Genital Warts Workup

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

Laboratory Studies

Diagnosis usually is made clinically; it may be helped by the application of acetic acid and biopsy.

Identification of precise HPV genotypes is available only in research laboratories by using DNA hybridization techniques.[14] This technique includes Southern blot (highly sensitive and also most time consuming), dot blot, and in situ hybridization. Others methods include enzyme-linked immunosorbent assay (ELISA) for immunoglobulin G (IgG) antibody (Ab) against HPV 16 capsid.

Certain screening tests are available with a relatively high sensitivity and specificity; they include ViraPap, ThinPrep Pap, and Hybrid capture II.

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Other Tests

The acetic acid test can be helpful in the diagnosis of genital warts, and the process is as follows:

  • Soaking acetic acid into suspicious lesions can enhance the degree of suspicion in lesions without classic features.
  • The method involves applying a 3-5% acetic acid–moistened gauze pad for 5-10 minutes on suspected lesions of the penis, cervix, labia, or perianal area.
  • Inconspicuous, flat, genital lesions that might be difficult to assess become visible. Dysplastic and neoplastic tissues turn white (acetowhite).
  • False-positive results are common and can result from anything that causes parakeratosis (eg, candidiasis, psoriasis, lichen planus, healing epithelium, sebaceous glands).
  • This technique can be combined with the use of colposcopy to examine cervical lesions.
  • The acetic acid test is reserved only for suspicious lesions and should not be used for routine screening.
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Histologic Findings

Histopathology can elucidate diagnosis in most cases.

  • Verrucae consist of acanthotic epidermis with papillomatosis, hyperkeratosis, and parakeratosis.
  • Elongated rete ridges may point to the center of the wart and dermal capillary vessels may be thrombosed.
  • Koilocytes are indicative of HPV infection. These are large keratinocytes with an eccentric, pyknotic, or large steel-gray nucleus surrounded by a perinuclear halo.
  • Anogenital warts lack a granular layer and tend to be more papillomatous and vascular than common warts.
  • An electron microscope may show viral particles in nuclei.
  • Immunohistochemical staining with the peroxidase-antiperoxidase technique stains cells infected by viral particles.
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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].

 
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Condyloma acuminatum.
Small papilloma of the vulva.
"Cauliflower" condyloma of the penis.
Small papilloma on the shaft of penis.
Small papilloma of the anus.
 
 
 
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