by creating distrust…even if HPV is common, I will feel a tremendous amount of guilt if my new partner suffers from my past mistakes.

For that reason, I would like to know how to rule out genital warts.

This last year has been rough, every time I detected what seemed to be the slightest abnormality, I ran to the clinic.  In truth, I would like to put an end to my worrying and what increasingly seems to be obsessive compulsive behavior, but I don’t know how do this.  A counselor maybe?