Genital Warts?

[Spurs1982]

Hi doctor, Over 2 years ago I had protected sex with a prostitute after a drunk night out. I panicked after this and had 3 different std examinations and everything came back negative. Recently after examining myself i noticed a small lump on the tip of my penis where the foreskin connects to a penis It is a small bump and when i stretch the skin it gets smaller. Im just worried that i might infect my girlfriend.  I am currently in a long term relationship. I am worried this could be a wart. Is it possible to get genital warts on my penis whilst wearing a condom? Also doctor is it possble to develop warts 18 months to 2 years after my stupid drunken incident. My girlfriend was a virgin before i met her, as was I, so this could of been the only time I could of been exposed to warts. Any help and advice would be greatly appreciatied.

[Edward W Hook, MD]

She did just what I was worried about when I said " If you wish to pursue this, have a knowledgeable clinician take a look but I would not encourage you to pursue or accept treatment if you are not sure what the lesion is “just in case”- this will do little for the concerns you have expressed."

It this time, with a parially treated lesion, there is no way to really know if this was a wart or not.  You need to move forward.  further opinions will not be helpful at this time. EWH

[Spurs1982]

Hi doctor, today I seen an std specialist and showed her my concern. She looked at it and immediately applied liquid nitrogen to the area. She said it could be a wart. After 30 seconds or so she stopped applying liquid nitrogen and said it was not a wart. On leaving the office she reassured me it was not a wart. I'm just concerned why she applied the liquid nitrogen if it not a wart. Do you think I should leave it at this or do you think I should get a second opinion? I am just concerned about infecting my fiancé. Thank you for your help and time.

[Edward W Hook, MD]

Condoms offer major protection against HPV but this protection is not total.  Further, some people who have not previously  had intercourse still get HPV although it is quite uncommon.

Also, let me repeat, it is not likely to be a wart for the reason I mentioned above.  The issue of clearnace of HPV is, I think, irrelevant to your question.  the lesion you noted is not likely to be a wart.  EWH

[Spurs1982]

Thank you doctor.i was never in another sexual relationship nor was my partner so that's a main reason why im worried I could give it to her. Your comments on condom protection is it possible to get a wart on the tip of my penis even though it was covered by a condom? Also I've read hpv also clears itself with 18 months, would this mean that likelihood is its not a wart??

[Edward W Hook, MD]

Welcome to the Forum. I'll try to help an to provide some perspective.  The bump that you mention is unlikely to be a wart.  It would be most unusual for a wart to appear two years after an exposure- on average warts appear about 6 months after the exposure at which they are acquired.  In your case, the fact that your exposures also make HPV infection a less likely cause of this lesion since. although not perfect, condoms do offer good protection against warts.   My guess is that this a normal skin structure that you have not noticed before or perhaps a cyst. Either way this is not something to worry about.  If you wish to pursue this, have a knowledgeable clinician take a look but I would not encourage you to pursue or accept treatment if you are not sure what the lesion is “just in case”- this will o little for the concerns you have expressed.

In addition, a word or two about HPV infections.  If you had other sexual partners prior to entering the relationship with your partner, you are highly likely to already have HPV.  For better or worse, at present HPV is a "fact of life" and most people have it or will have it at some point in the future.  Despite this fact, only a tiny minority of persons with HPV get the consequences of infection (primarily women and primarily cancer and pre-cancerous lesions).  HPV is the most commonly acquired STD.  Over 85% of sexually active women will have HPV infection at some time in their lives.  The figure for men is less well studied but similar.  While the vast majority of HPV infections are acquired through sexual contact, occasionally people get them through other mechanisms which are often unexplained.  Since most people have them and since they have few consequences, particularly for women who should both receive the HPV vaccine and who should be regularly screened for consequences of HPV infection with PAP smears, this is simply not something to spend a lot of time worrying about.

I hope my comments about your skin lesions are reassuring and that my comments about HPV provide some perspective.  Take care. EWH