Pearly papules vs. HPV: How to tell the difference

Pearly penile papules are small bumps that are generally the same color as the surrounding skin and normally develop around the head of the penis in rows. They may form one or many lines of papules.

The prevalence of pearly penile papules ranges from 14% to 48% of males, according to 2023 research. These papules may be more common in late adolescence and early adulthood. They appear to decrease as a person ages.

Pearly penile papules may also be more common in males who have not undergone circumcision. However, some research has shown that the prevalence of pearly penile papules among males who have been circumcised is around 17.1%.

Penile papules do not generally pose any risk to overall health or cause symptoms. However, an individual may feel anxious upon noticing them for the first time.

Research from 2023 found that around 2 in 3 males have expressed concern about medium-to-large papules, while 1 in 3 males has identified smaller papules as concerning.

HPV is a common transmissible virus that most individuals contract at some point in their lives. Around 42 million people in the United States currently have the infection, according to the Centers for Disease Control and Prevention (CDC).

Most people with HPV do not know they have it, and it does not typically cause symptoms. However, some people may develop warts due to the virus.

Some types of HPV can cause cell changes, known as dysplasia or hyperplasia, which may develop into cancer over time.

Warts are the only symptom of HPV when they occur.

On the genitals, these may have the following appearance:

• They might develop separately or in clusters that resemble cauliflower.
• They can grow across the shaft of the penis and the scrotum.
• Their size can be around 5 millimeters (mm), but they might become larger over time.
• They tend to be the same color as the skin or darker.
• They may become itchy, uncomfortable, or change color.

Pearly penile papules and genital warts due to HPV share some similarities but are different conditions. Males can have both conditions at the same time.

According to 2023 research, around 1% of males with pearly penile papules also have genital warts. People may often mistake the two conditions. Approximately 1 in 7 males presenting for a sexual health check have pearly penile papules but no sign of infection.

Genital warts can have a range of shapes and sizes, whereas pearly penile papules are small and generally have a dome shape.

An important difference is the location. While pearly penile papules develop around the head of the penis, genital warts can develop anywhere along the shaft or scrotum.

Papules are generally the same color as the surrounding skin or white. While genital warts may also take on the color of the surrounding skin, they might be darker.

Under a microscope, no viral particles are visible in the pearly papules. The cause of pearly penis papules is unclear, but it does not relate to a viral infection.

Genital warts specifically occur due to HPV types 6 and 11. People acquire HPV through sexual contact, but no research has confirmed why pearly penile papules develop.

Pearly papules and genital warts share a pattern of blood vessels that sit in the middle of the lesion and have the shape of a comma, hairpin, or dots.

Both do not link to more severe medical issues and are usually painless.

Neither genital warts nor pearly papules typically require treatment. Pearly papules are not usually cause for concern, and genital warts often resolve without treatment.

However, if people have concerns, anxiety, or self-image issues around the appearance of their genitals, they can speak with a healthcare professional about removal.

Laser therapy and cryotherapy can remove pearly penile papules. In laser therapy, a healthcare professional uses a carbon dioxide laser to burn off the papules.

While not much research has examined the safety and efficacy of cryotherapy for pearly papules, two case studies involving cryotherapy with liquid nitrogen yielded good cosmetic results.

No treatment can cure HPV, but it tends to leave the body within 2 years of acquiring the virus. However, people can choose treatment to remove genital warts depending on the warts’ size, location, and level of discomfort. Treatments might include:

• creams and ointments
• surgical excision
• cryosurgery
• electrocauterization
• laser vaporization
• surgical removal under general anesthesia

HPV is not totally preventable, but a person can take steps to reduce the risk. Using a condom or other barrier method during sexual activity can help prevent the transmission of HPV. However, these methods do not cover the entire skin area, and it can still be possible for genital warts to spread to others.

A vaccine can also help reduce the risk of HPV transmission. The CDC recommends it for children ages 11 to 12 years. Two doses 6 to 12 months apart provide protection. People can receive the vaccine up to 26 years old, but three doses may be necessary after 15 years of age.

Adults can choose to get the vaccine later in life (up to 45 years of age) on their healthcare professional’s advice. However, they are more likely to have acquired HPV by this point, after which the vaccine is no longer effective.

Doctors have not established the cause of pearly papules, so prevention is not possible.

Pearly penile papules are not an STI. They are not contagious and do not develop due to an infection of any kind.

People who have concerns about penile bumps can speak with a healthcare professional. They can identify genital warts by appearance. There are currently no tests to confirm a person’s HPV status. Females can have regular screenings for cervical cancer, which can be the result of HPV.

Pearly penile papules and genital warts are both often painless, and neither has links to serious complications or conditions.

However, HPV causes genital warts, while the cause of pearly papules is unknown. They also differ in shape, size, consistency, and location.

Treatment is not necessary for either, as papules do not cause issues, and genital warts often resolve without intervention.

However, the treatment methods for removing each differ. People who have concerns or uncertainties around these two skin symptoms may benefit from consulting with a health professional.