Do I have HPV?

[mohelp]

Hello Dr.

For the past 4 months I have had urethritis (no discharge) - initially a brief period of frequency and urgency - but thereafter, mainly just discomfort in my urethra that comes and goes; this urethritis was accompanied by some lesions on my penis. The lesions were confined to the foreskin area - although I have been circumcised - and also the glans. On the glans they were small dark red spots that did not appear to be raised. Just behind the head (where the foreskin would be) the lesions were pink and inflamed. Most were small, although one area was approximately 1 cm in diameter. On the larger lesion the skin would occasionally dry up and flake off.  No itching.

Could this be HPV? They don't look like the pictures of warts you see - not really raised and bumpy or cauliflower-like in appearance. However, I know that not all warts appear like the typical ones. I did do a vinegar test to see if they would turn white - and they did not, but not sure about the validity of that test.

Recently, I placed some hydrocortisone cream on them for one week and they more or less went away. (Can still sort of tell where the larger lesion was) I am, however, left with urethra pain that is bothersome.

I have had 3 practitioners examine the lesions and they say that "they do not look like genital warts" - but I am concerned that I may have a type of HPV that doesn't cause the typical warts. Screens for Chlamydia, gonorrhea, syphilis, and HIV are negative and the chronic duration excludes HSV.

I had a similar experience with the urethritis about 3 years ago - a urologist was unable to locate the cause and it eventually went away. I don't recall any associated lesions at that time - certainly nothing like they were this time. I seem to recall noticing this area of "dry skin" on my penis once before - but, again, not like it has been recently.

Could this be HPV? What else might I be suffering from? What tests should I seek?

Thank you!

[Gunny14]

A related discussion, Bumps and rash was started.

[H. Hunter Handsfield, M.D.]

Steroid creams have no effect on HPV.  Otherwise, I have nothing more to say.  If you go to an STD clinic, do not request any particular test.  Just tell them the issues and then follow their advice.  I'm guessing that they won't find anything abnormal and that you have anything that will ever threaten your health or that of a sex partner.  You may have to live with your symptoms, knowing for sure that they don't mean anything.  

[mohelp]

Thanks for the quick reply Dr. Handsfield. I had planned to see a dermatologist, but facing a long waiting list, I decided to use the hydrocortisone cream. I am assuming that hydrocortisone cream should be ineffective against HPV and since the cream seems to have taken care of the lesions, that HPV can be ruled out as their cause. Is that a safe assumption?

I am not sure what else could be causing this urethral discomfort. Since this began, I have been tested for chlamydia, gonorrhea, syphilis, and HIV. The first two by urinalysis and the last two through blood work. If I return to the STD clinic, what should I request? Should the health care providers be doing urethra swabs to look for the presence of other bacteria - or is that a normal part of urinalysis?

Thanks again.

[mohelp]

Thanks for the quick reply Dr. Handsfield. I had planned to see a dermatologist, but facing a long waiting list, I decided to use the hydrocortisone cream. I am assuming that hydrocortisone cream should be ineffective against HPV and since the cream seems to have taken care of the lesions, that HPV can be ruled out as their cause. Is that a safe assumption?

I am not sure what else could be causing this urethral discomfort. Since this began, I have been tested for chlamydia, gonorrhea, syphilis, and HIV. The first two by urinalysis and the last two through blood work. If I return to the STD clinic, what should I request? Should the health care providers be doing urethra swabs to look for the presence of other bacteria - or is that a normal part of urinalysis?

Thanks again.

[H. Hunter Handsfield, M.D.]

Your description doesn't sound like warts.  Combining that with the opinion of 3 different health care provider that they aren't warts, that also is my conclusion.  It is true that most HPV infections don't cause warts, but those types don't cause anything visible at all.  You can assume you have had HPV and perhaps still do, since almost all sexually active persons get genital HPV at one time or another; it is a normal consequence of being sexually active.  But if you do, it probably has nothing to do with the spots on your penis.

The description of redness and flaking suggest some sort of minor dermatitis.  There are several possible causes; any of the many skin conditions that can occur anywhere on the body sometimes can involve the penis.  Or, since it occurs under the foreskin, perhaps a minor fungal infection.  If it continues and you remain concerned, and if you haven't seen a dermatologist, that would be a logical next step.

As far as your "urethritis" is concerned, I am skeptical about it.  Symptoms like you describe do not, on their own, justify a diagnosis of urethritis.  Without evidence of actual inflammation, like discharge of pus or mucus from the penis or tests showing eleveted white blood cells in the urethra, there is no urethritis.  If you have been sexually active and not tested for STDs recently, that would be a logical step.  Your local health department STD clinic would be a good place to get it checked out and probably for the penile rash as well.

I hope this helps.  Best wishes--  HHH, MD