White Bumps: Molluscum, Warts, or Normal Follicles?

Molluscum contagiosum, condyloma, folliculitis?

Hello, doctor.
I have a question I'd like to ask! There are small white spots at the base of my penis near the pubic hair area.
I remember they have been there for a few months, and previously, when I visited a urologist, the doctor told me they were hair follicles and that it was normal.
I didn't think much of it until recently when I underwent a circumcision due to persistent inflammation.
Lately, I've started to pay more attention to those white spots.
Specifically, they seem to have increased in number, but not significantly, and I can't tell if they've gotten larger since I've only noticed them for a few months.
Last month, I started dating a girl, and we had sexual intercourse with a condom.
Later, I felt discomfort, and she informed me that she had previously had genital warts but had been treated.
I took her to a gynecologist, who said there were no signs of recurrence.
We both also went for HIV and syphilis testing, which came back negative.
However, I later tested for HPV and found an infection.
When I went back to the urologist, the doctor said he didn't see any issues related to genital warts and advised me not to worry too much.
Recently, I've become increasingly concerned about those white spots, so I consulted four urologists who all said they were normal hair follicles.
They mentioned that it's normal for men to have hair follicles on their genitalia, and some may be more prominent.
However, when I visited two dermatologists, one suggested that they might be genital warts, while the other said they were molluscum contagiosum.

I would like to know what I should do in this situation.
The urologists say everything is normal, but the dermatologists say it's a condition that needs treatment, and one of them performed cryotherapy on me.
I'm confused about whether the urologists or the dermatologists are correct.
What should I do?

R, 20~29 year old female. Ask Date: 2018/09/01

Dr. Lin Wenxu reply Urology

I’m sorry, but I can only answer your question after a pelvic examination.
However, I want to clarify that what you refer to as "cauliflower" is a skin lesion caused by human papillomavirus (HPV) infection.
It's important to note that not everyone infected with the virus will develop skin lesions; some individuals may harbor the virus without showing any symptoms.

Based on your description, you have seen six doctors, five of whom said there was nothing wrong, while one suggested it might be warts.
I believe the likelihood of it being warts is relatively low.
You can monitor the situation yourself; if it is indeed warts, the skin lesions will gradually increase in size or number.
If there are no changes over time, then it is likely normal.

Reply Date: 2018/09/01

More Info

When it comes to the white bumps you've described at the base of your penis, it's understandable to feel concerned, especially given your recent medical history and the conflicting opinions from different specialists. Let's break down the possible conditions and what you should consider moving forward.

Firstly, the white bumps you mentioned could be a few different things. The most common benign condition is normal hair follicles or sebaceous glands, which can appear as small white or flesh-colored bumps on the skin. These are completely normal and often more noticeable in areas with hair, such as the genital region.
However, there are also other conditions to consider:
1. Molluscum contagiosum: This is a viral infection that causes small, painless bumps on the skin. They can be white or flesh-colored and may have a dimple in the center. Molluscum is contagious and can spread through direct skin-to-skin contact.

2. Warts (Condylomata acuminata): These are caused by the human papillomavirus (HPV) and can appear as small, raised bumps. They can be skin-colored or white and may vary in size. It's important to note that some strains of HPV can lead to genital warts, which can be transmitted sexually.

3. Fordyce spots: These are small, painless, pale bumps that are actually enlarged sebaceous glands and are completely normal. They are not a sign of any disease and do not require treatment.

Given your history of having a partner with a history of genital warts, it is wise to be cautious. The fact that you tested positive for HPV but were told by urologists that there is no visible issue is a bit contradictory, but it’s important to note that HPV can sometimes be present without visible symptoms.

The differing opinions from the dermatologists and urologists can be frustrating. Here are some steps you can take:
1. Follow-Up: Since you've already seen multiple specialists, consider returning to a urologist who specializes in sexual health or a dermatologist with expertise in sexually transmitted infections. A second opinion from a specialist who can perform a thorough examination may provide clarity.

2. Biopsy: If there is still uncertainty, a biopsy of the bump may be warranted. This can help definitively determine whether the bumps are benign or indicative of a viral infection.

3. Monitor Changes: Keep an eye on the bumps. If they change in size, color, or number, or if you develop any new symptoms (such as pain, itching, or discharge), seek medical attention promptly.

4. Communication with Partners: Given your partner's history, it’s important to maintain open communication regarding sexual health. Regular screenings for STIs, including HPV, are advisable for both partners.

5. Treatment Options: If it is determined that the bumps are indeed molluscum contagiosum or warts, treatment options such as cryotherapy, topical treatments, or other methods can be discussed with your healthcare provider.

In conclusion, while the urologists have reassured you that the bumps are normal, the concerns raised by the dermatologists should not be dismissed. It’s essential to continue seeking clarity and ensure that you are taking the necessary steps to protect your health and that of your partner. Regular check-ups and open communication with healthcare providers will be key in managing your concerns effectively.

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