Bowenoid Papulosis

Bowenoid papulosis (pronounced “BOH-uhn-oid” “pap-yeh-LO-sis”) is a skin condition. It causes discolored, flat or raised bumps (papules) on your genitals or anus. They may go away within a few weeks or last for years. It most commonly spreads through sexual intercourse.

Bowenoid papulosis of the anus affects about 1 to 2 out of every 100,000 people in the general population. If you have a penis, it affects about 1 to 4 out of every 100,000. It’s slightly more common if you have a vulva, affecting about 3 to 5 out of every 100,000.

Other names for Bowenoid papulosis (BP) include:

• High-grade squamous intraepithelial lesion (HSIL)
• Intraepithelial neoplasia

Is it an STD?

Yes, Bowenoid papulosis is a sexually transmitted infection (STI). It may pass from person to person through:

• Anal sex
• Oral sex
• Skin-to-skin contact
• Vaginal sex

Is it serious?

Bowenoid papulosis is precancerous. That means it isn’t cancer, but it can become squamous cell carcinoma later. Squamous cell carcinoma is a type of skin cancer.

If you notice any skin changes on your body, it’s a good idea to schedule an appointment with a healthcare provider. An early BP diagnosis can help prevent it from progressing to cancer.

What are the symptoms of Bowenoid papulosis?

The main symptom of Bowenoid papulosis is one or more bumps on your genitals or around your anus. They usually appear on the tip of your penis (glans), foreskin or vaginal lips (labia). But they can also appear on your scrotum, groin and butt. They rarely appear in other areas of your body.

They may look:

• Flat
• Raised
• Smooth
• Rough
• Discolored (pink, red, brown or purple) or the same color as the skin around it

The bumps usually don’t hurt. Most people don’t have any other symptoms. But in rare cases, they may be itchy or sore.

Women usually have larger BP bumps than men — about 0.75 to 1 inches (2 to 3 centimeters) in diameter. Women usually have more bumps.

What causes Bowenoid papulosis?

Human papillomavirus (HPV) causes Bowenoid papulosis. There are over 100 different strains of HPV. But HPV 16 and HPV 18 cause most cases.

Is it contagious?

Yes, Bowenoid papulosis is very contagious. It spreads through skin-to-skin contact during sexual intercourse. You get BP when your genitals come into contact with the body parts of a partner who has BP.

It’s rare, but BP can affect other areas of your body. These areas may include your fingers and areas around your mouth. It’s possible to spread it through hand- or mouth-to-genital contact. This includes “manual stimulation” like hand jobs and fingering.

Risk factors

Anyone sexually active can get Bowenoid papulosis. It’s most common in people in their 30s.

Complications

HPV that causes Bowenoid papulosis could potentially develop into cancer. If you have BP, you have an increased risk of developing:

• Cervical cancer
• Vaginal cancer
• Vulval cancer
• Penile cancer
• Invasive squamous cell carcinoma

It’s important to remember that having BP doesn’t mean you’ll develop cancer. But you may need to schedule regular appointments with a healthcare provider. Regular monitoring can help prevent BP from causing cancer.

How doctors diagnose Bowenoid papulosis

A provider will first review your health history and ask you about your symptoms. They’ll also look at your affected areas. They may use a magnifying device with a light (dermoscopy) to get a closer look.

If they suspect Bowenoid papulosis, they’ll confirm it with a skin biopsy. During a skin biopsy, they’ll remove a small amount of affected tissue and send it to a lab to look for signs of BP.

How do you cure Bowenoid papulosis?

Sometimes, Bowenoid papulosis doesn’t need treatment. Healthcare providers may suggest regular appointments to monitor it. Your appointments may include a Pap smear. During a Pap smear, your provider uses a medical device to widen your vaginal walls. This allows them to take a closer look at your vagina and cervix. They’ll also swab cells from your cervix and send them to a lab to look for signs of BP.

If you need treatment, your provider may recommend:

• Medicated creams: Applying 5-fluorouracil and 5% imiquimod creams may treat mild cases.
• Ablation therapy: Your provider uses extreme heat or cold to destroy BP bumps.
• Electrosurgery: Your provider uses electricity to destroy the bumps.
• Photodynamic therapy: Your provider uses light and photosensitizing drugs to destroy the bumps.
• Excision: Your provider uses a sharp medical knife (scalpel) to cut out the bumps.

In some cases, providers may combine treatments.

When should I see my healthcare provider?

Call your primary care provider (PCP) if you notice any changes around your genitals. They can make an official diagnosis or refer you to a dermatologist.

During your appointment, you may wish to ask the following questions:

• What tests do you suggest to diagnose Bowenoid papulosis?
• Are there any signs I should look out for that it’s getting worse?
• Do you think I need treatment?
• Will it go away on its own?
• Should I schedule follow-up appointments for monitoring?
• How often should I schedule appointments?
• Can I still get an HPV vaccine if I have Bowenoid papulosis?
• Is there anything else I can do to protect myself or my partner(s)?

What is the prognosis for Bowenoid papulosis?

The outlook for Bowenoid papulosis is generally good. Symptoms go away completely for most people. You may not even need treatment.

But there is a risk that BP may turn into cancer. It’s important to see a healthcare provider if you have any changes to or around your genitals. Early diagnosis and treatment reduce your risk of cancer.

Can it be prevented?

The easiest way to prevent Bowenoid papulosis is to avoid sexual intercourse. But if you’re sexually active, it’s a good idea to talk to a healthcare provider about the HPV vaccine. They can answer any questions about their safety and effectiveness.

You can also help lower your BP risk by:

• Getting an STI test before having sex with any new partners
• Limiting your number of sexual partners
• Practicing safe sex by using dental dams and condoms each time you have sex

You should also tell your partner(s) if you have BP. If they have any questions, encourage them to talk to a provider.

What conditions are similar to Bowenoid papulosis?

Conditions that have similar symptoms to Bowenoid papulosis include:

• Bowen’s disease
• Genital warts
• Lichen planus
• Lichen sclerosus
• Psoriasis
• Seborrheic keratosis