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Pearly Penile Papules (PPP)

Pearly Penile Papules (PPP) are a common occurrence in young men, and are actually a variation of normal anatomy.

They appear as multiple, distinct growths arranged symmetrically in a circular pattern at the base of the penile head (assuming the penile tip as a triangle where the tip of the penis represents the tip of the triangle).

These papules are usually arranged in 1-3 circular rows, set a couple of millimeters apart.

Symptoms

Multiple, distinct growths arranged around the base of penile head.

Diagnosis

Routinely diagnosed from a physical examination from a trained clinician.

Causes

Considered to be the embryological remnant of penile spines.

What are the symptoms of Pearly Penile Papules?

Pearly penile papules usually present as small (1–3mm) pearly, dome-shaped bumps that typically appear around or under the corona of the glans (the head of the penis). They may be flesh-coloured, white or yellow and often appear in rows. They are painless and do not cause any adverse effects. They are not itchy and do not cause any penile discharge or smell. They may change over time, and often regress with age.

Many young men present to sexual health clinics with great concern or embarrassment after noticing these penile papules. The attention to these lumps can be drawn during changes of puberty or after a sexual contact, and can knock off the confidence of young men.

Sometimes a patient attends the clinic on multiple occasions to have STI checks to seek reassurance, and it may take a while for the patient to share their concern about PPPs with the nurse or doctor.

If a patient has had a genital examination with their doctor in primary care or in a specialist sexual health clinic, normally the doctors will not mention the presence of pearly penile papules as it is not a specific medical illness and does not require any treatment.

Who gets Pearly Penile Papules?

Anyone with a penis can have pearly penile papules, however, they are found more commonly in younger people, with the highest incidence found in those aged 20–40. They generally appear after puberty, and may be more common in Black people and those who have not been circumcised.

Are there any complications of Pearly Penile Papules?

There are no complications associated with having pearly penile papules as they are a common and normal part of penile anatomy. They are not associated with sexually transmitted infection, personal hygiene or development of any cancers.

I think I have Pearly Penile Papules. What should I do?

If you think you have pearly penile papules, you might want to see a healthcare professional to ensure you are not mistaking the PPP for a condition that may require treatment, such as a sexually transmitted infection, or a skin condition.

What causes Pearly Penile Papules?

Pearly penile papules are thought to be an embryological remnant of penile spines, which are still present on the penis of some other primates.

Penile spines play an important role in animals such as ducks, where the friction of the spines in the female genital tract is thought to induce ovulation. The papules in humans often secrete an oily substance called sebum, which acts to lubricate the penis.

There is a hypothesis that pearly penile papules play a role in sexual stimulation of the female, however this is yet to be investigated.

Are Pearly Penile Papules an infection?

Pearly penile papules are part of the normal anatomy of the penis and are not caused by an infection. PPP is not an indication of poor personal hygiene, a common misconception.

Can I pass on Pearly Penile Papules?

Pearly penile papules are not infectious in origin and as such cannot be passed on to anyone else. 

Are Pearly Penile Papules an STI?

Pearly penile papules are not a sexually transmitted infection and are common in all men regardless of if they are sexually active or not. Sexual activity appears to have no effect on the development, progression or regression of PPP, and they do not increase the risk of contracting an STI. 

How are Pearly Penile Papules diagnosed?

Pearly penile papules are primarily diagnosed based on inspection of the lesions. It is important that examination is undertaken by a clinician experienced in dealing with penile skin conditions so that a correct diagnosis of PPP is made (and other possible diagnoses ruled out).

Occasionally PPP are misdiagnosed as Genital warts, and this results in unnecessary distress, relationship difficulties and unnecessary treatment.

Our approach to PPP diagnosis includes:

(1) Taking patients concerns seriously – It is important that the patients who have concerns about PPP or spots on their penis are taken seriously

(2) Unhurried physical examination – undertaken in a private setting in an unhurried manner

(3) Discuss concerns & anxieties – Concerns and anxieties of patients must be identified during consultation, and the impact of clinical examination, and information available from history by a healthcare professional with expertise in genital health.

Sometimes dermatoscopy can be used to study the lesions in greater detail.

In rare cases where the diagnosis is not clear, a biopsy may be taken off the lesions, which is examined under a microscope. It’s important to see an experienced healthcare professional to rule out other conditions such as sexually transmitted infections, which may require urgent treatment.

What factors can help a correct diagnosis?

Pearly penile papules can be misdiagnosed as other conditions such as sexually transmitted infections, skin conditions and other normal conditions. PPP are most commonly misdiagnosed as genital warts or molluscum contagiosum.

The number, size, shape, symmetry as well as pattern of distribution of the lesions are taken into account in making a diagnosis of PPP.

PPP tends to be localised to the penile corona, whereas warts and molluscum can affect any part of the genitals. The size of the lesions can also help in the diagnosis; PPP are rarely larger than 1–3mm whereas molluscum lesions are typically 2–5mm in size and genital warts can be variable in size.

What is the difference between Genital warts and Pearly Penile Papules?

Genital warts are a sexually transmitted infection caused by the human papillomavirus (HPV), whereas PPP are a normal part of the penile anatomy. Genital warts can only develop following exposure to an individual infected with the HPV virus and therefore occur almost exclusively in sexually active individuals, whereas PPP can exist at any point, irrespective of sexual activities or exposures. Genital warts and PPP can appear as similar lesions on the penis, and can often be confused by those less experienced in the diagnosis of the conditions.

Genital warts tend to be larger, asymmetrical, and are more likely to change in shape and size over time. PPP tends to be localised to the penile corona (the area between the head and shaft of the penis, whereas genital warts can affect any part of the genitals, including the anus and skin of the groin.

Rarely a patient can develop warts amidst the pearly penile papules, and these are usually distinguished by their appearances.

What is the difference between Molluscum contagiosum and Pearly Penile Papules?

Molluscum contagiosum is a benign skin condition caused by infection with the Molluscum contagiosum virus (MCV), whereas PPP are not caused by any infectious agent and are entirely normal. Molluscum can only develop following exposure to the MCV virus whereas PPP exist independently of any external stimulus or infection.

Lesions caused by Molluscum are typically round and firm, around 2–5mm in size, with a characteristic central punctum or dimple whereas PPP are smaller, softer and more “fleshy”. Molluscum can appear anywhere on the body, however commonly affect the skin of the genitals and surrounding areas such as the thighs. PPP tend to only occur specifically on the underside of the head of the penis, and are not found on the thighs.

Can another condition be mistaken as Pearly Penile Papules?

People with PPP often worry that they have genital warts, and this is the most common misdiagnosis. Other sexually transmitted infections that can be mistakenly diagnosed in a person with PPP include molluscum contagiosum, syphilis and scabies. PPP can also resemble other skin conditions such as folliculitis, an inflammation of the hair follicles; or lichen nitidus, a rare inflammatory skin condition.

PPP can also be mistaken for other variations of normal anatomy, such as the presence of sebaceous glands. Normal sebaceous glands include Tyson’s glands, which appear on either side of the frenulum (the band of tissue connecting the head of the penis to the underside of the shaft), and Fordyce spots, which typically appear along the shaft of the penis. PPP can also be mistaken for skin tags, another normal variation that does not require treatment.

What will happen to my Pearly Penile Papules in the long term?

In many cases, pearly penile papules regress with age, and the incidence of PPP is lower in older people. In most cases however, the papules persist harmlessly, and do not change much over time.

Do I have to tell my partner I have (or had) Pearly Penile Papules?

PPP is not a sexually transmitted infection so there is no need to inform your partner that you have them. However, PPP are commonly mistaken for an STI such as genital warts, so it may be worth discussing with your partner and reassuring them that it is not an infection and cannot be transmitted to them.

How can I prevent Pearly Penile Papules?

Pearly penile papules are a part of normal genital anatomy and there is not a way to prevent them from occurring. Most people will develop PPP in their 20’s or 30’s, and it is less likely to develop PPP beyond the age of 40.

There are no lifestyle factors linked to the development of PPP, however maintaining a healthy lifestyle and practicing safe sex are recommended for everyone.

PPP appear to occur less commonly in people who are circumcised, however circumcision will not guarantee PPP will not develop.

Managing stigma

Penile papules are commonly mistaken for a sexually transmitted infection such as herpes or genital warts. It is useful to research PPP and learn that it is an entirely normal anatomical variant and does not have any adverse effects on health or sex life.

The presence of PPP can lead to anxieties or embarrassment about the appearance of the penis and can have a knock-on detrimental effect on self-esteem and sex life. It may be useful to discuss PPP with any partners and explain to them what they are, so as to reduce anxiety and stigma.

Page reviewed by Dr. Manoj Malu (Clinical Director)

Last reviewed date: 6 June 2021
Next review due: 6 June 2024

Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.

References & Further Reading

Clarewell Clinics