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    PPP or Genital Warts?

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      Reviewed by our clinical team

      Man holding crotch

      For most of us, the idea of pulling down our underwear and finding something itchy, lumpy or sore is our worst nightmare.

      Unfortunately, sexually transmitted infections (one of the leading causes of genital growths and blisters) are very common around the UK – according to the latest reports, there were over 468,000 diagnoses of STIS in 2019 in England alone.

      Of course, because of the prevalence of sexually transmitted infections (STIs) and diseases, many people who find something unpleasant on their genitals might assume they have an STI when in actual fact they’re dealing with a completely different type of condition.

      In a worst case scenario, a chlamydia symptom such as vaginal bleeding could actually be caused by a serious disease such as cervical cancer. More common, however (and less concerning) is the confusion that can happen when a man develops pearly penile papules, or PPP.

      Pearly penile papules (PPP)

      Pearly penile papules (PPP) are very small, white or flesh-coloured lumps that grow around the head of the penis in lines, sometimes beneath the foreskin. They are not infectious and are not a symptom of poor hygiene. They also shouldn’t be painful or itchy. PPP is a common condition and is not a cause for concern. Some men may be bothered by the appearance of PPP and in this case can get them removed, however this should be done by a doctor – squeezing or popping the papules yourself can lead to scarring and infection.

      One of the main issues associated with PPP is that it can cause anxiety by being easily confused with other conditions. The most common of these is genital warts, the second most common sexually transmitted disease in the UK after chlamydia.

      Genital warts

      Genital warts are small fleshy growths that can grow on the penis, scrotum or upper thighs, or inside the urethra or the anus. They can cluster in lumps or grow separately and are usually painless, however they can become itchy and inflamed, and in some cases can bleed. Genital warts are spread through skin-to-skin contact during sex, and are caused by the human papillomavirus (HPV). Though warts don’t pose any serious threat to your health or fertility, they are infectious and can be unsightly. Medical treatments to remove the warts include topical creams or lotions, and physical removal by a trained medical professional.

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      Similarities between PPP and genital warts

      Pearly penile papules and genital warts share some attributes in common. Both are:

      • Usually painless
      • Not associated with serious medical complications
      • Not associated with poor hygiene

      Pearly penile papules and genital warts can also both be removed with the correct medical procedures and treatments. You should not attempt to remove papules or warts by yourself.

      Differences between PPP and genital warts

      Appearance

      • Pearly penile papules are small, shiny and fairly uniform in size. They are white or flesh-coloured and resemble whiteheads.
      • Genital warts are flesh-coloured, irregular in shape and often grow in clusters. They can have a soft texture or be rough and hard.

      Location

      • PPP only occurs on the head of the penis. The papules grow close together in lines around the base of the penis head.
      • Genital warts can grow anywhere on the penis, scrotum, anus, or inner thighs. They can also grow inside the anus or the urethra.

      Cause

      • PPP is not an STI. It has no known cause.
      • Genital warts are an STI. They are caused by the human papillomavirus, most commonly the HPV types 6 and 11. You are most likely to develop genital warts after having unprotected sex with someone who has warts.

      Treatment

      • Pearly penile papules can be removed using laser therapy.
      • Genital warts can be removed by applying prescription creams such as Warticon, Aldara, or by receiving cryotherapy, laser surgery or excision.

      Other conditions causing lumps on the penis

      If you have lumps on your penis, they may be a sign of something other than PPP or genital warts.

      Other conditions that can cause lumps include:

      • Fordyce spots – small, harmless yellow or white spots that grow on the shaft of the penis
      • Lichen planus – a non-infectious rash of itchy purple or red bumps that can affect the penis
      • Genital herpes – a viral STD that causes sore red blisters to develop on and around the genitals

      The important thing to remember is that, while many of these conditions are not a serious cause for concern, it’s always best to get any unusual growths checked out by a doctor.

      Our genital photo assessment service allows a doctor to diagnose a sexual health condition without needing to see you in person.

      VideoGP by LloydsPharmacy

      References

      https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/914184/STI_NCSP_report_2019.pdf

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