Genital warts

Genital warts are a very common STI.

Caused by human papillomavirus (HPV) infection, most commonly HPV types 6 and 11.

Peak incidence of genital HPV infection occurs in 16- to 25-year-olds.

Diagnosis is made based on clinical presentation.

Generally has a benign course and is not often associated with oncogenic potential.

Treatment can be challenging, as there is no cure and recurrences are common.

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]Mansur CP. Human papillomaviruses. In: Tyring SK, ed. Mucocutaneous manifestations of viral diseases. New York, NY: Marcel Dekker; 2002:247-94. The infection manifests as verrucous fleshy papules that may coalesce into plaques. Lesion size ranges from a few millimetres to several centimetres.[2]Wikström A. Clinical and serological manifestations of genital human papillomavirus infection. Acta Derm Venereol Suppl (Stockh). 1995;193:1-85. http://www.ncbi.nlm.nih.gov/pubmed/8721519?tool=bestpractice.com The warts may be located anywhere in the anogenital or genital area, including on mucosal surfaces.[3]Wiley DJ, Douglas J, Beutner K, et al. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis. 2002 Oct 15;35(Suppl 2):S210-24. https://academic.oup.com/cid/article/35/Supplement_2/S210/316436 http://www.ncbi.nlm.nih.gov/pubmed/12353208?tool=bestpractice.com The colour can vary from whitish to flesh-coloured 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]Czelusta AJ, Evans T, Arany I, et al. A guide to immunotherapy of genital warts: focus on interferon and imiquimod. BioDrugs. 1999 May;11(5):319-32. http://www.ncbi.nlm.nih.gov/pubmed/18031142?tool=bestpractice.com They are generally asymptomatic, but may be painful, friable, or pruritic.[5]Kirnbauer R, Lenz P, Okun MM. Human papillomavirus. In: Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology Vol 1. London: Mosby; 2003:1217-33.[6]Beutner KR, Reitano MV, Richwald GA, et al. External genital warts: report of the American Medical Association consensus conference. Clin Infect Dis. 1998 Oct;27(4):796-806. http://www.ncbi.nlm.nih.gov/pubmed/9798036?tool=bestpractice.com This topic will cover diagnosis and treatment of internal and external warts, excluding cervical warts.