Causes of Penile Lesions

Infectious Causes

Human papillomavirus (HPV) types 6 and 11 cause most genital warts, presenting as papillary, exophytic, or cauliflower-like lesions on the penis, vulva, scrotum, perineum, and perianal skin, according to the Centers for Disease Control and Prevention 1
HPV types 16, 18, 31, 33, and 35 are strongly associated with penile intraepithelial neoplasia and invasive carcinoma, accounting for 45-80% of penile cancers, as reported by the European Association of Urology 4
Genital warts can occur on external genitalia as well as in the urethra, anus, and mouth, with intra-anal warts seen predominantly in patients with receptive anal intercourse, according to the Centers for Disease Control and Prevention 1
Gonococcal and chlamydial infections cause urethritis with associated penile discharge and inflammation, as stated by the Centers for Disease Control and Prevention 1
In immunocompromised patients, fungi and mycobacteria are more likely causes of epididymitis and penile lesions, according to the Centers for Disease Control and Prevention 1

Lichen sclerosus presents as a phimotic, hypopigmented prepuce or glans penis with a cellophane-like texture, affecting the prepuce, coronal sulcus, and glans, and carries a 2-9% risk of developing squamous cell carcinoma, as reported by the British Association of Dermatologists 2
Chronic balanitis from poor hygiene, phimosis, or diabetes contributes to chronic inflammation and increased cancer risk, according to the American Urological Association 3
Phimosis is associated with 25-60% increased risk of penile cancer and significantly hinders early detection, as stated by the American Urological Association 3

Penile intraepithelial neoplasia (PeIN) is the precursor lesion of penile squamous cell carcinoma, with clinical terms including erythroplasia of Queyrat, carcinoma in situ, and Bowen's disease, as reported by the European Association of Urology 4
Squamous cell carcinoma comprises more than 95% of penile cancers, presenting as a painless lump, ulcer, or fungating mass, according to the European Association of Urology 4
HPV-associated subtypes include basaloid (4-10% of cases) and warty carcinoma (5-10% of cases), as reported by the European Association of Urology 4

Tobacco use increases risk 3.0-4.5 times for developing penile cancer, according to the American Cancer Society 3
HIV infection confers an 8-fold increased risk, possibly related to higher HPV co-infection rates, as stated by the Centers for Disease Control and Prevention 3
PUVA therapy is associated with a 286 times higher risk of penile cancer, according to the American Academy of Dermatology 3
History of sexually transmitted diseases increases overall risk of penile lesions and cancer, as reported by the Centers for Disease Control and Prevention 3
Poor hygiene contributes to chronic inflammation and infection, according to the American Urological Association 3

Biopsy is mandatory for lesions that are pigmented, indurated, fixed, ulcerated, or fail to respond to adequate treatment, as well as when there is any suspicion of neoplastic change, as stated by the British Association of Dermatologists 2
Evaluation should include syphilis serology and HIV counseling and testing, particularly when sexually transmitted infections are suspected, according to the Centers for Disease Control and Prevention 1