Genital Warts Clinical Presentation

  • Author: Tsu-Yi Chuang, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 30, 2012
 

History

Genital warts generally do not become clinically apparent until several months after inoculation with human papillomavirus (HPV). Genital warts follow a slow and indolent course and may develop by inoculation from opposing surfaces.

Next

Physical

Anogenital warts consist of pink-to-brown papillomatous papules or nodules of the genitalia, perineum, crural folds, and anus, as shown in the image below.

Condyloma acuminatum. Condyloma acuminatum.

Warts vary in size and can form large, exophytic, cauliflowerlike masses. Discrete papules, 1-3 mm in size can present on the shaft of the penis. The growth can extend into the vagina, urethra, cervix, perirectal epithelium, anus, and rectum. Note the images below.

"Cauliflower" condyloma of the penis. "Cauliflower" condyloma of the penis. Small papilloma on the shaft of penis. Small papilloma on the shaft of penis. Small papilloma of the vulva. Small papilloma of the vulva. Small papilloma of the anus. Small papilloma of the anus.
Previous
Next

Causes

The definitive cause of anogenital warts is human papillomavirus (HPV) infection.[1, 2, 3, 10] HPV is part of the papovavirus class, which includes SV 40, BK, and JC virus. The HPV capsid lacks an envelope, which makes it very stable and resistant to various treatments. No serologic typing of HPV is available because of the lack of consistent in vitro culture methods. Typing of HPV is according to genotype, which usually is determined by molecular hybridization techniques using molecularly cloned HPV DNA of known type as the standard. Two HPV are said to be of different types when their DNA hybridize (bind) less than 50% as efficiently to each other as to themselves.

Nearly 40 types of HPV (of nearly 120 sequenced to date,[11] ) have been found in genital warts. They are very host specific. These viruses do not infect laboratory animals and are not susceptible to acyclovir. As a rule, HPV types causing common warts of the skin do not infect moist epithelium and vice versa. Multiple clinical associations with unique genotypes of HPV have been documented. HPV types and their association with the clinical disease are as follows:

  • Plantar warts - Types 1, 2, 4, 60, and 63
  • Common warts - Types 1, 2, 4, 26, 27, 29, 57, 65, and 75-78
  • Meat/poultry/fish handlers - Types 1-4, 7, 10, and 28
  • Flat warts - Types 3, 10, 27, 28, 38, and 49
  • Epidermodysplasia verruciformis - Types 2, 3, 5, 8, 9, 10, 12, 14, 15, 17, 19, 20, 21-25, 28, 36-38, 40, 47, and 50
  • Squamous cell carcinoma or actinic keratosis - Types 14, 16, 18, 36, and 41
  • Squamous cell carcinoma, keratoacanthoma type - Types 7, 9, 16, 29, and 37
  • Squamous cell carcinoma, in immunocompromised - Types 48 and 60
  • Bowen disease (nongenital) - Types 2, 16, 26-29, 31, 33, 34, 54, 56, 58, 61, 62, and 73
  • Melanoma - Types 16, 18, 35, and 38
  • Oral focal epithelial hyperplasia - Types 13 and 32
  • Oral papilloma - Types 11, 7, 32, 57, 72, and 73
  • Laryngeal papilloma (recurrent respiratory papillomatosis)[12] - Types 2, 6, 11, 16, 30, 40, and 57
  • Laryngeal carcinoma – Types 6, 11
  • Conjunctival papillomas and cancer - Types 6, 11, and 16
  • Epidermal cyst - Types 57, 60
  • Condyloma acuminatum -1-5, 6, 11, 10, 16, 18, 30, 31, 33, 35, 39-45, 51-59, 70, and 83
  • Giant condyloma of Buschke and Löwenstein and other verrucous carcinoma - Types 6, 11, 57, 72, and 73
  • Bowenoid papulosis - Types 16, 34, 39, 40, 42, and 45
  • Vulvar intraepithelial neoplasia - Types 56, 59-64, 67, and 71
  • Anal squamous cell carcinoma and intraepithelial neoplasia - Types 16, 18, 58, and 83
  • Cervical squamous intraepithelial lesions
    • Low-grade squamous intraepithelial lesions (LGSIL) - Types 6, 11, 16, 18, 26, 27, 30, 31, 33-35, 40, 42-45, 51-58, 61, 62, 67-69, 71-74, 79, and 81-84
    • High-grade squamous intraepithelial lesions (HGSIL) - Types 6, 11, 16, 18, 31, 33, 35, 39, 42, 44, 45, 51, 52, 56, 58, 59, 61, 64, 66, 68, and 82
  • Cervical cancer[13] - Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 70, 73, and 82
  • High-risk HPV types - Southeast Asia, type 18; West Africa, type 45; Central/South America, types 39 and 59
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Tsu-Yi Chuang, MD, MPH  Clinical Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Staff Dermatologist, Desert Oasis Healthcare

Tsu-Yi Chuang, MD, MPH is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and International Society of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Ryan Brashear, MD  Staff Physician, Department of Dermatology, Indiana University School of Medicine

Ryan Brashear, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Mark W Cobb, MD Consulting Staff, WNC Dermatological Associates

Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Society of Dermatopathology

Disclosure: Nothing to disclose.

References

  1. Chuang TY. Condylomata acuminata (genital warts). An epidemiologic view. J Am Acad Dermatol. Feb 1987;16(2 Pt 1):376-84. [Medline].

  2. Chuang TY, Perry HO, Kurland LT, Ilstrup DM. Condyloma acuminatum in Rochester, Minn, 1950-1978. II. Anaplasias and unfavorable outcomes. Arch Dermatol. Apr 1984;120(4):476-83. [Medline].

  3. Nebesio CL, Mirowski GW, Chuang TY. Human papillomavirus: clinical significance and malignant potential. Int J Dermatol. Jun 2001;40(6):373-9. [Medline].

  4. Rhea WG Jr, Bourgeois BM, Sewell DR. Condyloma acuminata: a fatal disease?. Am Surg. Nov 1998;64(11):1082-7. [Medline].

  5. Chuang TY, Perry HO, Kurland LT, Ilstrup DM. Condyloma acuminatum in Rochester, Minn., 1950-1978. I. Epidemiology and clinical features. Arch Dermatol. Apr 1984;120(4):469-75. [Medline].

  6. [Best Evidence] Kliewer EV, Demers AA, Elliott L, Lotocki R, Butler JR, Brisson M. Twenty-year trends in the incidence and prevalence of diagnosed anogenital warts in Canada. Sex Transm Dis. Jun 2009;36(6):380-6. [Medline].

  7. [Best Evidence] Hoy T, Singhal PK, Willey VJ, Insinga RP. Assessing incidence and economic burden of genital warts with data from a US commercially insured population. Curr Med Res Opin. 2009;25:2343-51. [Medline].

  8. de Sanjose S, Quint WG, Alemany L, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. Nov 2010;11(11):1048-56. [Medline].

  9. [Best Evidence] Sturgiss EA, Jin F, Martin SJ, Grulich A, Bowden FJ. Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic. Sex Health. 2010;7:55-9. [Medline].

  10. Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med. May 5 1997;102(5A):3-8. [Medline].

  11. Bernard HU, Burk RD, Chen Z, van Doorslaer K, Hausen H, de Villiers EM. Classification of papillomaviruses (PVs) based on 189 PV types and proposal of taxonomic amendments. Virology. May 25 2010;401(1):70-9. [Medline].

  12. Lee LA, Cheng AJ, Fang TJ, et al. High incidence of malignant transformation of laryngeal papilloma in Taiwan. Laryngoscope. Jan 2008;118(1):50-5. [Medline].

  13. Clifford GM, Smith JS, Plummer M, Muñoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer. Jan 13 2003;88(1):63-73. [Medline].

  14. de Villiers EM. Papillomavirus and HPV typing. Clin Dermatol. Mar-Apr 1997;15(2):199-206. [Medline].

  15. Beutner KR, Wiley DJ, Douglas JM, et al. Genital warts and their treatment. Clin Infect Dis. Jan 1999;28 Suppl 1:S37-56. [Medline].

  16. Garland SM, Waddell R, Mindel A, Denham IM, McCloskey JC. An open-label phase II pilot study investigating the optimal duration of imiquimod 5% cream for the treatment of external genital warts in women. Int J STD AIDS. Jul 2006;17(7):448-52. [Medline].

  17. Langley PC. A cost-effectiveness analysis of sinecatechins in the treatment of external genital warts. J Med Econ. Mar 2010;13(1):1-7. [Medline].

  18. Read TR, Hocking JS, Chen MY, Donovan B, Bradshaw CS, Fairley CK. The near disappearance of genital warts in young women 4 years after commencing a national human papillomavirus (HPV) vaccination programme. Sex Transm Infect. Dec 2011;87(7):544-7. [Medline].

  19. [Best Evidence] Brown DR, Kjaer SK, Sigurdsson K, et al. The impact of quadrivalent human papillomavirus (HPV; types 6, 11, 16, and 18) L1 virus-like particle vaccine on infection and disease due to oncogenic nonvaccine HPV types in generally HPV-naive women aged 16-26 years. J Infect Dis. Apr 1 2009;199(7):926-35. [Medline].

  20. Blomberg M, Friis S, Munk C, Bautz A, Kjaer SK. Genital warts and risk of cancer - a Danish study of nearly 50,000 patients with genital warts. J Infect Dis. Mar 15 2012;[Medline].

  21. Genital warts and sexual abuse in children. American Academy of Dermatology Task Force on Pediatric Dermatology. J Am Acad Dermatol. Sep 1984;11(3):529-30. [Medline].

  22. Beutner KR, Reitano MV, Richwald GA, Wiley DJ. External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts. Clin Infect Dis. Oct 1998;27(4):796-806. [Medline].

 
Previous
Next
 
Condyloma acuminatum.
Small papilloma of the vulva.
"Cauliflower" condyloma of the penis.
Small papilloma on the shaft of penis.
Small papilloma of the anus.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.