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Checking clients for visible symptoms of STI can be challenging because there are many individual differences in genital and anal anatomy. Sometimes, these natural differences may be mistaken for an STI. 

This page describes some of these anatomical differences to help you tell the difference.

Pearly penile papules

Pearly penile papules look like a small ring of tiny white bumps or skin tags around the edge of the head of the penis. Pearly papules can be easily confused with warts, but they are not the same thing. They occur naturally in many people and are not sexually transmitted or contagious.

A good way to tell pearly papules from warts is that warts are usually hard and scattered over the anus and genitals, with no apparent pattern or uniformity. Pearly papules generally sit in regular, almost straight lines in a ring around the widest part of the head of the penis. It’s highly unlikely that warts would appear in a similar pattern.

Fordyces Spots

Fordyce spots are enlarged oil glands under the skin. They look like very small white dots or lumps that are evenly spread just under the skin of the vulva and the penis (particularly when skin is stretched). They may produce a thick, chalky discharge when they are squeezed. They can also appear on the lips. Fordyce spots are present in 80% of adults but are more visible on some people than others. 

Fordyce spots are not an STI, and they are not infectious. 

Parafrenular glands (Tyson’s glands)

Tyson/parafrenular glands are enlarged oil glands located on the underside of the penis below the head. They may appear like two small white lumps sitting opposite each other. As they are a normal feature of many penises and treatment is not required. Tyson/parafrenular glands are not an STI, and they are not infectious.

Vitiligo

Vitiligo is a non-contagious skin condition where lighter or white patches develop on the skin. Vitiligo occurs when pigment-producing cells die or stop producing melanin – the pigment that gives your skin, hair and eyes colour. It affects 1 to 2 in every 100 people. Vitiligo can affect any area of the skin, but it commonly affects the face, neck, hands, and skin creases. Vitiligo is not dangerous and does not cause symptoms like pain or itching, but it can spread over time.

Angiokeratomas

Angiokeratomas can occur alone or in multiples and appear as deep-red or purple papules (small, solid, raised bumps on the skin). They usually appear over the scrotum or vulva but can also appear on the penis. Angiokeratomas tend to advance with age, but treatment is only required if they bleed frequently. Angiokeratomas are not an STI and are not contagious.

Lymphocoeles

Lymphocoeles feel like a cord-like structure that can occur vertically or horizontally on the shaft of the penis. The condition develops when the lymph channels in the penis are temporarily blocked, usually due to vigorous masturbation or prolonged, intense sex sessions. Lymphocoele of the penis is generally harmless, will usually resolve on its own and does not require any treatment. 

Skin tags

Skin tags are typically the size and shape of a grain of rice. They are common in the skin creases of the groin in middle-aged men. They are also often found in the armpit and on the sides of the neck. They are not an STI, and they are not infectious.

Folliculitis (infected ingrown hair)

Folliculitis is an inflammation affecting the hair follicles (pimples), which are the hair-producing pores on the skin. It can occur anywhere on the body where there is hair but is frequently seen at the base of the penis. They are not an STI, and they are not infectious, but they can increase the risk of STI or BBV transmission when the sores are open/popped. 

Folliculitis causes a rash with clusters of red bumps or whiteheads, each with a hair in the middle. These can become itchy or sore, and there may be pus (sometimes with blood) when squeezed. It is quite common and usually harmless but can be irritating. If an infection is more severe or deeper under the skin, the person may feel feverish or unwell. 

Mild folliculitis often settles down with an antiseptic wash and genital hygiene measures. More severe folliculitis might need antibiotic ointment or tablets. If the infection has progressed into a large boil or sore, this may need draining by a doctor.