Sores on the Penis – Causes, Symptoms, and Treatment Options

Experiencing painful, reddish sores on your penis can be alarming. It’s natural to wonder if these penis sores are serious or require immediate medical attention. This article will explore various types of penile sores, their potential causes, how to identify them, and when it’s important to consult a dermatologist.

What Causes of Penile Sores?

To find out the cause for a penis sore, thorough history and physical examination is required with special attention to previous sexual history, including contraceptive use and any previous sexually transmitted infection history. A thorough skin survey with genital examination will be followed by inguinal lymph node examination. Investigations like biopsy, MRI will be performed only in suspicious instances.

Sore is any type of tender, painful ulcer or lesion of the skin or mucous membrane. Penile sores includes the genital ulcers and lesions arising over penis, which can be infectious, neoplastic (new growth) or inflammatory in origin. Most of the penis sores presenting to a health care provider somehow will be benign or infectious in origin.^[1]

According to the spread, Penile sores classified into two broad categories,

• Sexually Transmitted Infections (STIs): Genital herpes, genital warts, syphilis, molluscum contagiosum, and chancroid are common STIs that can cause penile sores.
• Non-infectious conditions: Other factors such as skin irritations, allergies, or underlying medical conditions can also contribute to penile sores.

STIs Causing Penile sores

Genital Herpes

Cause:

Herpes simplex virus (HSV) infection

This virus generally spreads during sex. You can get it by having vaginal, anal, or oral sex with someone who has genital herpes. If your sexual partner has a cold sore and performs oral sex on you, you can also get genital herpes this way.

Symptoms:

• Painful, fluid-filled blisters on the penis, Red sores on penis
• Burning or tingling sensation before or during an outbreak
• Tenderness or swelling in the groin area
• Fever
• Headache
• Muscle aches

Diagnosis:

• Clinical examination of the lesions
• Swab of the sore for laboratory testing to confirm HSV infection

Treatment:

• Antiviral medications (acyclovir, valacyclovir, famciclovir) to shorten outbreaks and manage symptoms^[2]
• Self-care measures (keeping sores clean and dry, wearing loose-fitting underwear, applying cold compresses)

Genital Warts

Cause:

Human papillomavirus (HPV) infection

Penile warts are the most common sexually transmitted disease in males.^[3] Penile warts are caused by human papillomavirus (HPV), notably HPV-6 and HPV-11.

Symptoms:

• Flesh-coloured, wart-like growths on the penis

• May be asymptomatic or cause discomfort or itching

Diagnosis:

• Clinical examination of the lesions

Treatment:

• Topical medications (podofilox, imiquimod, sinecatechins)
• Clinician-administered therapies (podophyllin, cryotherapy, electrocautery, laser therapy)
• Surgical excision in severe cases

Syphilis

Cause:

Treponema pallidum bacterium

Its prevalence is high in low-income and middle-income countries, and its incidence has increased in high-income countries in the last few decades among men who have sex with men.^[4] Syphilis is a major cause of adverse pregnancy outcomes in low-income and middle-income countries.

Symptoms:

• Primary stage: Painless sores, circular sore called a chancre at the site of infection
• Secondary stage: Rash, fever, fatigue, sore throat, swollen lymph nodes
• Later stages: Can affect the heart, brain, eyes, and other organs

Diagnosis:

• Blood tests (VDRL, RPR)
• Darkfield microscopy of the chancre

Treatment:

• Antibiotic treatment (penicillin)
• Follow-up testing to monitor the infection

Molluscum Contagiosum

Cause:

Molluscum contagiosum virus (MCV)

Molluscum contagiosum, also called water warts, is a benign condition of the skin. The skin lesions of molluscum contagiosum are called mollusca.

Symptoms:

• Small, dome-shaped, pinkish-purple bumps on the skin
• Central umbilication
• Usually asymptomatic, but may cause itching , pain or cosmetic concerns

Diagnosis:

• Clinical examination of the lesions

Treatment:

Often self-limiting, spontaneous resolution may occur

Treatment options may include:

• Physical removal (cryotherapy, curettage, laser therapy)
• Topical medications (podophyllotoxin, potassium hydroxide, salicylic acid, benzoyl peroxide, tretinoin)
• Systemic treatment (oral medications or antiviral therapy in rare cases)^[5]

Chancroid

Cause:

Haemophilus ducreyi bacterium

Chancroid predominantly affects younger sexually active individuals in the 21 to 30-year-old age group. This group reflects a large proportion of career sex workers and the typical younger male population in developing countries that partake of their services. An asymptomatic carrier state has been noted among women, potentially allowing for the unsuspected transmission of the disease.^[6]

Symptoms:

• Painful, ulcerated sores on the genitals
• Tender, often unilateral, regional lymphadenopathy
• May progress to suppurative buboes

Diagnosis:

• Clinical examination
• Gram stain of the exudate (may show “school of fish” findings)
• Culture for H. ducreyi (if available)

Treatment:

• Antibiotics (azithromycin, ceftriaxone, erythromycin, ciprofloxacin)
• Treatment for sexual partners

Non-STI Causes of Penile Sores

In addition to STIs, penile sores can be caused by other factors, including

Psoriasis on penis / penile psoriasis

• Cause: Autoimmune condition that affects the skin
• Symptoms: Red, scaly patches or sores on the penis
• Treatment: Topical corticosteroids, coal tar, calcipotriene, pimecrolimus, tacrolimus, or systemic medications

Lichen planus on penis

• Cause: Autoimmune disease that can affect the skin, including the genitals
• Symptoms: Purplish, flat-topped bumps on the penis, often with white lines running through them
• Treatment: Antihistamines, topical corticosteroids, systemic corticosteroids, PUVA therapy, retinoic acid, tacrolimus, or pimecrolimus

Other Rare causes of Penile sores

Granuloma Inguinale

• Cause: Bacterial infection caused by Klebsiella granulomatis
• Symptoms: Deep, slow-developing ulcers on the genitals
• Treatment: Antibiotics

Diabetes Ulcers

• Cause: Poor circulation in individuals with uncontrolled diabetes
• Symptoms: Sores on the genitals
• Treatment: Medical care to prevent infections and improve healing, controlling Diabetes

Penile Cancer

• Cause: Rare but serious condition, often associated with risk factors like uncircumcised penis, phimosis, chronic inflammation, smoking, immunosuppression, and HPV infection[9]
• Symptoms: Persistent lumps or ulcerated lesions on the penis
• Treatment: Surgery, radiotherapy, or chemotherapy, depending on the stage of the cancer

Atopic Dermatitis (Eczema)

• Itchy, red bumps from eczema can occasionally appear
  on the genitals. While they rarely ulcerate, it’s important to consult a doctor for proper

Diagnosis and Treatment

A dermatologist will conduct a thorough examination of the penile sores and may order tests to determine the underlying cause. Treatment options will vary depending on the diagnosis and may include:

• Antiviral medications: For viral infections like herpes and HPV
• Antibiotics: For bacterial infections such as syphilis and chancroid
• Topical creams or ointments: To treat conditions like psoriasis and lichen planus
• Surgery or laser therapy: For the removal of warts or other lesions
• Lifestyle modifications: For conditions like diabetes, maintaining good blood sugar control is essential.

Additional Considerations

• Prevention: Practicing safe sex, including using condoms, can help reduce the risk of contracting STIs that cause penile sores.
• Regular check-ups: If you have a history of STIs or are at high risk, regular check-ups with a dermatologist are recommended.
• Early detection: Early diagnosis and treatment can be crucial for managing penile sores and preventing complications.

When to See a Dermatologist

According to American academy of family physicians, The diagnosis and management of penile cutaneous lesions can be challenging for some physicians because of a lack of familiarity and patient embarrassment. Despite these challenges, primary care physicians are capable of diagnosing and managing many penile lesions, and determining which patients require subspecialist referral.^[10]

It’s essential to consult a dermatologist if you experience any of the following symptoms related to penile sores:

• Persistent or worsening sores
• Painful sores
• Unusual appearance of sores
• Associated symptoms like fever, fatigue, or swollen lymph nodes
• Concerns about STIs