Wart or skin tag on penis shaft

[fspar]

I tested positive for high-risk HPV in 2002. I likely contracted it over 10 years ago. I've never had genital warts or an abnormal pap smear. I had a growth removed from my tongue in 2003. The dentist said it looked like a papilloma but it wasn't biopsied. I developed it a few months after my husband and I stopped using condoms. I tried to yank it off, and later gave my husband oral sex while the area was still raw.  He developed a small bump on the middle of the shaft of his penis a few months after this oral sex and about 14 months after we stopped using condoms.  It is a tiny, flesh-colored, smooth projection on a little stalk.  In early 2005, a urologist examined the bump. He laughed at my husband for being worried about it and said unequivocally it was a skin tag.  He said it didn't look like a wart and would have been much bigger after having it for a year if it was.  He called me into the room to tell me it didn't need to be removed.  I told him I had HPV and he then said, "If you have HPV, it has to come off."  He went on to say if we were going to stay married it really didn't matter but he could "keep taking them off." My husband decided not to have it off.  Now, two years later, the bump has not changed in size or appearance. No similar bumps have come up, although this morning I noticed an even tinier little sliver of white skin sticking up under the rim of the head of his penis (further down than a pearly penile papule would be).  My questions for you:
1.  Do you think the first bump is a skin tag or wart?  Is it easy to distinguish between them?
2.  Do you think it needs to come off?  
3.  Does it increase my likelihood of developing genital warts if he doesn't have it off?  
4.  Will it increase his immunity if he does have it off?
5.  Do you think the tiny sliver of skin is a wart, or is this normal?
6.  Is he likely to develop more warts at this point after at least three years of exposure without condoms?  
7.  Is he now likely immune to the HPV I have?  If so, why hasn't the bump disappeared?

[H. Hunter Handsfield, M.D.]

As you suggest, I am not a mind reader.  But my guess is that the urologist was reacting to your concern, not with his objective assessment.  Happily, your husband had better judgment than the urologist, and your husband's decision led him (and you) down the right path.

Many physicians do not understand HPV infections, partly because the understanding of scientific issues on HPV have been evolving rapidly.

It's also partly a matter of terminology, i.e. biological cure (virus definitely gone forever) versus clinical cure (HPV DNA persists, but kept in check forever by the immune system, with no future disease and no ability to transmit the infection).  Nobody knows what proportion of people who are cured are biologically cured or "only" clinically cured.  But for most people it doesn't matter.

Thanks for the thanks about the forum--  HHH, MD

[fspar]

Dr. Handsfield, thank you so much for your answer.  I have one last question for you.  Initially the urologist was sure it was a skin tag that didn't need to come off, but when he found out I had HPV, he began talking about the lesion as if it were a wart after all.  Obviously you're not a mind reader, but in your professional opinion, why might he flip flop like this, if tags and warts are easily distinguishable from each other?  This is the thing that worries me.  Also, he definitely implied that my husband and I would both have HPV for life.    

Thank you again for the service you provide.    

[H. Hunter Handsfield, M.D.]

Your husband's lesion probably is a skin tag, and definitely is not a wart.  Skin tags and warts are easily to tell apart by experienced health care providers like urologists, so there is no reason to doubt him.  Second, almost all warts go away with in a few months; or new ones woudld appear; or the lesion would have grown.  An unchanging lesion for 2 years is no wart.  If your oral problem of several years ago indeed was a papilloma (wart), probably it was not the same infection as the 'high risk' one, which presumably was diagnosed by pap smear.

So to your questions:  1,5) A urologist's diagnosis of penile skin tag should be accurate.  It definitely isn't a wart.  2) I see no reason to remove it, but your husband needs to confirm that opinion with the urologist, or get a second opinion; I cannot give that kind of advice from afar. 3) Even if your husband's penile bump is a wart, you are either already infected with that strain of HPV, or are immune to it. People do not catch the same kind of HPV a second time, and you obviously have been repeatedly exposed to it all these years.  4) Not applicable, since it's not a wart.  But it wouldn't make a difference anyway. 6) No way.  7) Your HPV infection probably is long gone, and your husband probably has been immune to that strain for years.  His penile bump hasn't disappeared because it isn't a wart.

You should follow your provider's advice about your 'high risk' HPV type, which presumably was diagnosed by pap smear.  Other than that, HPV simply is not a health issue for either you or your husband and probably never was.

Good luck--  HHH, MD