Summary
Definition
Genital warts are the most prevalent form of viral genital mucosal lesions and are caused by infection with several types of human papillomavirus (HPV).[1] The infection manifests as verrucous fleshy papules that may coalesce into plaques. Lesion size ranges from a few millimeters to several centimeters.[2] The warts may be located anywhere in the anogenital or genital area, including on mucosal surfaces.[3] The color can vary from whitish to flesh-colored to hyperpigmented to erythematous.[Figure caption and citation for the preceding image starts]: Wart on shaft of penisFrom Dr Tyring's personal collection; used with permission [Citation ends].
[Figure caption and citation for the preceding image starts]: Close-up of penile wartFrom Dr Tyring's personal collection; used with permission [Citation ends].
Lesions typically appear within weeks to months after exposure to HPV.[4] They are generally asymptomatic, but may be painful, friable, or pruritic.[5][6] This topic will cover diagnosis and treatment of internal and external warts, excluding cervical warts.
History and exam
Key diagnostic factors
- increased risk of exposure to HPV
- immunocompromise
- sessile exophytic papillomas
Other diagnostic factors
- asymptomatic
- pruritus
- bleeding
- pain
- urinary symptoms
Risk factors
- intercourse at an early age
- increasing number of lifetime sexual partners
- young sexually active adults
- increasing number of partner's lifetime sexual partners
- immunocompromise
Diagnostic investigations
1st investigations to order
- no initial test
Tests to avoid
- low-risk HPV testing
Investigations to consider
- biopsy
- anoscopy
- urethroscopy
Treatment algorithm
nonpregnant and immunocompetent
immunocompromised
pregnant
Contributors
Authors
Natalia Mendoza, MD
Pariser Dermatology Specialist
Williamsburg
VA
Disclosures
NM declares that she has no competing interests.
Stephen K. Tyring, MD, PhD, MBA
Clinical Professor
Departments of Dermatology, Microbiology and Molecular Genetics and Internal Medicine
University of Texas Health Science Center
Houston
TX
Disclosures
SKT declares that he has no competing interests.
Acknowledgements
Dr Natalia Mendoza and Dr Stephen K. Tyring would like to gratefully acknowledge Dr Brenda L. Pellicane, a previous contributor to this topic.
Disclosures
BLP declares that she has no competing interests.
Peer reviewers
Angela Moore, MD
Clinical Assistant Professor
University of Texas Medical Branch at Galveston
Galveston
TX
Disclosures
AM declares that she has no competing interests.
Steve Baguley, FRCP, MSc
Consultant Genitourinary Physician
Woolmanhill Hospital
Aberdeen
Scotland
UK
Disclosures
SB declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Forcier M, Musacchio N. An overview of human papillomavirus infection for the dermatologist: disease, diagnosis, management, and prevention. Dermatol Ther. 2010 Sep-Oct;23(5):458-76. Abstract
Ahmed AM, Madkan V, Tyring SK. Human papillomaviruses and genital disease. Dermatol Clin. 2006 Apr;24(2):157-65. Abstract
Meites E, Szilagyi PG, Chesson HW, et al. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):698-702.Full text Abstract
Beutner KR, Wiley DJ, Douglas JM, et al. Genital warts and their treatment. Clin Infect Dis. 1999 Jan;28 Suppl 1:S37-56. Abstract
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Condyloma latum
- Molluscum contagiosum
- Pearly penile papules
More DifferentialsGuidelines
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: human papillomavirus disease
- Recommended adult immunization schedule for adults ages 19 years or older: United States, 2023
More GuidelinesPatient information
Genital warts
HPV (human papillomavirus) vaccine
More Patient information
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