Common Causes
Normal Anatomical Variations
- Pearly penile papules:
- Small, dome-shaped bumps around corona
- Pink, white, or skin-colored
- Arranged in rows
- Completely harmless
- Present in 15-40% of men
- No treatment needed
- Fordyce spots:
- Small, raised, pale spots
- Visible oil glands
- 1-3mm in diameter
- On shaft or scrotum
- Normal and harmless
- Tyson glands:
- Small glands on frenulum
- Produce lubricating fluid
- May appear as tiny bumps
- Normal anatomy
- Hair follicles:
- Small bumps at base of shaft
- Where pubic hair grows
- May become inflamed
- Normal unless infected
Sexually Transmitted Infections
- Genital warts (HPV):
- Soft, flesh-colored growths
- Cauliflower-like appearance
- Single or clusters
- May be flat or raised
- Painless usually
- Highly contagious
- Genital herpes:
- Painful blisters or sores
- Clear fluid-filled vesicles
- Break open and crust
- Recurrent outbreaks
- Tingling before outbreak
- Highly contagious
- Syphilis:
- Painless ulcer (chancre)
- Firm, round sore
- Clean base
- Heals without treatment
- Highly infectious
- Requires antibiotic treatment
- Molluscum contagiosum:
- Small, dome-shaped bumps
- Central dimple
- Pearly or flesh-colored
- 2-5mm diameter
- Painless
- Viral infection
Non-STI Infections
- Folliculitis:
- Infected hair follicles
- Red, inflamed bumps
- May have pus
- Can be painful
- Often from shaving
- Balanitis:
- Inflammation of glans
- Red patches or bumps
- May have discharge
- Pain and swelling
- Common in uncircumcised men
- Yeast infection:
- Red bumps or rash
- Itching and burning
- White discharge
- Under foreskin
- More common in diabetics
- Bacterial infections:
- Various presentations
- Red, inflamed bumps
- May have pus
- Can spread rapidly
Skin Conditions
- Psoriasis:
- Red patches with silvery scales
- Well-defined borders
- May be itchy
- Chronic condition
- Can affect genitals
- Eczema/Dermatitis:
- Red, itchy patches
- May have small bumps
- Dry, scaly skin
- Contact or atopic
- Lichen planus:
- Purple, flat-topped bumps
- May have white lines
- Can be itchy
- Autoimmune condition
- Angiokeratomas:
- Small, dark red/purple spots
- Blood vessel growths
- Usually harmless
- May bleed if scratched
Other Causes
- Penile cancer: Rare but serious, persistent sore or growth
- Cysts: Fluid-filled sacs, usually benign
- Allergic reactions: To soaps, condoms, lubricants
- Trauma: From injury or rough sexual activity
- Insect bites: Localized bumps from bites
- Medication reactions: Some drugs cause skin reactions
Associated Symptoms
Local Symptoms
- Pain or tenderness
- Itching or burning
- Discharge (clear, white, or pus)
- Bleeding
- Ulceration or open sores
- Swelling of penis or foreskin
- Difficulty retracting foreskin
- Pain during urination
- Pain during sexual activity
- Changes in skin color
Systemic Symptoms
- Fever
- Swollen lymph nodes (groin)
- Body aches
- Fatigue
- Rash elsewhere on body
- Joint pain
- Flu-like symptoms
Urinary Symptoms
- Painful urination (dysuria)
- Frequent urination
- Urethral discharge
- Blood in urine
- Difficulty starting urination
- Weak urine stream
Diagnosis and Evaluation
Medical History
- Sexual history and partners
- Use of protection
- Previous STI history
- Duration of symptoms
- Associated symptoms
- Recent new products used
- Medical conditions
- Current medications
Physical Examination
- Visual inspection of lesions
- Palpation for tenderness
- Lymph node examination
- Full genital examination
- Skin examination
- Urethral examination
Diagnostic Tests
- STI testing:
- HPV DNA testing
- Herpes PCR or culture
- Syphilis serology
- HIV testing
- Gonorrhea/chlamydia testing
- Other tests:
- Biopsy if cancer suspected
- Skin scraping for microscopy
- Bacterial culture
- Fungal culture
- Patch testing for allergies
Treatment Options
Based on Cause
- Normal variations:
- No treatment needed
- Reassurance and education
- Cosmetic removal if desired
- Genital warts:
- Topical medications (imiquimod, podofilox)
- Cryotherapy (freezing)
- Laser therapy
- Surgical removal
- HPV vaccination for prevention
- Herpes:
- Antiviral medications
- Acyclovir, valacyclovir
- Suppressive therapy
- Pain management
- Bacterial infections:
- Appropriate antibiotics
- Topical or oral
- Complete full course
- Fungal infections:
- Antifungal creams
- Oral antifungals if severe
- Keep area dry
General Management
- Good hygiene practices
- Avoid irritants
- Wear loose, breathable clothing
- Safe sex practices
- Partner notification if STI
- Follow-up testing
- Avoid sexual contact during treatment
Prevention
- Use barrier protection
- Limit number of partners
- Regular STI screening
- HPV vaccination
- Good genital hygiene
- Avoid sharing towels
- Prompt treatment of infections
When to Seek Medical Care
See a Doctor Immediately
- Rapidly spreading rash or infection
- Severe pain or swelling
- High fever with genital symptoms
- Difficulty urinating
- Bleeding that won't stop
- Signs of severe infection
- Open sores or ulcers
Schedule an Appointment
- Any new or changing bumps
- Bumps after unprotected sex
- Painful or itchy bumps
- Bumps with discharge
- Persistent bumps (>2 weeks)
- Recurrent symptoms
- Partner diagnosed with STI
Regular Screening
- Annual STI screening if sexually active
- More frequent if multiple partners
- Before new sexual relationships
- If partner has symptoms
- As recommended by doctor