An early syphilis chancre may present as a non-ulcerated, button shaped lump on the penile skin. Chancres are often indurated and there is usually some sign of epidermal breakdown or inguinal lymphadenopathy. Syphilis serology may be negative for the first few days of a chancre and should be repeated 2–4 weeks later if syphilis is suspected. In very early syphilis, treponemal polymerase chain reaction (PCR), using a dry cotton swab vigorously rubbed on the lesion at the time of the initial consultation, may be more likely to yield a positive result. While only some specialist laboratories perform this, most can forward the specimen on for appropriate testing.


When diagnosis is uncertain, a biopsy may be performed to rule out other conditions.1 Several modes of therapy are used for treating pearly penile papules, including cryotherapy, electrodesiccation, podophyllin, curettage and carbon dioxide laser ablation. Ablation using intermittent- or continous-mode carbon dioxide laser is reported to have the best outcome cosmetically. Treatment should be reserved for patients who are highly distressed by the appearance of this very common and benign entity.2

They most commonly appear in a row, somewhat like a string of pearls, which is why they are called pearly papules. Men who’ve suffered from this skin ailment know these papules look gruesome and tend to worry about their sexual health. However, the papules are fairly common and hardly serious. They pose no health risks and are completely painless. About 20% of men are expected to develop some form of PPP in their lifetime. It is also unrelated to sexual activity or personal hygiene.


Dr Groff is a partner at Cosmetic Laser Dermatology which is an esteemed cosmetic clinic located in beautiful San Diego, California and a member of the West Dermatology network. The team of board-certified dermatologists is committed to providing each and every patient with the highest level of care in a comfortable setting. Cosmetic Laser Dermatology's dermatologists are all highly respected in the field for their use of innovative treatments, involvement in advanced medical research, and continued participation in clinical trials.
Many studies show that pearly penile papules are less common in circumcised males and is they are supposed to be secondary to chronic trauma undergone by uncovered corona which leads to the papule involution. However, Rehbein, in his study of 840 males, showed a higher prevalence among circumcised people. A recent study in young circumcised men showed a prevalence of 17.1%.
Psychological distress from PPP is often experienced by men through feelings of low self-esteem or self-consciousness. While surgical removal may provide relief from such distress for some people, the high cost of surgery limits its access. Ads claiming to remove PPP in a short amount of time may be scams and should be avoided. The best advice for those experiencing psychological distress from PPP is to love your body. While it is understandable to feel some anxiety over a physical “abnormality,” especially when it affects such a delicate region of the body, acceptance and respect for oneself is inarguably the healthiest (and most cost-effective) mode of treatment.
The papules appear as one or several rows of small, pearly or flesh-colored, smooth, dome-topped bumps situated circumferentially around the corona or sulcus of the glans. They may range in size from less than 1 mm to 3 mm.[7] As of 1999, different studies have produced estimates of incidence ranging from 8 to 48 percent of all men.[8] Studies suggest that it occurs more often on younger men and those who have not been circumcised.[9] One study found them in 33.3% of males who had not been circumcised and in 7.1% of males who were circumcised.[8]
Another consideration with any ablative laser is herpes simplex virus and bacterial prophylaxis. In the authors’ cases, they did not prophylax for herpes, because neither patient reported a prior herpetic outbreak. However, in individuals with a history of genital herpes, the authors recommend a five-day course of valacyclovir 500mg twice daily starting the day before the procedure. Bacterial prophylaxis was offered to the patient presented in Case 1. Despite his nonadherence, no bacterial complications resulted. The patient in Case 2 did not receive antibiotics and also had an uneventful recovery. Concern for bacterial contamination due to the “unclean” anatomic location and prophylaxis with a first-generation cephalosporin is at the discretion of the clinician.

Actually, these bumps are very common, especially among men in their twenties and thirties. Uncircumcised men also report a high occurrence of the papules as well. Throughout your lifetime, it is possible that the bumps will appear and disappear on their own. Even though they are harmless, do not pick at them or try to pop them. You can cause some serious damage- scarring and infection can occur. See a doctor if they bother you.
Since the introduction of the National Human Papillomavirus Vaccination Program for young women in 2007, the incidence of genital warts has fallen dramatically in young Australian heterosexuals.1 With the extension of this vaccination program to young men, it is expected that the incidence of genital warts will fall further and will also decline in homosexual men: genital lumps in young adults are now less likely to be warts. This article aims to assist diagnosis by outlining some common anatomical variants and comparing them to a few pathological conditions. There are other conditions that may cause genital pathology that are not covered, and treatment is not discussed in detail.

Objective: Pearly penile papules are asymptomatic, benign growths distributed around the corona of the penis that can frequently be a source of significant psychological distress for the patient. Various treatment options are limited mainly by their complications. Design: Two case reports and a review of the literature. Setting: University academic setting. Participants: Two subjects of skin types I and V. Measurements: Visual inspection and photographs were used to determine clearance. Results: Two cases of pearly penile papules that were successfully treated using a fractionated CO2 laser. Conclusion: The fractionated CO2 laser is a well-tolerated treatment for pearly penile papules. Importantly, this modality is useful even in darker skin types.
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Pearly penile papules are very common; they are present in about 25% of adult males, and are harmless in nature. These bumps do not pose a risk to your health or the health of your sexual partner(s). They play no role in sexual performance and pose no health risk. For this reason, treatment is only advised if the bumps are a cause of psychological stress. If you decide to seek treatment, you should be sure to get a proper diagnosis from a doctor. Treatment is typically surgical removal of each papule via carbon dioxide laser surgery, radiosurgery, freezing, excisional surgery, or electro-desiccation. Other home remedies have also been used, although they are variable in effectiveness and should be carefully researched prior to use, as home attempts may be unsafe and can possibly worsen the appearance of the penis. These include applying gels or pastes such as toothpaste, castor oil, lemon juice, or eucalyptus oil to the papules for weeks at a time until the bumps seem to shrink in size.
Pearly penile papules (PPP) are common, benign lesions that appear on the corona of the glans penis during adolescence or early adulthood. Despite their benign nature, PPP are known to cause significant distress because of their resemblance to sexually transmitted infections such as condyloma acuminata. PPP can be clinically distinguished based on their uniform, dome-shaped papules that orient in one to two rows around the glans penis. There is no association between PPP and sexually transmitted infections, and treatment is generally reserved for patients with excessive concern. Physicians should be aware of this distinction in order to adequately reassure anxious patients. For patients who still desire treatment after counseling, cryotherapy and laser therapy represent two reliable treatment options with low rates of recurrence.
Conclusions and Relevance These 4 case reports illustrate the advantages of using PDL when treating PPP. In each patient, the appearance of the papules was either completely diminished or significantly reduced after the procedure. This result was achieved with only minimal discomfort felt by the patients. The use of PDL offers dermatologists a new treatment modality for PPPs that is safe, easily performed, and produces excellent aesthetic results.
Experts aren’t completely sure why some guys have PPP. Since PPP aren’t harmful in any way, they are also considered a normal skin variation. Additionally, guys can have PPP regardless of their race, geographic location, or sexual preference. Several reports say that uncircumcised guys may be more likely to have them than those who are circumcised.
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