Common penis shapes chart8/31/2023 Molluscum contagiosum lesions is another casue occasionally confused with folliculitis, but there is sometimes a red halo. Herpes simplex virus may also be associated with a prodrome of malaise, fatigue and paraesthesia of the affected area. If a lesion is aspirated, thick purulent material (which may be blood stained), is often seen, whereas, vesicles due to HSV express a clear or straw coloured fluid. Patients are often concerned that genital herpes simplex virus (HSV) is the cause, but the association with a hair follicle and the quality of the pain helps distinguish folliculitis from HSV. Folliculitis presents as a pustule around the hair follicle, which is frequently itchy and sometimes painful. Molluscum contagiosum Folliculitisįolliculitis is an inflammation of the hair follicles, frequently seen at the base of the penis ( Figure 8). As the natural history of HPV in immunocompetent hosts is spontaneous recovery over 12–24 months, patients may also opt to have no treatment. All of these therapeutic options typically require multiple treatments over a number of weeks. 8 There are a number of options for treatment including cryotherapy, podophyllotoxin and imiquimod. Warts are most commonly due to strains 6 and 11 of HPV. A smooth-looking wart may be difficult to distinguish from an acrochordon (skin tag) or other normal structure, but using a bright light and magnification will reveal fine dots or a cobblestone pattern. Warts on the shaft of the penis or pubic area tend to be more indurated and dome shaped, whereas those under the prepuce or emerging from the urethra are softer and fronded ( Figure 6). Warts vary in size from a millimetre to a few centimetres. Penile warts(Condylomata acuminata) are irregular, rough lesions that can occur anywhere along the penile shaft, glans and prepuce they can also arise from the meatus. Penile lumps that may require treatment Warts Skin tags have a fibrovascular centre and normal overlying epidermis. They are often also present in the axillae and on the lateral skin of the neck. They typically have the size and shape of a grain of rice. Also note small pearly penile papules Skin tagsĪlso known as acrochordons, skin tags are common in the skin creases of the groin in middle aged men. Histologically, PPPs resemble angiokeratomas.įigure 5. 2,3 In difficult cases dermoscopy can be useful, as PPPs will have delicate, regular vessels that are distinct from genital warts. PPPs occur in up to 20% of men and are frequently mistaken for warts, but bear no relationship to them. PPPs are numerous, uniform, symmetrical and dome shaped, and vary from 1 to 3 mm in length. They can occur as a single row, or in multiple orderly rings encircling the corona. Pearly penile papules (PPPs) are tiny lumps seen in neat rows around the corona of the glans penis ( Figure 1). New lesions appear, previous lesions increase in size Irregular projections with hairpin, comma-like and irregular vasculature surrounded by a whitish band whitening of lesion with dilute acetic acid.Previous quadrivalent-HPV vaccination, especially if given before the commencement of sexual activity Distinguishing characteristics of a genital wart compared to a normal anatomical variant These images can also be used to reassure patients and educate them on the differences between normal anatomy and conditions that would require treatment. Having access to a bank of images, such as those on the Melbourne Sexual Health Centre website ( is very useful. Despite these features, it can sometimes still be difficult to be sure, especially if the appearance is atypical. Table 1 outlines some typical features that are suggestive of genital warts. Normal variants should not produce any symptoms of pain or be associated with inguinal lymphadenopathy. Most anatomical variants share characteristic features that help with recognition, such as symmetry, a smooth surface and well circumscribed border. There are other conditions that may cause genital pathology that are not covered, and treatment is not discussed in detail. This article aims to assist diagnosis by outlining some common anatomical variants and comparing them to a few pathological conditions. 1 With the extension of this vaccination program to young men, it is expected that the incidence of genital warts will fall further and will also decline in homosexual men: genital lumps in young adults are now less likely to be warts. Since the introduction of the National Human Papillomavirus Vaccination Program for young women in 2007, the incidence of genital warts has fallen dramatically in young Australian heterosexuals.
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