What Is Bowenoid Papulosis? Symptoms, Causes, Treatment, and Prevention
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Bowenoid papulosis is a skin condition that causes flat or raised bumps on the genitals or around the anus. It is caused by HPV, most often HPV 16 and HPV 18, spread through sexual skin contact. [1] The bumps are usually painless and may go away, but because the condition is precancerous, see a provider about diagnosis, monitoring, treatment and prevention.
Key takeaways
Bowenoid papulosis causes small, discolored, flat or raised bumps on or around the genitals and anus, and it is caused by HPV. [1]
It is a sexually transmitted infection that spreads through anal, oral, and vaginal sex as well as skin-to-skin contact. [1]
The bumps are usually painless, and most people have no other symptoms; some bumps clear within weeks while others last for years. [1]
The condition is precancerous, so it can develop into squamous cell carcinoma without progressing in every case. [1]
Treatment ranges from watchful waiting with regular monitoring to medicated creams, ablation therapy, electrosurgery, photodynamic therapy, or surgical excision. [1]
Prevention focuses on safer sex practices, limiting partners, STI testing with new partners, and talking to a provider about the HPV vaccine. [1]
What the research says
Bowenoid papulosis is a form of HPV-related high-grade intraepithelial neoplasia, so most of the strongest evidence comes from studies of those closely related precancerous lesions rather than bowenoid papulosis alone.
Treating HPV-related high-grade lesions lowers the risk of progression to cancer. In a randomized trial of 4,446 people living with HIV who had biopsy-proven anal high-grade squamous intraepithelial lesions, anal cancer was diagnosed in 9 treated participants (173 per 100,000 person-years) versus 21 in the active-monitoring group (402 per 100,000 person-years). The rate of progression to cancer was 57% lower with treatment (Palefsky et al., N Engl J Med, 2022) [2].
Imiquimod cream and surgery worked about equally well for vulvar high-grade lesions. In a randomized trial of 110 patients, complete clinical response was 80% (37 of 46) with imiquimod and 79% (41 of 52) after one surgical procedure, and patients in both groups had good cosmetic outcomes and stable sexual wellbeing (Trutnovsky et al., J Low Genit Tract Dis, 2024) [3].
In a large penile series, most patients needed surgery and few progressed to cancer. Among 345 patients with penile intraepithelial neoplasia, 14.4% could be treated with topical agents or cryotherapy alone, 85.6% had some form of surgery (circumcision most often), and 2.6% progressed to squamous cell carcinoma. The authors found topical treatment alone disappointing (Kravvas et al., J Dermatolog Treat, 2022) [4].
What Is Bowenoid Papulosis?
Bowenoid papulosis is a skin condition that causes discolored, flat or raised bumps (papules) on your genitals or anus. The bumps may go away within a few weeks or last for years. The condition most commonly spreads through sexual intercourse. [1]
The bumps are medically called papules, and they tend to appear in clusters on or around the genital area. In the general population, bowenoid papulosis of the anus affects about 1 to 2 out of every 100,000 people. If you have a penis, it affects about 1 to 4 out of every 100,000 people. It is slightly more common if you have a vulva, affecting about 3 to 5 out of every 100,000 people. [1]
You may see this condition referred to by other names, including high-grade squamous intraepithelial lesion (HSIL) and intraepithelial neoplasia. These names describe the same underlying process of precancerous cell changes in the skin. [1]
Is bowenoid papulosis 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, and vaginal sex. [1]
Is it serious?
Bowenoid papulosis is precancerous. That means it is not cancer, but it can become squamous cell carcinoma later. [1] Squamous cell carcinoma is a type of skin cancer.
If you notice any skin changes on your body, it is a good idea to schedule an appointment with a healthcare provider. An early diagnosis can help prevent the condition from progressing to cancer.
Symptoms of Bowenoid Papulosis
The main symptom is one or more bumps on your genitals or around your anus. They usually appear on the tip of the penis (glans), the foreskin, or the vaginal lips (labia). They can also appear on the scrotum, groin, and buttocks. They rarely appear in other areas of the body. [1]
The bumps may look:
Flat
Raised
Smooth
Rough
Discolored (pink, red, brown, or purple) or the same color as the skin around them
The bumps usually do not hurt, and most people do not have any other symptoms. In rare cases, they may be itchy or sore. [1]
People with a vulva usually have larger bumps than people with a penis, about 0.75 to 1 inch (2 to 3 centimeters) in diameter. They also usually have more bumps. [1]
Feature | Typical presentation |
Main symptom | One or more bumps on the genitals or around the anus |
Common locations | Tip of penis (glans), foreskin, labia |
Other locations | Scrotum, groin, buttocks |
Rare locations | Fingers and areas around the mouth |
Bump texture | Flat or raised; smooth or rough |
Bump color | Pink, red, brown, purple, or skin-colored |
Pain | Usually painless |
Other symptoms | None in most cases; rarely itchy or sore |
Bump size with a vulva | About 0.75 to 1 inch (2 to 3 cm) diameter |
Bump count with a vulva | Usually more bumps than with a penis |
What Causes Bowenoid Papulosis?
Human papillomavirus (HPV) causes bowenoid papulosis. There are more than 100 different strains of HPV, but HPV 16 and HPV 18 cause most cases. [1]
Is it contagious?
Yes, bowenoid papulosis is very contagious. It spreads through skin-to-skin contact during sexual intercourse. [1] You get it when your genitals come into contact with the body parts of a partner who has the condition.
It is rare, but bowenoid papulosis can affect other areas of the body, including your fingers and areas around your mouth. It is possible to spread it through hand- or mouth-to-genital contact. This includes manual stimulation such as hand jobs and fingering. [1]
Anyone who is sexually active can get bowenoid papulosis. It is most common in people in their 30s. [1]
Complications
The HPV that causes bowenoid papulosis could potentially develop into cancer. If you have the condition, you have an increased risk of developing the following:
Cervical cancer
Vaginal cancer
Vulval cancer
Penile cancer
Invasive squamous cell carcinoma [1]
It is important to remember that having bowenoid papulosis does not mean you will develop cancer. [1] But you may need to schedule regular appointments with a healthcare provider. Regular monitoring can help prevent the condition from causing cancer.
Complication | What it means |
Cervical cancer | Increased risk of cancer of the cervix |
Vaginal cancer | Increased risk of cancer of the vagina |
Vulval cancer | Increased risk of cancer of the vulva |
Penile cancer | Increased risk of cancer of the penis |
Invasive squamous cell carcinoma | The condition can progress to a type of skin cancer |
Overall note | Having bowenoid papulosis does not guarantee cancer develops |
How Is Bowenoid Papulosis Diagnosed?
A provider will first review your health history and ask about your symptoms. They will also look at your affected areas. They may use a magnifying device with a light (dermoscopy) to get a closer look. [1]
If they suspect bowenoid papulosis, they will confirm it with a skin biopsy. During a skin biopsy, they remove a small amount of affected tissue and send it to a lab to look for signs of the condition. [1]
Diagnostic step | What happens |
Health history review | Provider reviews your medical and sexual history |
Symptom discussion | You describe the bumps and any changes |
Visual examination | Provider examines the affected areas |
Dermoscopy | Magnifying device with a light gives a closer look |
Skin biopsy | Small tissue sample sent to a lab for confirmation |
How Is Bowenoid Papulosis Treated?
Sometimes, bowenoid papulosis does not 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 (speculum) to widen the vaginal walls, which allows them to take a closer look at the vagina and cervix. They also swab cells from the cervix and send them to a lab to look for signs of the condition. [1]
If you need treatment, your provider may recommend one of the following options.
Medicated creams. Applying 5-fluorouracil and 5% imiquimod creams may treat mild cases. [1]
Ablation therapy. Your provider uses extreme heat or cold to destroy the 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. [1]
Treatment option | How it works | Best for |
Watchful waiting with regular monitoring | No active treatment; provider checks the bumps over time | Cases that may resolve on their own |
Pap smear with cervical swab | Speculum exam and cell swab sent to a lab | Ongoing monitoring |
Medicated creams (5-fluorouracil, 5% imiquimod) | Cream applied directly to the bumps | Mild cases |
Ablation therapy | Extreme heat or cold destroys the bumps | Various cases |
Electrosurgery | Electricity destroys the bumps | Various cases |
Photodynamic therapy | Light plus photosensitizing drugs destroy the bumps | Various cases |
Excision | Scalpel cuts out the bumps | Various cases |
Combined treatments | Providers may use more than one approach | Cases that need stronger treatment |
When Should You See a Healthcare Provider?
Call your primary care provider 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 this condition?
Are there any signs I should look out for that indicate it is 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 this condition?
Is there anything else I can do to protect myself or my partner(s)?
Prognosis: What Is the Outlook?
The outlook for bowenoid papulosis is generally good. Symptoms go away completely for most people, and you may not even need treatment. [1]
But there is a risk that the condition may turn into cancer. It is 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. [1]
Can Bowenoid Papulosis Be Prevented?
The easiest way to prevent bowenoid papulosis is to avoid sexual intercourse. But if you are sexually active, it is a good idea to talk to a healthcare provider about the HPV vaccine. [1] They can answer any questions about its safety and effectiveness.
You can also help lower your 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 [1]
You should also tell your partner(s) if you have the condition. If they have any questions, encourage them to talk to a provider.
Prevention strategy | How it helps |
HPV vaccine | Protects against the HPV strains that cause most cases |
STI testing before new partners | Identifies infections before exposure |
Fewer sexual partners | Reduces the chances of encountering HPV |
Dental dams and condoms every time | Lowers skin-to-skin transmission risk |
Telling your partner(s) | Allows them to seek care and protect themselves |
Conditions Similar to Bowenoid Papulosis
Several other conditions can produce similar-looking skin changes, which is why a biopsy is important for an accurate diagnosis.
Similar condition | How it differs |
Bowen's disease | A precancerous skin condition related to squamous cell carcinoma |
Genital warts | HPV-related growths with a different appearance and behavior |
Lichen planus | An inflammatory condition affecting skin and mucous membranes |
Lichen sclerosus | A chronic skin condition causing patchy, thin skin |
Psoriasis | An autoimmune condition causing scaly patches |
Seborrheic keratosis | Noncancerous skin growths common with aging |
Finding Out What Changed on Your Body
It can be a shock any time you notice unexpected changes to any part of your body. This is especially true if changes occur around your genitals. Your immediate thoughts may concern your health and the health of your sexual partner(s). What caused this? How did I get it? Could I have spread it to someone else? Will I ever be able to safely have sex again?
Before you get too overwhelmed by your thoughts, talk to a healthcare provider. They can make an official diagnosis, explain what it means, and guide you through your next steps. You may not have any problems or need treatment. But in some cases, your provider may want to schedule regular appointments to make sure it does not get worse. They can also answer any questions you have about prevention and treatment.
Conclusion
Bowenoid papulosis is a manageable, HPV-related skin condition that most often causes painless, discolored bumps around the genitals or anus. Many cases resolve without treatment, and the overall outlook is good. The key is not to ignore what you see. Because the condition is precancerous, an early diagnosis and a clear monitoring plan make a real difference in preventing progression to cancer. Safer sex practices and the HPV vaccine add an important layer of protection for you and your partners.
Take the next step with confidence. Visual guides make health information easier to understand, share, and remember. Rinnit's infographic templates can help you create clear, professional visuals for your own health education content.
Frequently Asked Questions
What is bowenoid papulosis?
Bowenoid papulosis is a skin condition that causes discolored, flat or raised bumps (papules) on your genitals or anus. It most commonly spreads through sexual intercourse and is caused by human papillomavirus (HPV).
Is bowenoid papulosis an STD?
Yes. Bowenoid papulosis is a sexually transmitted infection. It may pass through anal sex, oral sex, skin-to-skin contact, and vaginal sex.
What causes bowenoid papulosis?
HPV causes bowenoid papulosis. There are more than 100 strains of HPV, but HPV 16 and HPV 18 cause most cases.
What do the bumps look like?
The bumps may look flat or raised, smooth or rough, and discolored (pink, red, brown, or purple) or the same color as the surrounding skin.
Where do the bumps appear?
The bumps usually appear on the tip of the penis (glans), the foreskin, or the labia. They can also appear on the scrotum, groin, and buttocks, and rarely in other areas of the body.
Are the bumps painful?
The bumps usually do not hurt. Most people do not have any other symptoms, though in rare cases they may be itchy or sore.
How common is bowenoid papulosis?
Bowenoid papulosis is rare. In the general population, it affects about 1 to 2 out of every 100,000 people. It is slightly more common if you have a vulva (about 3 to 5 per 100,000) and affects about 1 to 4 per 100,000 people with a penis.
Is bowenoid papulosis contagious?
Yes, it is very contagious. It spreads through skin-to-skin contact during sex, and can also spread through hand- or mouth-to-genital contact, including manual stimulation.
Who is most at risk?
Anyone who is sexually active can get bowenoid papulosis. It is most common in people in their 30s.
Is bowenoid papulosis cancer?
No, but it is precancerous. It is not cancer, but it can become squamous cell carcinoma, a type of skin cancer, later. Having the condition does not mean you will develop cancer.
What cancers are associated with bowenoid papulosis?
If you have the condition, you have an increased risk of cervical cancer, vaginal cancer, vulval cancer, penile cancer, and invasive squamous cell carcinoma.
How is bowenoid papulosis diagnosed?
A provider reviews your health history, examines the affected areas, and may use dermoscopy (a magnifying device with a light). A skin biopsy confirms the diagnosis.
Does bowenoid papulosis always need treatment?
No. Sometimes it does not need treatment, and providers may suggest regular monitoring appointments, which may include a Pap smear with a cervical swab.
What treatments are available?
Treatments include medicated creams (5-fluorouracil and 5% imiquimod) for mild cases, ablation therapy using extreme heat or cold, electrosurgery, photodynamic therapy, and surgical excision. Providers may combine treatments.
What is the outlook?
The outlook is generally good. Symptoms go away completely for most people, and you may not need treatment at all. Early diagnosis and treatment reduce the risk of cancer.
Can bowenoid papulosis be prevented?
Yes, risk can be reduced through safer sex practices, such as using dental dams and condoms every time, limiting sexual partners, getting an STI test before having sex with new partners, and discussing the HPV vaccine with a healthcare provider.
What conditions look similar to bowenoid papulosis?
Bowen's disease, genital warts, lichen planus, lichen sclerosus, psoriasis, and seborrheic keratosis can produce similar-looking changes, which is why a biopsy is needed for an accurate diagnosis.
Should I tell my partner(s) if I have bowenoid papulosis?
Yes. You should tell your partner(s), and encourage them to talk to a provider if they have any questions.
Related Reading
References
Cleveland Clinic. Bowenoid Papulosis. Cleveland Clinic Health Library. Medically reviewed; last updated October 28, 2025. https://my.clevelandclinic.org/health/diseases/bowenoid-papulosis
Palefsky JM, Lee JY, Jay N, et al. Treatment of anal high-grade squamous intraepithelial lesions to prevent anal cancer. N Engl J Med. 2022;386(24):2273-2282. PMID 35704479. https://doi.org/10.1056/NEJMoa2201048
Trutnovsky G, Holter M, Gold D, et al. Aesthetic outcome and psychosexual distress after treatment for vulvar high-grade squamous intraepithelial lesions. J Low Genit Tract Dis. 2024;28(1):48-53. PMID 37934148. https://doi.org/10.1097/LGT.0000000000000785
Kravvas G, Ge L, Ng J, et al. The management of penile intraepithelial neoplasia (PeIN): clinical and histological features and treatment of 345 patients and a review of the literature. J Dermatolog Treat. 2022;33(2):1047-1062. PMID 32705920. https://doi.org/10.1080/09546634.2020.1800574
Medical disclaimer
This article is for general informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment decisions related to your specific situation.
Comments