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Common Causes Of Bumps & White Spots On Penis & Foreskin

This situation may be familiar to many men: while taking a shower one day, you happen to notice some white spots on your foreskin. You do a double take as you lean down to inspect your manhood. What could it be? How long have they been there? The questions are aplenty as you instinctively reach for your smartphone to begin a Google search.

There are many conditions that can cause white spots to develop on the penis and foreskin. Some men may be born with them, while others may develop them as a result of poor hygiene practices or sexually transmitted infections (STIs). It is important to know what the white spots are due to, as not all conditions require treatment. Listed below are some common causes of white spots on the foreskin and penis.


Pearly Penile Papules

Pearly penile papules (PPP) are small, dome-shaped or projection-like bumps that are located just below the head of the penis, usually arranged in a neat row. They can be white, flesh-coloured, yellow or translucent in colour. They do not cause any pain or itch. PPP is considered as a normal variant of the male penile anatomy, and are harmless bumps. It is not cancerous and there is no cancer risk. It is not a sexually transmitted infection and is not contagious. It is common and can occur in up to 38% of young men up to age 25.

PPP can be left alone and does not require treatment. However, for men who find them unsightly, they can be removed. Treatment options include laser therapy, cryotherapy and electrosurgery. 

READ: What are Pearly Penile Papules?


Fordyce Spots

Also known as Fordyce glands, these are harmless, small white or yellow bumps that are found on the foreskin. They are basically enlarged sebaceous glands, and can occur alone or in clusters. They do not cause any pain or itch. Fordyce spots can also commonly occur on the edges of your lips or on the inside of your cheeks.

Just like PPP, Fordyce spots are not cancerous and infectious, and also does not require treatment. Similarly, they can be removed if men find them unsightly. Treatment options include topical retinoid cream, oral isotretinoin, laser therapy and electrosurgery. 


Tyson’s Glands

Also known as preputial glands, Tyson’s glands are modified sebaceous glands that are found on the inner surface of the foreskin. They occur in pairs and are located on either side of the frenulum. These glands are also present on the hood of the clitoris in females. Tyson’s glands are normal structures and do not require treatment.  


Skin Tags

Skin tags are small, soft, flesh-coloured growths on the skin. They usually have a stalk and hang off the skin, and can vary in size from a few millimetres up to several centimetres. They tend not to grow on the penis itself, but rather, around the groin and scrotum. They often grow in areas where the skin folds and rubs against itself, and as such they are often also found on the neck, armpits, eyelids and under the breast. They affect men and women equally. Obesity, diabetes and pregnancy can increase the chances of occurrence.

Skin tags are benign tumours of the skin and do not require treatment. Occasionally, they may fall off on their own. People often wish to get them removed for aesthetic reasons, or if the skin tags are large and get in the way. Treatment options include cryosurgery, electrosurgery, ligation and excision.  

READ: Skin


Balanitis

Balanitis is inflammation of the foreskin and head of the penis. Spots can appear on the penile head or foreskin, and can be white or reddish. Other symptoms include redness, pain, itching, discharge, swelling and difficulty with retraction of the foreskin, and sometimes pain when passing urine. 

Balanitis can affect as many as 1 in 10 males, and can occur at any age. It is more likely to occur in uncircumcised men. The most common cause of Balanitis is a bacteria or fungal infection, or a combination of both. This can result from inadequate personal hygiene and/or phimosis (tight foreskin). There are non-infectious causes for balanitis as well. Risk factors for recurrent balanitis include diabetes, HIV and other sexually transmitted infections. 

To investigate balanitis, your doctor may perform swab tests to identify the responsible organism. Treatment involves topical and/or oral anti-fungal and antibiotics. The long term solution to balanitis is a circumcision.

READ: Causes, symptoms and treatment of Balanitis.

Pimples

Pimples develop as a result of the pores of our skin being blocked by dead skin cells, sebum and other debris. The sebaceous gland continues to produce sebum and build up under the blockage, allowing bacteria to grow in the area, resulting in inflammation, infection and pain. They can occur anywhere on the body, including the penis.

Pimples can be left alone and usually resolve on their own without treatment. It is important to resist the urge to pop the pimples as this may lead to superimposed infection, scarring and hyperpigmentation. However, they may end up self erupting and discharge small amounts of pus. Treatments for pimples include topical over-the-counter creams such as benzoyl peroxide, antibiotic creams and, if more severe, oral antibiotics.

READ: Skin


Folliculitis

Folliculitis is an inflammation or infection of the hair follicles. It can occur anywhere on the body, including the penis, where it is frequently seen at the shaft or base of the penis, or the pubic area. Folliculitis tends to result from shaving, waxing or chafing of the hair follicles. The damage to the hair follicles allows bacteria to enter. Sometimes, ingrown hairs can also occur from hair removal treatments, eventually leading to folliculitis as well. Folliculitis can be painful and/or itchy. Treatment options include topical and/or oral antibiotics. 

READ: Common causes of penile itching and pubic itching


Genital Warts

Genital warts are caused by the Human Papillomavirus (HPV). HPV is the most common sexually transmitted infection and can be spread via vaginal, oral or anal sex. They appear as flesh-coloured growths over the genitals that can cluster and resemble a cauliflower. Most of the time they do not have any symptoms but can sometimes itch. Bleeding can also occur during sexual intercourse. 

READ: Causes, symptoms and treatment for Genital Warts
READ: How to get rid of Genital Warts

Left alone, the warts can remain the same or increase in size and number. They will disappear once the body has shed the virus completely, typically over a course of 1 to 2 years. Treatment options include topical medications such as imiquimod, cryotherapy and electrosurgery. Vaccines are available to help prevent HPV infection, consider getting a HPV vaccination. 

READ: HPV Vaccination For Men
READ: Rapid HPV Testing

Genital Herpes

Genital herpes is caused by the Herpes Simplex Virus (HSV) and is a sexually transmitted infection. Itching of the penis is usually the first symptom, and can occur in other areas such as the scrotum, groin, buttocks and anus. Shortly after, tiny clusters of painful blisters develop, which can then rupture and form shallow ulcers with crusts. Other symptoms include painful urination, enlarged groin lymph nodes, fever and body aches. The virus can lie dormant in the body for years without causing any symptoms, therefore some people may not even be aware that they are infected. 

Genital herpes can be diagnosed via swab testing of the lesions. When there are no symptoms, no treatment is required. Flares can be treated with oral and topical antiviral medications. There is unfortunately no cure for genital herpes, as the virus will permanently remain in the body.

READ: Rapid Herpes Testing

Molluscum Contagiosum

This is a benign infection of the skin caused by the Molluscum Contagiosum virus, resulting in painless, small, shiny pearl-shaped lesions. They can happen anywhere on the body as a result of physical contact, but when they occur on the genital area, it is usually as a result of sexual contact. The virus is thus spread via sexual contact, or even to another part of the person’s own body, from scratching the lesions and touching another part of the body. They can appear alone, or in clusters. They usually do not cause any symptoms, but can sometimes itch. 

Left alone, the lesions will eventually disappear once the body has shed the virus completely, typically over a course of several months to a year. Treatment options include topical medications such as salicylic acid, cryotherapy, laser therapy and curettage.

READ: Everything you need to know about Molluscum Contagiosum

In conclusion, do not panic if you notice white spots on your penis, as not all white spots require treatment.  Speak to your doctor for advice on white spots or bumps and request for an examination. 

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Condyloma Lata vs Condyloma Acuminata

Condyloma

Condyloma refers to wart-like skin growths – usually in the genital, anal, or oral regions but occasionally found in other areas of the body – that are caused by a sexually transmitted infection. The most common type is known as genital warts and is termed condyloma acuminata.

These are caused by an infection with Human Papilloma Virus (HPV), the same group of viruses that can lead to cervical cancer as well as other oral and anogenital cancers. The prevalence of genital warts in the general population is estimated to be around 3-5%, making it the most common STD globally. See: 

Read: Rapid HPV Testing (Next Day Results)
Read:
Anal Pap Smear


Condyloma Acuminata On The Penis

When condyloma acuminata are detected, we must always look for and differentiate these lesions from condyloma lata, which are caused by secondary syphilis infection. These two types of condyloma can appear extremely similar and are easily mistaken for the other.

They may also both be present as a co-infection, seeing as they share common risk factors. It is essential that syphilis infection is considered and tested for when condyloma lesions are found, so that rapid diagnosis, treatment, and partner tracing can be performed. 

Condyloma lata

Condyloma lata of secondary syphilis tend to be slightly larger and more moist than common genital warts, and may even ulcerate in later stages. They are usually found in the anogenital or oral regions, but can also be found sometimes on the palms or soles of the feet. Other signs of syphilis may be a diffuse body rash or a classic painless sore or chancre (seen in earlier stages of primary syphilis).

Both types of condyloma are mainly transmitted through penetrative anal or vaginal sex, as well as oral sex (fellatio and cunnilungus). However, as they can be spread with direct contact with mucosa and/or broken skin, there have even been cases of transmission through mutual masturbation.

If you or your partner noticed any suspicious skin lesions, please visit our doctors for a full consultation and assessment. 

Find a Doctor | Make an appointment 


Also STD & HIV Related Read:

Is HPV Vaccine Necessary for Males?

HPV is a virus that can infect both males and females of all ages. HPV infections may lead to diseases such as skin warts, genital warts, vaginal/vulvar cancers, cervical cancer, penile cancer and anal cancer. There are hundreds of subtypes of HPVs, with about 40 known to affect the genital area. Of these, there are high-risk types known to cause cancer and low-risk types which may cause genital warts. Vaccines against some of these high and low-risk types are available today.

 

Most HPV infections clear naturally, but there is no way to predict who can clear the virus on their own, or who will carry the virus and potentially spread it. The virus itself cannot be treated. However, some of the diseases it causes can be managed. For example, if a person infected with HPV presents with a wart, we can use medications to treat it or use various techniques to remove it, but the virus itself is not eradicated from the body. That is why vaccination is so important for everyone so that the virus will not take root in the body.

 

HPV vaccinations have been available since 2006, and the vaccination has seen high uptake in many countries as they have been introduced into their national immunization schedule. HPV vaccination, along with pap smears and HPV testing, has been the cornerstone in reducing the burden of cervical cancer in women. In fact, we are already starting to see the benefits of this vaccine in reduced precancerous lesions of the cervix among countries with high uptake of this vaccine.

Read: Counterfeit HPV Vaccines (Gardasil 9) In Hong Kong

The vaccination in its early introduction largely left out males. The U.S. Food and Drug Administration has recently approved the use of Gardasil 9 for both males and females ages 9 to 45. The HPV vaccination is also now recommended by the U.S Center for Disease Control for men through age 21, for men who have sex with men, transgendered people, or those who have a compromised immune system (including HIV) who are ages 26 and younger. In the UK, from September this year, boys aged 12 and 13 would be offered the shots as part of a government health programme.

Read: HPV Vaccination for Men-Who-Have-Sex-With-Men

HPV has been linked to more than 99 per cent of cervical cancers, as well as 90 per cent of anal cancers, about 70 per cent of vaginal and vulvar cancers and more than 60 per cent of penile cancers. The protection against female cancers has already been proven. It also appears that vaccinated boys will receive some protection against anal and penile cancers as well.

 READ: Perianal Warts (Peri-Anal Warts) & Anal Warts Removal

 

There are 3 different types of HPV vaccines available in Singapore. Cervarix, which protects against 2 high-risk HPV types – 16 and 18. Gardasil 4, which protects against the high risk 16 and 18 and 2 more low-risk types 6 and 11. And Gardasil 9, the only vaccine used in the United States now which protects against 9 subtypes (6, 11, 16, 18, 31, 33, 45, 52, and 58). The vaccination schedule is 3 doses; one on your first visit, one 2 months later and the last one 6 months after the first dose (0,2,6) Other dosing schedules may be suitable depending on your age.

So should you as a male get vaccinated? Speak to your doctor about it to discuss the pros and cons. As for myself as a male – I’m already vaccinated.

HPV Vaccination is available in all our clinics in Singapore & Malaysia


Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  3. 11 Causes of Penile Itching & Pubic Itch
  4. HPV Infection & HPV Vaccination for Men who have sex with Men
  5. STD Risk for Receptive Unprotected Anal Sex in Men
  6. Low HIV Risk Doesn’t Mean No HIV Risk
  7. HIV PrEP for Travel – How You Need to Know
  8. An Overview on STD from an STD Doctor
  9. Everything You Need to Know About Herpes Simplex Virus
  10. How Do I Treat Oral Herpes (Cold Sores)
  11. Syphilis Symptoms – Painless Sore & Ulcers
  12. HIV Symptoms – What You Need to Know
  13. Sex During Period (Sex & Menstruation) What To Know
  14. 10 Common HIV Related to Opportunistic Infections

Common Causes of Penile Itching and Pubic Itching

A myriad of conditions can cause a man to have penile itching or pubic itching. The excruciating urge to scratch and relieve that itch at such an inconvenient part of the body can be a major source of embarrassment to some. When severe, it can result in extreme discomfort in the day, and disrupt one’s sleep at night.

 

Here are some of the causes of Penile Itching and Pubic Itching:

 

6 Common Causes of Penile Itch:

 

1. Balanitis

Balanitis is a common infection of the foreskin and head of the penis. It is caused by bacteria or fungus, or a combination of both.

Symptoms include redness, swelling, discomfort, penile itching, and sometimes pain when passing urine.
(See: Penile Infection, Infection of the Penis)

When fungal infection (candidiasis) is present, a whitish cottage cheese-like discharge can be found under the foreskin. Balanitis is often hygiene related, but can also be caused by STDs. It is more likely to occur in uncircumcised males.  Watch: What are the causes of Foreskin Infection (Balanitis)

2. Genital Herpes

Genital herpes is caused by the Herpes Simplex Virus (HSV). Itching of the penis (penile itching) is usually the first symptom and can occur in other areas such as the scrotum, groin, buttocks and anus.

Shortly after, tiny clusters of fluid-filled blisters or ulcers can develop and these are usually painful. Other symptoms include painful urination, enlarged groin lymph nodes, fever and body aches. The virus can lie dormant in the body for years without causing any symptoms, therefore some people may not even be aware that they are infected.

Read: Genital Blister, Genital Ulcers & Genital Warts & Causes of Oral Herpes (Cold Sore)

 

3. Genital Warts

Genital warts are caused by the Human Papillomavirus (HPV), a sexually transmitted disease. They appear as flesh-coloured growths that can cluster and resemble a cauliflower. Most of the time they do not have any symptoms but can sometimes itch. Bleeding can also occur during sexual intercourse.

Read: Genital Warts Treatment

 

4. Contact Dermatitis

Contact dermatitis is a skin reaction to contact with an irritant. This can happen anywhere on the body, including the penis. When this happens, it is usually caused by latex condom usage. The skin of the penis can turn red and itchy.

Sometimes the skin can break causing serious discharge, and bacterial infection can occur. Mild cases can be treated with a corticosteroid cream. Non-latex condoms can be used if you have a latex allergy.

 

5. Urethritis

One of the causes of penile itching is Urethritis. Urethritis refers to inflammation of the urethra, the tube that carries urine from the bladder to outside the body. This condition most often causes pain or itching in the penis, which worsens when passing urine.

Other symptoms include urethral discharge, urinary frequency or urgency, difficulty urinating, and blood in the semen. Urethritis is most commonly caused by a bacterial infection and can be sexually transmitted. See other STD Symptoms 

 

6. Psoriasis

Psoriasis on elbows.

Genital psoriasis often occurs alongside psoriasis of the skin. Skin cells develop at an extremely fast rate, resulting in the accumulation of skin cells on the skin surface, building up into itchy, red plaques of scaly skin. See Psoriasis Treatment

5 Common Causes of Pubic Itch

 

1. Jock Itch

Also known as tinea cruris, jock itch is a fungal infection of the skin in the genital area, groin and buttocks. The rash is usually itchy, red, scaly and ring-shaped. It tends to occur in people who sweat a lot and/or are overweight.

 

2. Pubic Lice

More commonly known as crabs, these are tiny parasitic insects that attach to the hair and skin in the pubic region. Pubic lice can be easily spread via sexual contact or other forms of close contact, and can spread to other body areas with coarse hair such as beards, armpits and chest hair. It is also possible for pubic lice to spread by using an infected person’s clothes, towels, or bed.

 

3. Folliculitis

This is a condition in which hair follicles become inflamed and is usually caused by bacterial or fungal infection, or inflammation from ingrown hair. Initially, the affected hair follicles may have small red bumps or white-headed pimples, but can swell and become painful and subsequently develop into crusty sores.

 

4. Contact Dermatitis

As mentioned earlier, this condition can also occur in the pubic area.

 

5. Molluscum Contagiosum (mo-LUS-kum kun-tay-jee-OH-sum)

Molluscum Contagiousum is a benign viral infection of the skin and is caused by the molluscum contagiosum virus, resulting in painless, small, shiny pearl-shaped lesions. They can happen anywhere on the body as a result of contact, but when they occur in the genital area, it is usually as a result of sexual contact. They can appear alone or in clusters. They usually do not cause any symptoms, but can sometimes itch.

If you need to speak to our doctors, please visit our men’s clinics.  Alternatively, you can email us hello@dtapclinic.com or call us for an appointment.
Take Care.


Other Read:

 

HPV Infection & HPV Vaccination for Men who have sex with Men

About 40 types of HPV are passed on through sexual contact. The virus can be spread through skin-to-skin contact that doesn’t involve penetrative sex. Condoms will not necessarily fully protect people from coming into contact with it. Also Read: Anal Pap smear for men

What you need to know about Gardasil 9 HPV Vaccine and HPV in Men who have sex with Men

 

What is Human papillomavirus (HPV)?

The Human Papilloma Virus (HPV) is not one virus, but a family of about 200 different strains that cause common warts, genital warts and some cancers.
Sexually active adults mostly acquire at least one variety of HPV and it’s a near-universal infection in people with HIV. Even people with a one-lifetime partner can get HPV if their partner has it.
About 40 types of HPV are passed on through sexual contact. The virus can be spread through skin-to-skin contact that doesn’t involve penetrative sex. Condoms will not necessarily fully protect people from coming into contact with it.
For most people, HPV will not cause any harm. Only some varieties of HPV can cause cancer and even if you do come in contact with these strains, the chances of developing cancer are very small.
However, some people do not clear the virus from their bodies, and this can cause:

  • Genital warts on the penis and anus. It is also possible to have these types of warts on the lips and in the mouth.
  • Cancer of the anus, penis and oropharynx (back of the throat, including the base of the tongue and tonsils).

Although some other strains of HPV are associated with cancers, two main strains of HPV – HPV 16 and HPV 18 – cause 70% of cervical cancers in women and over 80% of anal cancers worldwide.
It is estimated that HPV is responsible for about 5% of cancers worldwide. However, anal cancer is one of the most common cancers for people living with HIV.

Learn more about Rapid HPV Testing (Next Day Result)

HPV & Men Who Have Sex With Men (MSM)

Every year anal cancer is diagnosed in about two people per 100,000 in the general population.
Men who have sex with men are about 20 times more likely than heterosexual men to develop anal cancer, and men-who-have-sex-with-men who are living with HIV are even more likely (up to 100 times more than the general community).

What is the new Gardasil 9 (HPV Vaccine)?

GARDASIL 9 is a vaccine (injection/shot) given to individuals 9 through 26 years of age to help protect against diseases caused by some types of Human Papillomavirus (HPV).
In boys and men 9 through 26 years of age, GARDASIL 9 helps protect against:

  • Anal cancer
  • Precancerous anal lesions
  • Genital warts – Penile warts, Anal Warts and other areas

These diseases have many causes. Most of the time, these diseases are caused by nine types of HPV: HPV Types 6, 11, 16, 18, 31, 33, 45, 52, and 58. GARDASIL 9 protects against diseases caused by these nine types of HPV.

What is the difference between Gardasil and new Gardasil 9?

Gardasil only covers 4 strains of HPV: 6, 11, 16, 18.
Gardasil 9 covers that and 5 more strains, 31,33,45,52.

HPV-4 types
(6, 11,16,18)
HPV-9 types
(6,11,16,18,31,33,45,52,58)
Cervical cancer cases70%90%
High-grade cervical lesions50%75-85%
Low-grade cervical lesions30-35%50-60%
HPV-related vulvar cancer cases70-75%85-90%
HPV-related vaginal cancer cases65%80-85%
HPV-related anal cancers85-90%90-95%
Genital wart cases90%90%

As you can see, Gardasil 9 has a broader HPV coverage compared to Gardasil.

Frequent Asked Questions (FAQs)

1.) Can I get Gardasil 9 if I am above 26 years old?

Gardasil 9 in Singapore is indicated for boys and men from ages 9 to 26. That does NOT mean that men above the age of 26 years cannot get the vaccine.
If you are above 26 years old, the best thing to do is to have a discussion with our doctor about the pros and cons of the vaccine then make a decision on whether or not you will benefit from it.

 

2.) Can I get Gardasil 9 even if I have had genital warts?

There are 200 different strains of HPV. Even if you have been infected with 1 strain, the vaccine can help protect you against other strains.
Also, there is data to show that people who have received treatment for HPV related cancers and had the HPV vaccine were less likely to get recurrences of their cancers.
So even if you have had or currently have genital warts, you should still have a frank conversation with our doctor about how Gardasil 9 can benefit you.

3.) Can I get Gardasil 9 even though I have already had the older version of Gardasil?

Yes, you certainly can. Scientific data has proven that it is absolutely safe to receive the full dose of Gardasil 9 even though you have already completed the vaccination using the older version of Gardasil.
If you have any concern about HPV infection treatment or you are interested in getting HPV vaccination, please contact us for more information.

Gardasil 9 vaccination is avilable in all our clinics in Malaysia and Singapore.
You can call any of our clinics or email us at hello@dtapclinic.com for an appointment.

Take Care!


Other Reads:

  1. Low HIV Risk Doesn’t Mean No HIV Risk
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. HIV PrEP for Travel – How You Need to Know
  5. An Overview on STD from an STD Doctor
  6. Everything You Need to Know about Herpes Simplex Virus
  7. How Do I Treat Oral Herpes (Cold Sores)
  8. Syphilis Symptoms – Painless Sore & Ulcers
  9. HIV Symptoms – What You Need to Know
  10. 10 Common HIV related Opportunistic Infections

HPV Vaccination for Men – What You Need to Know

The Human Papilloma Virus (HPV) is a group of viruses which infect the skin and mucous membranes of the body and are transmitted through skin contact or through the transfer of genital fluids.
There are over 200 subtypes, with the majority of them do not cause a clinically significant medical problem. Around 30 subtypes infect the genital area.

HPV in Men: How Do HPV present in Men?

When they present with symptoms, they usually present as genital warts.
Rarely, HPV in men can cause penile, oropharyngeal or anal cancer. This is more common in people living with HIV.

Not everyone infected with HPV will get symptoms.

If genital warts grow, the common areas they grow are on the foreskin, on the shaft of the penis, on the pubic region at the base of the penis, around the anus and inside the anal canal.
Remember, you do NOT need to have anal sex to get warts around the anus.
Remember, condoms do NOT protect you 100% against HPV. So you can get infected with HPV even if you use a condom every time!

Is there a cure for HPV infections in men?

Unfortunately, there is no medication that is available to target the HPV virus specifically.
However, there is treatment available for its symptoms. As the infection is usually self-limiting. 90% of the time, the body’s immunity usually clears the infection after some time.
Warts, however, can be removed by a variety of methods. There are creams, lotions, lasers and other methods for removing warts.
Learn about: “How to Get Rid of Genital Warts

Sometimes, if the warts are really plentiful and limited to the foreskin, circumcision is done to remove all warts,
Warts often recur and usually, several genital warts treatments are needed before they go away completely.

Is there an HPV vaccine for Men?

Yes, there is! Gardasil 9 is indicated for use in men and boys to protect them against getting HPV.

Does Gardasil protect you against all strains of HPV in men?

No. It only protects you against HPV 6, 11, 16 and 18, with HPV 6 and 11 causing 90% of the genital wart presentations.

Is the vaccine still beneficial if I have had genital warts in the past?

It may still be beneficial as you may not have been exposed to all 4 strains covered in the vaccine. It is best to discuss this with your doctor.
Also, studies have shown that the HPV vaccine reduces the risk of HPV symptom recurrence in people who are already infected.

Are there any side effects from Gardasil vaccination?

The HPV vaccine is very safe. If any side effects do occur, some of the common side effects include pain, redness, or swelling in the injected arm, headache, fever, feeling tired, nausea, muscle or joint pain. In very rare occasions, a severe allergic reaction may occur.

What is HPV vaccination regimen like?

A total of 3 vaccines are given over a total period of 6 months ( 2nd dose given 2 months after the first dose and the 3rd dose is given 4 months after the 2nd dose)

If you have any concern about HPV infection treatment or you are interested in getting HPV vaccination, please contact us for more information.
Take Care!


Other Reads:

  1. Low HIV Risk Doesn’t Mean No HIV Risk
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. HIV PrEP for Travel – How You Need to Know
  5. An Overview on STD from an STD Doctor
  6. Why Do I Have Abnrmal Vaginal Discharge
  7. Everything You Need to Know about Herpes Simplex Virus
  8. How Do I Treat Oral Herpes (Cold Sores)
  9. Syphilis Symptoms – Painless Sore & Ulcers
  10. HIV Symptoms – What You Need to Know
  11. 10 Common HIV related Opportunistic Infections

Genital Blisters, Genital Warts and Genital Ulcers – Causes & Treatments

Genital blisters, genital warts, genital ulcers – more common than you think but invariably exceedingly distressing for the person suffering from them. Today we talk a little about the various causes for the above genital skin conditions.
Genital lumps, bumps and sores can be an alarming phenomenon for anyone. One day you notice a tiny little bump, or perhaps several bumps.
Now you’re not sure when they appeared – was your skin normal last week, or did you just never notice the bumps for a good duration? Or perhaps you notice what you thought was a little pimple or an ingrown hair follicle which happens from time to time because you shave. But now it’s burst, leaving a painful raw ulcer.

What are the Causes of Genital Blisters, Genital Warts and Genital Ulcers?

1) What are the Causes of Genital Blisters?

Genital blisters are small, fluid-filled bumps and can occur anywhere over the genital region.

a) Genital Herpes

One of the classic causes of genital blisters is genital Herpes, caused by the Herpes Simplex Virus.
Here’s a video about Herpes

Genital herpes has Several Stages:
Stage 1: Prodrome – the skin appears normal but you may feel an unusual sensation like a tingling or itching. This indicates that the virus is active and heralds an impending outbreak
Stage 2: Redness – you may notice some nonspecific red spots which may be uncomfortable or slightly painful.
Stage 3: Blisters – this is usually when people realise something is not right, Initially, these may resemble tiny pimples. They then grow in size and become fluid-filled and painful.
Stage 4: Ulcers – the blisters burst, leaving shallow, painful ulcers
Stage 5: Scabbing or crusting – a scab or crust forms over the ulcer, which eventually heals
Also, check out What is Oral Herpes & Cold Sore

b) Balanitis

In males, balanitis may sometimes present with tiny blisters. The term “balanitis” is a descriptive term which means inflammation of the head of the penis and foreskin. This usually manifests as skin redness, with some tiny blisters or whitish bumps, as well as possible itching/pain or discomfort.
There can be multiple causes of balanitis. The skin on the penis is no different from skin elsewhere on your body and redness, discomfort and irritation can be caused by many factors:

  • Infections such as fungal skin infections
  • Skin irritation caused by external factors like soaps (irritant or contact dermatitis)
  • Mechanical trauma in the form of excessive friction e.g. masturbation or sexual intercourse with insufficient lubrication
  • Poor hygiene
  • Sensitive skin e.g. in people prone to eczema or dry skin

Depending on the possible underlying trigger or cause, various topical creams may be useful. In some cases, skin swab tests or urine tests may be useful in checking for underlying infections.
Read more about What is a Penile Infection?

2) What are the Causes of Genital Warts?

a) Human Papilloma Virus

This is THE cause of genital warts. Genital warts are skin coloured, fleshy bumps which may occur singly or in clusters around the genital and anal region. They can range from tiny firm bumps to larger, irregular shaped bumps which are classically described as “cauliflower-like” in appearance.
The Human Papilloma Virus (HPV) is a sexually transmitted viral infection. There are many strains of HPV and they are transmitted through sexual contact. Some strains are responsible for genital warts, while other “high risk” strains can lead to an increased risk of cancers such as cervical, oral and anal cancers.
If you have warts, it effectively means you have been infected by at least one strain of HPV. If you are female and you are not already doing your regular PAP smear for cervical cancer, you should do a PAP smear with high risk HPV testing because an individual may have not just one but several strains of HPV. You can read more about PAP smears and cervical cancer screening.
There are various methods available for the treatment of genital warts, ranging from topical medications to freezing or cryosurgery electrosurgery. But one must be prepared that warts can unfortunately recur as the treatment for warts addresses the effects of a HPV infection but does not clear the virus from your body.
The best defence we have against genital warts is the HPV vaccine – Gardasil 9, which provides immunity against certain wart causing strains of HPV.

3) What are the Causes of Genital Ulcers?

When people think of genital ulcers, often the first few causes that spring to mind may be herpes or syphilis. However, genital ulcers can be due to other infections as well as rarer, non-infective causes such as autoimmune diseases.
This is why various tests are useful in differentiating the causes of genital ulcers. The treatment of choice varies drastically depending on what the underlying cause is.
Caused by Sexually transmitted infections (STIs)

  • Herpes Simplex Virus (Common)
  • Syphilis (Common)
  • Chancroid (Rare)
  • LGV (Rare)
  • Donovanosis (Rare)

Non-infective causes

  • Behcet’s (Autoimmune)
  • Crohn’s disease (Autoimmune)
  • Fixed drug eruption (rare causes)
  • Skin Cancer (rare causes)

a) Herpes Simplex Virus

(Painful shallow ulcers and blisters)

As mentioned earlier, both genital blisters and ulcers are different stages of a herpetic flare. A genital skin swab test for the presence of HSV DNA is helpful in confirming HSV as the cause of genital ulcers.

b) Syphilis

(Painless ulcers)

Syphilis can cause ulcers both during its primary and secondary stages.  A chancre, a painless round ulcer, occurs in primary syphilis, while in secondary syphilis, multiple painless ulcers may occur as well. One of the defining traits of a syphilitic ulcer is its painlessness.
These ulcers may be accompanied by other symptoms such as a rash elsewhere on the body.

C) Chancroid

(Multiple painful deep ulcers and swollen groin lymph nodes)

Chancroid is a painful ulcer which is frequently associated with enlarged and painful inguinal (groin) lymph nodes. These are located along your underwear line and may be felt as tender swollen lumps. There are usually several or multiple deep and painful ulcers.
This is caused by a bacterium called Hemophilus ducreyi, which is transmitted through sexual contact. Painful lymph nodes and negative test results for both Herpes and syphilis support this diagnosis. The good news is that antibiotic treatment can clear this up.

Lymphogranuloma venereum (LGV)

Small ulcer, swollen groin lymph nodes, possible rectal pain

Lymphogranuloma venereum (LGV) is an uncommon cause of genital ulcers. It is caused by the bacterium called Chlamydia trachomatis (serovars L1-3). This Chlamydia is different from the “subtype” of Chlamydia trachomat is that causes the common STD you are thinking about. A Rapid Chlamydia & Gonorrhoea PCR test will be about to detect the infection.
The ulcer it causes tends to be small and often goes unnoticed. The lymph node swelling is dramatic and painful and may even discharge pus.
If this was acquired through anal intercourse, inflammation of the anal and rectal canal (known as “proctitis”) can occur, causing rectal pain, bleeding and discharge and diarrhoea.

Donovanosis

Shallow beefy looking ulcers

This is again a rare cause of genital ulcers in the developed world. It is caused by a bacterium called Klebsiella granulomatis and causes shallow ulcers which may bleed easily. This is usually diagnosed with a punch biopsy, which is when a sample of skin tissue is removed for evaluation in the lab.

Other rare causes:

Autoimmune or inflammatory causes, skin cancers, drug reactions

“Autoimmune” diseases occur when your body’s immune system has a tendency to attack itself and one of the many manifestations can be genital ulcers. These are rare and treatment is by a specialist doctor. These ulcers will go away only with good control of the underlying disease.
Sometimes, a bad reaction to a certain medication may cause a persistent, painful ulcer.
Very rarely, genital ulcers may be due to cancer.

All in All

The good news is that most of the above mentioned causes for genital blisters, warts and ulcers can be treated. But an even better step would be to protect yourself from even developing these – safe sexual practices (using barrier protection, doing your regular sexual health screening, and getting the HPV vaccine) are your best bet against these.
Take Care!


  1. HPV Infection & HPV Vaccination for Men who have sex with Men
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. How Late Can a Period Be (Delayed Menstrual Cycle)
  4. What are the Causes of Abnormal Penile Discharge?
  5. STD Risk for Receptive Unprotected Anal Sex in Men
  6. Low HIV Risk Doesn’t Mean No HIV Risk
  7. HIV PrEP for Travel – How You Need to Know
  8. An Overview on STD from an STD Doctor
  9. Everything You Need to Know About Herpes Simplex Virus
  10. How Do I Treat Oral Herpes (Cold Sores)
  11. Syphilis Symptoms – Painless Sore & Ulcers
  12. HIV Symptoms – What You Need to Know
  13. 10 Common HIV related to Opportunistic Infections

10 Causes of Abnormal Vaginal Lumps and Bumps

Some women may develop lumps or bumps in the vaginal area sometime during their lives.

 
The severity of the condition, indicated by these lumps and bumps, can be classified into three categories:

  • Harmless
  • Infection or sexually-transmitted disease
  • Malignancy

 
For the most part, these lumps or bumps are harmless. The following conditions fall under this group.
 

1.) Cysts

Cysts can occur anywhere in the body. They are sacs, that range in size, filled with liquid or other substances. In the vaginal area, these cysts are usually benign and painless unless infected. It would feel like a small pebble just underneath the skin of the vulva.
 

There are two kinds of cysts:

Sebaceous Cysts

Sebaceous cysts result from the blocked hair follicles and ingrown hair when shaving or waxing. Most of these cysts do not require treatment and can be ignored if it does not cause any problems. However, some may need a small incision if they enlarge or become infected.
 

Bartholin Cysts

When the Bartholin gland (a gland in the vaginal and vulva region) becomes blocked and swells, this will cause a Bartholin cyst to form. The cyst is also harmless unless it becomes infected and turns into an abscess (a swollen area containing pus). In such cases, a trial of antibiotics usually is effective. In some cases, minor surgery may be necessary.
 

2.) Molluscum Contagiosum

A virus called pox virus causes molluscum contagiosum. It is a skin infection which causes multiple tiny bumps to spread across the area of infected skin. These harmless bumps or raised lesions are pearly white to skin-coloured and will eventually vanish after 1-2 years.
Molluscum contagiosum commonly appears in children and other parts of their bodies. However, it may pose as a sign of an STD when it occurs in adults. It is then advised for these people to get tested for other STDs.
Effective treatment options available to cure this particular type of molluscum contagiosum include:

  • Electrosurgery
  • Freezing (liquid nitrogen)
  • Topical cream

 

3.) Vestibular Papillomatosis

VP is a skin condition whereby multiple shiny small papules appear over the skin of the inner labia and vaginal opening. Similar to pearly penile papules (PPP) in men, VP is a normal variant of female genitalia; therefore treatment is not necessary.
It should be noted that Vestibular Papillomatosis is commonly mistaken for genital warts because of their similar appearance. Genital wart is a type of Sexually Transmitted Disease (STD). Therefore it is essential to have a correct diagnosis of the condition as a measure to prevent undue stress or prolonged deterioration. Our doctors are able to distinguish between both conditions.
 

4.) Fordyce Spots

Fordyce spots are enlarged oil glands materialising as small white to yellow lumps over the inner labia. These spots can also appear on the lining of the mouth and occasionally on the penis in men. They are completely painless and harmless.
The condition where lumps and bumps associated with an infection is folliculitis. Other conditions that are STD-related include genital warts, syphilis and herpes.
 

What are some of the causes of Bleeding after Sex (Post Coital Bleeding)?

5. Folliculitis

Folliculitis is the skin condition where the hair follicles in the labia region become inflamed and infected, causing tender red spots containing pus to surface. The hair follicles become inflamed from bacterial, fungal or even viral infection (e.g. herpes), due to situations that irritate ingrown hair, like shaving or waxing. The treatment is dependent on the type of infection.
 

6. Genital Warts

Genital wart is a Sexually Transmitted Disease (STD) caused by the Human Papilloma Virus (HPV), usually, type 6 and 11. Genital warts present as small, skin-coloured cauliflower-like bumps that can either develop into one single lump or more commonly into multiple lumps. Genital warts are highly contagious through skin-to-skin contact.
Depending on the individual, the HPV warts may go away, remain present or spread and increase in amount. Even without developing these warts, the individual can still be a carrier of the HPV virus.
There are HPV vaccinations now available to protect you from certain strains of HPV including type 6 and 11.
(The new Gardasil 9 HPV Vaccination is available in all our clinics in Singapore and Malaysia)
 

7. Syphilis

Syphilis is a sexually-transmitted disease that is caused by a bacterial infection. From this, a chancre, a painless sore, will appear in the genital or mouth area. The sore can eventually go away untreated in a few weeks. However, this will lead to the development of severe complications because the infection remains.
Please click here to find out more about syphilis, including treatment options.
 

8. Genital Herpes

Genital herpes is a contagious sexually-transmitted disease appearing as multiple painful blisters or ulcers clustered in the genital area. The infection can spread quickly to sexual partners, even with the use of condoms.
Although there is currently no cure for the infection, there are different treatments, like antiviral medications, to prevent and control recurring outbreaks of blisters.
 

Lumps and bumps can also be a malignant growth, and potentially a sign of cancer.

 

9. Vaginal Cancer

Vaginal or vulvar cancer can be presented as a lump or bump in the vaginal region. Besides the lumps, this type of cancer is also accompanied by other symptoms, including:

  • Abnormal vaginal bleeding
  • Unusual vaginal discharge
  • Pain during intercourse

In such cases, a pelvic examination and pap smear are done to look for any red flags. A pelvic examination and a pap smear test is done to check for signs of early changes and cancer.
If the results are positive, the doctor will then discuss the next steps for treatment.
 

10. Vaginal Melanoma

Melanoma is a type of skin cancer arising from pigmented cells. 2% of melanoma are diagnosed in the vagina or vulva. This cancer is more prevalent in women older than 50.
Vaginal melanoma appears as a pigmented lump in the vaginal area. Other non-specific symptoms include itching, bleeding and pain.
 
If you are experiencing Abnormal Vaginal Lumps & Bumps, it is highly recommended to visit our female doctors at our Women Clinics as soon as possible.
 
Take Care!

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. What is HPV Vaccination (Gardasil 9)
    4. 10 Causes of abnormal Vaginal Lumps and Bumps
    5. An Overview of Gonorrhoea
    6. What is the Treatment for Cold Sores? What causes Cold Sores?

 
 
 

Genital Warts: The Cauliflower-Like Lumps on the Genitals

Genital warts are white or flesh-coloured, smooth, small bumps that can appear anywhere in the general area of the genitals. They can also grow larger and appear as fleshy, cauliflower-like lumps on the genitals. Neither of which are more dangerous than the other, it is merely a characteristic and the stage that the illness was noticed.
Genital warts is an STD symptom caused by the Human Papilloma Virus (HPV).

HPV can cause multiple illnesses in the body as there are multiple strains of the virus attributing to different diseases in humans. Out of the hundreds of known strains of HPV, about 30 strains of the virus cause diseases of the genital area. These include warts, or in more sinister cases, cancer of the anus, cervix, vagina, and penis. Read: Causes of Vaginal Lumps & Bumps & Perianal Warts (Peri-Anal Warts)

Most of the other strains have no known effect on humans.


How do I get infected by the Human Papilloma Virus (HPV)?

Human Papilloma Virus (HPV) is a contagious disease that is transmitted through genital skin contact or through direct contact with genital fluids of a person already infected with HPV.
For transmissible illness such as these, using barrier methods of protection for sexual intercourse such as condoms should be emphasised. However, condoms are not very effective against transmitting HPV just because the HPV virus does not require penetrative sex to transmit the virus.

It can also be transmitted from a mother to an unborn child if the mother has an active HPV infection during the course of the pregnancy.


How do I know I am infected with HPV? How can it be detected?

A majority of people infected with HPV do not realise they even have the virus as it does not present with any symptoms.

Some people will notice bumps or warts around the genital area, otherwise known as genital warts. These usually occur one to three months after initial infection with HPV.


The most sinister manifestation of the HPV disease is cervical cancer affecting women in their 30s or 40s. The simplest way to detect cervical cancer is by identifying if an individual is an active risk of getting the disease and doing regular PAP smears. MOH guidelines are also apparent on the timing and interval for PAP smears for women in the reproductive age group. Sometimes a biopsy of unhealthy cervical looking tissue may be needed.

For men-who-have-sex-with-men (MSM), it is recommended that they do an anal PAP smear to investigate for HPV.

We also provide Rapid HPV Testing (next day result) in all our clinics in Singapore.


How can HPV & Genital Warts be treated?

In most cases, the HPV infection is self-limiting therefore no treatment is deemed necessary.

Unless an individual has issues with antibodies or a weak immune system in general, the body should be able to contain and eradicate the virus from the body in due time.
If an individual has an impaired immune system or a weak immune response, a lingering infection or a co-infection with another sexually transmitted illness can occur.

In cases of genital warts, the treatment options are largely dependent on the severity of the infection. The most common treatment options include creams and paint-on ointments. These induce a state of cell death so warts around the genital will eventually wither and fall off the skin.

Some patients may be offered cryotherapy where the wart is frozen then removed. The wart is frozen prior to that so that there will be no transmission of the wart after.
Apart from the above surgical options for wart removal also exist. This is where a surgeon uses electrocautery or a scalpel and surgically excise warts. See: Genital Warts Removal

Unfortunately, the majority of genital warts or other warts can recur very frequently and is rather common to have warts recur post removal. Sometimes, repeated treatments are required for complete remission, but patients should be aware of the recurrence rates in such an infection.


HPV and Cervical cancer

Some HPV viruses are known as high-risk viruses. This is particularly true in virus strains 16 and 18. This is because it induces changes in the cells in the cervix of a woman and causes cervical if not detected early.

It is in this light that it is recommended that all sexually active women are advised to go for regular PAP smear tests, screen for HPV infections and visit your doctor for HPV vaccination in Singapore.


HPV and PAP Smear

Pap smear is a relatively painless test that can be quickly done. It involves inserting a speculum into the vagina of the patient to allow for inspection then a tool is inserted to obtain scraping. The patient should go back to resume activities of daily living with no hindrance once after the procedure completed by our female doctor.
These scrapings and obtained cells are then examined under a microscope to look for abnormal cells.

We also provide Rapid HPV Testing & Pap Smear in all our clinics in Singapore.

HPV and HPV Vaccination

Human Papilloma Virus (HPV) is a group of virus that can cause:

  • Vaginal Cancers
  • Vulvar Cancers
  • Anal Cancers
  • Penile Cancers
  • Oropharyngeal Cancers (cancers of the throat and tongue)
  • Genital warts or Papillomas

HPV vaccination is used to protect against HPV-related diseases and cancers.
To complete the HPV vaccination, 3 doses of injections will be given. The recommended HPV vaccine schedules are:
First dose: During your doctor visit.
Second dose: 1 – 2 months after the first dose
Third dose: 4-5 months after the second dose


Get More protection with New 9-valent HPV vaccine (Gardasil 9)

There are over a hundred strains of HPV and they are each given a designated number e.g. HPV 6 or HPV 16 or HPV52.
HPV strains that cause warts will NOT cause cancers and HPV strains that cause Cancer will NOT cause warts.

Compared to the older Gardasil, the new GARDASIL 9 offers a wider range of protection against HPV strains.
Both Gardasil and Gardasil 9 give you protection against the cancer-causing HPV 16 and 18 and the wart-causing HPV 6 and 11.
Gardasil 9 protects additional 5 other high-risk types: 31, 33, 45, 52 and 58.
Together these types cause about 90% of cervical cancers.

Another HPV vaccine Cervarix, on the other hand, protects only against the commonest cancer-causing HPV 16 and 18. There is no wart protection with Cervarix.
If you are interested in getting the HPV testing & PAP smear, genital warts treatment or HPV vaccine, please visit our STD clinics and speak to our male and female doctors.
If you or your partner are experiencing any possible signs or symptoms of infection, or have had any potential risk exposures, please see our STD doctors today.
Take Care. Be Safe!



Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. Anal Pap Smear for Anal Cancer Screening
  3. HIV Rash: What You Need To Know
  4. Genital Blister, Genital Ulcers & Genital Warts – What You Need to Know
  5. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  6. 11 Causes of Dyspareunia (Pain During Intercourse)
  7. 10 Common HIV related to Opportunistic Infections
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Herpes: Everything You Need to Know!
  13. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  14. Syphilis Symptoms (Painless STD Sores & STD Rashes)