Genital Warts: Symptoms, Diagnosis, and Treatment

The issue of cauliflower?

Hello Doctor,
I would like to ask you about a cauliflower issue.
In April of this year, I noticed a bruise on the skin at the base of my penis (about 1 cm from the body), approximately 0.4 cm in flat surface area.
It was not swollen, painful, or itchy, and it did not affect my sexual life.
This condition lasted for about a month, so I decided to break the skin of the bruise and squeeze out the blood.
A few days later, the broken skin healed on its own, but there was still a small area of bruising.
I then broke the skin again to squeeze out the blood, but this time, after the skin healed, a small growth resembling a polyp appeared.
It was not painful or itchy.
During this period, I continued to have sexual relations with my girlfriend.
The small polyp (about 0.5 cm in size) persisted until October this year without significant changes.
After seeing news reports, I became worried that I might have genital warts or syphilis.
I went to the hospital for a consultation, and the urologist examined me and stated that it should not be genital warts or early-stage syphilis.
It might be due to excessive stimulation during the healing process, and he advised me to observe it for a while longer and to avoid improper touching of the polyp.
However, after two months, although there was not much change and the polyp had not disappeared (but I still couldn't help but touch it), I returned to the hospital for another consultation and registered with a different doctor.
To my surprise, after examining me, the doctor immediately said it should be genital warts and that it had grown too large (still about 0.5 cm) and that I needed to undergo cauterization surgery.
I was truly astonished by this news, as I have a stable sexual partner and pay great attention to personal hygiene.

Could you please help me with the following questions?
1.
Is it not typical for the initial symptoms of genital warts to present as a flat protrusion on the skin? The growth I have seems to have developed after I injured the area.
Is it possible that I contracted it through unclean hand contact after injuring the skin (not through sexual activity)? Additionally, is it common for genital warts to appear at the base of the penis rather than primarily on the glans?
2.
Is there a possibility that the second doctor misdiagnosed my condition? Are there other lesions that could resemble genital warts? Was it appropriate for the doctor to immediately recommend cauterization and mention a biopsy for pathological examination?
3.
Since the injury healed, I have had this polyp-like growth for over six months without significant proliferation or enlargement, and there has been no pain, itching, or skin breakdown.
From my research online, I understand that genital warts typically show noticeable growth or spreading.

4.
If the pathological examination confirms that it is indeed genital warts, what kind of treatment or consultation should my girlfriend, who currently shows no symptoms, undergo?
I would greatly appreciate it if you could take the time to provide detailed answers to my questions.
Thank you very much!

Fanrao de nanren, 30~39 year old female. Ask Date: 2006/12/27

Dr. Liu Jianting reply Urology

It is indeed concerning.
Based on your description, I tend to agree more with the opinion of the first physician.
However, the pathology report from the second physician may also be worth considering.
As for your girlfriend's situation, she should consult a gynecologist, and she should avoid unnecessary manipulation.

Reply Date: 2006/12/27

More Info

Genital warts, also known as condylomata acuminata, are caused by certain strains of the human papillomavirus (HPV). They are typically characterized by small, flesh-colored or gray growths that can appear on the genital area, including the vulva, vagina, cervix, penis, scrotum, and around the anus. Understanding the symptoms, diagnosis, and treatment of genital warts is crucial for effective management and prevention of further complications.

Symptoms of Genital Warts
The initial symptoms of genital warts can vary significantly among individuals. In many cases, the warts may not cause any discomfort, pain, or itching. They can appear as small bumps or growths that may be flat or raised, and they can sometimes resemble cauliflower due to their texture. In your case, the growth you described, which developed after a skin injury, may have been influenced by the healing process and subsequent irritation.
It's important to note that while genital warts can appear in various locations, including the base of the penis, they are not limited to the glans or shaft. They can indeed develop in any area that comes into contact with the virus, including areas that may not be directly involved in sexual activity.

Diagnosis
Diagnosis of genital warts typically involves a physical examination by a healthcare provider. In some cases, a biopsy may be performed to rule out other conditions or to confirm the presence of HPV. The fact that two different doctors provided differing opinions on your condition highlights the complexity of diagnosing skin lesions, especially in sensitive areas. While it is possible for a misdiagnosis to occur, the recommendation for a biopsy and potential removal of the growth is a common practice, especially if there is any uncertainty regarding the nature of the lesion.

Treatment Options
If genital warts are confirmed, there are several treatment options available. These include:
1. Topical Treatments: Prescription medications such as imiquimod (Aldara) or podofilox (Condylox) can be applied directly to the warts to help reduce their size and promote clearance.

2. Cryotherapy: This involves freezing the warts with liquid nitrogen, which can effectively destroy the tissue.

3. Electrosurgery: This method uses electrical currents to burn off the warts.

4. Surgical Removal: In cases where warts are large or persistent, surgical excision may be necessary.

5. Laser Treatment: This is used for extensive warts that do not respond to other treatments.

Considerations for Sexual Partners
If genital warts are diagnosed, it is essential for your partner to be informed and possibly evaluated as well. HPV can be transmitted even when warts are not visible, and it is possible for someone to carry the virus without showing any symptoms. Regular check-ups and open communication with your partner about sexual health are vital.

Conclusion
In summary, while your initial injury and subsequent growth may not have been caused by direct sexual contact, it is essential to follow through with the recommended treatment and monitoring. If the biopsy confirms genital warts, both you and your partner should discuss preventive measures and treatment options with your healthcare provider. Maintaining good hygiene and being aware of any changes in your genital area can help manage and prevent further complications. Always consult with a healthcare professional for personalized advice and treatment plans.

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