Human Papillomavirus (HPV) is a common virus transmitted through skin-to-skin contact, often during sexual activity. It is the cause of genital warts, which present as lesions on the penis and surrounding areas. While most HPV infections clear on their own, the appearance of visible penile lesions frequently causes anxiety. These growths, known medically as condylomata acuminata, are the most common clinical manifestation of HPV infection and are typically benign, though they require medical evaluation.
Recognizing the Physical Appearance of Penile Lesions
HPV-related lesions on the penis can manifest in several different physical forms, varying in size, shape, and color. The most recognized form is the “cauliflower-like” growth, consisting of multiple small, fleshy papules clustered together to create a rough, bumpy surface. These lesions frequently appear on the penile shaft, the glans (head), under the foreskin in uncircumcised males, on the scrotum, or in the perianal area.
Other presentations are often much more subtle, including small, dome-shaped papules that are discrete and scattered across the skin. Some lesions can be flat, slightly raised, or appear as smooth plaques, making them difficult to distinguish from normal skin texture. Their color usually ranges from flesh-toned, pink, or white to a darker, hyperpigmented shade, depending on the patient’s natural skin tone.
Although these growths are generally painless, their presence may cause minor physical symptoms or discomfort. Patients sometimes report localized itching, a feeling of pressure, or tenderness in the affected area. Lesions that are large or located in areas subject to friction may also become irritated and occasionally bleed.
Medical Diagnosis and Differentiating Risk Types
The initial diagnosis of HPV-related penile lesions is most often made through a simple visual inspection by a healthcare provider. The provider examines the genital and anal areas to identify any visible warts, assessing their size, location, and characteristic appearance. If any lesions are small or subtle, a provider may apply a dilute acetic acid solution, sometimes called the vinegar test, which can cause the infected areas to temporarily turn white, making them easier to see.
Distinguishing between the different types of HPV is important for understanding the risk associated with the lesions. HPV types are classified into low-risk and high-risk groups based on their potential to cause cancer. Low-risk types, specifically Human Papillomavirus types 6 and 11, are responsible for approximately 90% of all visible genital warts and have a very low potential for malignancy.
High-risk types, such as HPV 16 and 18, typically do not cause visible warts but are instead linked to the development of pre-cancerous and cancerous changes. When a lesion appears atypical, pigmented, or is ulcerated, a biopsy is often necessary to confirm the diagnosis and rule out high-grade changes like penile intraepithelial neoplasia (PeIN). PeIN is a pre-cancerous condition that, if left untreated, can potentially progress to invasive penile carcinoma.
Treatment Options for Lesion Removal
Treatment for HPV penile lesions focuses on the physical removal or destruction of the visible warts, as there is no cure for the underlying viral infection. The choice of treatment modality depends on the size, location, and number of lesions, as well as patient and provider preference. A common approach is the use of prescription topical treatments that patients can apply at home.
These self-administered medications include imiquimod cream, which works by stimulating the local immune system to fight the virus, and podofilox solution or gel, which directly causes the destruction of the wart tissue. Imiquimod is typically applied three times per week for up to 16 weeks, while podofilox involves a cycle of application for three days followed by four days of rest, repeated for several weeks.
For lesions that are larger, resistant to topical therapy, or located in sensitive areas, the provider may administer in-office procedures. Clinician-applied chemical agents include trichloroacetic acid (TCA), a strong acid that chemically burns the wart tissue. Other ablative methods involve cryotherapy, which freezes the lesions using liquid nitrogen, or surgical options like excision or laser removal.
Prevention of HPV Infection and Transmission
Preventing initial infection with Human Papillomavirus is the most effective defense against developing penile lesions. The most impactful preventive measure is vaccination with the HPV vaccine, Gardasil 9, which protects against the nine types of HPV most commonly associated with both genital warts and cancers. The vaccine is recommended for males and females typically starting in early adolescence, but it is approved for use in men up to age 45.
While condoms reduce the risk of sexually transmitted infections, their effectiveness against HPV is limited because the virus spreads through skin-to-skin contact outside the covered area. Even after successful treatment, the HPV infection can remain latent, meaning recurrence is possible, and the virus can still be transmitted. Healthcare providers recommend that patients with HPV inform their partners and ensure both are monitored for new lesions.