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Sexually Transmitted Diseases/Warts, Herpes, or Normal Sebaceous Glad/Folliculitis

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Question
What could this be?
What could this be?  
QUESTION: Mark:

I’m concerned about a series of bumps I’ve discovered several months ago along the shaft of my penis. They may have been there longer, but I’ve only started noticing them recently. I am a sexually active gay male who engages in frottage, unprotected oral sex, and mutual masturbation only. In March of 2011 I tested negative for both HSV I and II via a Combo test. However, I have engaged in the above-mentioned activities since.

The bumps are extremely small, in some respects shaped like a bean, vary from fleshy to white in color, and appear to be under the skin. They are isolated to the underside of my penis shaft about a quarter to halfway down from my head. Even though I am circumcised I do have a lot of excess skin and they tend to hide within the folds. I really have to look for these bumps because they are so small and hide within the skin. Usually (but not always) I have to really stretch out the skin to get a good look at them. I popped a similar bump, which was a bit larger and  a white, stringy pus came oozing out. The other bumps look like they could potentially be popped, but I have yet to do so. I have come close to popping them by placing the bumps between two fingers and gently raising them up and they look as though they want to pop. Of course, I cannot be certain if they would all pop so easily.

I went to planned parenthood on two different occasions and all the clinicians could tell me was that they didn’t appear to look like herpes or warts, because they were too small and did not have a cauliflower appearance (as warts do). I was told they were normal sebaceous glands and/or folliculitis. It is important to note that I do have some hairs in the same area as some of the bumps, although I have not seen any obvious hairs sticking out of any of the bumps. I do masturbate quite vigorously and often without any lubrication using my left hand and clothe. The bumps do appear in the area where my hand grasps my penis. Could these bumps be caused by my masturbation? Do they look like what the clinicians have stated or could they be warts or even herpes?

I tried to enhance the photo so you could get an idea of what one of the bumps looks like. It is not the best shot, but I had to stretch out the skin and this particular bump is very small and hard for the camera to pick up. The picture makes it look flat but it is a bit more raised, like a bump, but still small and appearing to be under the skin and poppable. I could try to take another if it helps. I count quite a few of these bumps at present, but again they are very tiny. Thank you so much for your help.

ANSWER: Hello Jay,
You're right, the photograph does not show the bump you speak of very well. Sometimes using the macro feature on a camera can create larger image suitable for posting. I don't believe that the bump is herpes or HPV; it sounds more like Fordyce spots, or folliculitis. Although it doesn't sound related to your having sex or masturbating, you may wish to try a silicone based lubricant. Very inert (and slippery), and a little goes a very long way. Ok with condoms or any other type of sex with a partner or by yourself.

Hope this helps!  Good luck!
--mark



---------- FOLLOW-UP ----------

Bump 1
Bump 1  

Shaft
Shaft  
QUESTION: Mark:

Thanks for your answer. I just wanted to follow up with additional images. The first is another shot of the one on top. Below my fingernail (12 O'clock) is where this particular bump in question is located. The larger bump to the 3 O'Clock appears to have a hair growing out of it. I get these, as I stated, in different locations on my shaft. The other shots are a series of smaller bumps I have on the other side of my shaft. They have been there for awhile. The larger red one was a bump similar to the one at the first pic, but got red and inflamed after I started picking at it the other day. Nothing came out when I picked at it though, or nothing I could see-it has gotten better (reduced redness however) after a couple days. I think there is actually a hair coming out of it. From the pics provided, do any of these bumps look like warts or herpes? I sometimes get a mild burning feeling on my shaft when seated (but again I masturbate daily and with no lube just cloth) and in the past I have gotten a reddish rash/irritation, that was itchy but never any large blisters or warts that look like pictures I've seen on the internet. The rash/irritation hasnt come in a long time, but if I remember correctly cleared up with cordisone cream or fungal cream (similar to that used on athletes foot) and seemed to come after masturbating. I've had the rash before my last Herpes test (HSV I/II Combo negative) and afterward once, so it might be just from masturbating. Any additional thoughts would be great. The clinician I saw who said they were normal sebaceous glands and/or folliculitis also recommended against HSV testing without obvious blisters. What do you think? Thanks again.

Answer
Hello Again, Jay,
The skin does not look like either an acute herpes or wart infection. But the photo is not not clear enough to see the area for a better idea of what it might be. There is a whitish area below your finger, but it's still too small to identify. Such a whitish area may be due to any type of skin infection or irritation, including HPV.

The best advise is to let the skin heal without interference for several weeks or so. Then reassess.

Good luck!
--mark  

Sexually Transmitted Diseases

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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