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Genital Warts in Emergency Medicine Clinical Presentation

  • Author: Delaram Ghadishah, MD; Chief Editor: William D James, MD  more...
 
Updated: Apr 26, 2016
 

History

Painless bumps, pruritus, and discharge are the chief complaints encountered with genital warts. Generally, two thirds of individuals who have sexual contact with a partner who has genital warts develop lesions within 3 months. A history involving multiple lesions, rather than a single isolated wart, is more common. Involvement of more than 1 area is more common.

History may indicate previous or other current sexually transmitted diseases (STDs). Oral, laryngeal, or tracheal mucosal lesions (uncommon) presumably transfer through oral-genital contact. History of anal intercourse warrants a thorough search for perianal lesions.

Urethral bleeding or urinary obstruction (uncommon) may be the presenting complaint when the wart involves the meatus.

Vaginal bleeding during pregnancy may be due to condyloma eruptions. Coital bleeding also may occur.

Latent illness may become active, particularly with pregnancy and immunosuppression.

Lesions may regress spontaneously, remain static, or progress.

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Physical

Single or multiple papular eruptions may be seen. Eruptions can be pearly, filiform, fungating, cauliflower (shown in the image below), or plaquelike.

Genital warts. "Cauliflower" condyloma of the peni Genital warts. "Cauliflower" condyloma of the penis. Courtesy of Tsu-Yi Chuang, MD, MPH.

Lesions can be quite smooth (particularly on the penile shaft), verrucous, or lobulated. Some appear harmless, as in the image below; others have a more disturbing appearance. Multiple sites often are involved simultaneously.

Genital wart in pubic area. Genital wart in pubic area.

Color may vary from that of the skin to erythema or hyperpigmentation.

Check for irregularities in shape, form, or color that may suggest melanoma or malignancy.

Seek perianal lesions, particularly in patients with a history or risk of immunosuppression or anal intercourse.

Search for evidence of other STDs (eg, ulcerations, adenopathy, vesicles, discharge).

Genital warts have a propensity for the penile glans and shaft in men and for the vulvovaginal and cervical areas in women, as shown in the images below.

Genital warts. Small papilloma on the shaft of pen Genital warts. Small papilloma on the shaft of penis. Courtesy of Tsu-Yi Chuang, MD, MPH.
Genital warts. Small papilloma of the vulva. Court Genital warts. Small papilloma of the vulva. Courtesy of Tsu-Yi Chuang, MD, MPH.

Urethral meatus and mucosal lesions can occur.

Some lesions are subclinical, and some are hidden by hair or in the inner aspect of uncircumcised foreskin.

Although earlier reports have suggested otherwise, the presence of external genital warts warrants a thorough search for cervical and urethral lesions. Such internal lesions have been found in more than half of females with external lesions. Infected males have a 20% chance or more (in one report) of having subclinical urethral lesions. More than 50% of female patients with external lesions have negative Papanicolaou test (Pap smear) results but positive HPV infection results using in situ hybridization.

Pruritus may be a complaint. Discharge may be evident.

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Causes

Genital warts are caused by several of the epidermotropic human papillomaviruses (HPVs). HPV-6 and HPV-11 most commonly are isolated; however, many of the more than 60 types of HPV may cause condyloma. Male sex partners of women with cervical intraepithelial neoplasia often have infections of the same viral type.

Smoking, oral contraceptives, multiple sex partners, and early coital age are risk factors for acquiring genital warts.

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Contributor Information and Disclosures
Author

Delaram Ghadishah, MD Physician, Emergency Department, Kaiser Permanente West Los Angeles Medical Center

Delaram Ghadishah, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey Glenn Bowman, MD, MS Consulting Staff, Highfield MRI

Disclosure: Nothing to disclose.

Acknowledgements

Mark W Fourre, MD Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine; Program Director, Department of Emergency Medicine, Maine Medical Center

Disclosure: Nothing to disclose.

Rasha A Hindiyeh, MD, MBA Physician, Department of Internal Medicine, University of California Irvine School of Medicine

Disclosure: Nothing to disclose.

A Antoine Kazzi, MD Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Elizabeth Rubano, MD Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center

Elizabeth Rubano, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Binita R Shah, MD, FAAP Professor of Clinical Pediatrics and Emergency Medicine, SUNY Health Sciences Center at Brooklyn; Director of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Kings County Hospital Center

Binita R Shah, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

References
  1. [Guideline] American College of Obstetricians and Gynecologists (ACOG). Human papillomavirus. Washington (DC): American College of Obstetricians and Gynecologists (ACOG). 2005 Apr. ACOG practice bulletin; no. 61. [Full Text].

  2. [Guideline] Centers for Disease Control and Prevention, Workowski KA, Berman SM. Genital Warts. Sexually Transmitted Diseases Treatment Guidelines 2010. Available at http://www.cdc.gov/std/treatment/2010/genital-warts.htm. Accessed: November 4, 2014.

  3. [Guideline] American College of Obstetricians and Gynecologists. Human Papillomavirus Vaccination. Available at http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Human-Papillomavirus-Vaccination. Accessed: November 4, 2014.

  4. [Guideline] FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010 May 28. 59(20):626-9. [Medline]. [Full Text].

  5. [Guideline] FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010 May 28. 59(20):630-2. [Medline]. [Full Text].

  6. Mandic A. Primary prevention of cervical cancer: prophylactic human papillomavirus vaccines. J BUON. 2012 Jul-Sep. 17(3):422-7. [Medline].

  7. [Guideline] Centers for Disease Control and Prevention. HPV Vaccines. Available at http://www.cdc.gov/hpv/vaccine.html. Accessed: November 4, 2014.

  8. Food and Drug Administration. FDA Approves New Vaccine for Prevention of Cervical Cancer. Oct 16, 2009. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm187048.htm. Accessed: January 5, 2010.

  9. Diamantis ML, Bartlett BL, Tyring SK. Safety, efficacy & recurrence rates of imiquimod cream 5% for treatment of anogenital warts. Skin Therapy Lett. 2009 Jun. 14(5):1-3, 5. [Medline].

  10. American Academy of Dermatology. Genital Warts. Available at https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/genital-warts. Accessed: April 26, 2016.

 
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Genital wart in pubic area.
Genital wart in pubic area.
Genital wart in pubic area.
Genital wart in pubic area (close-up). Note the pearly appearance.
Genital warts. Condyloma acuminatum. Courtesy of Tsu-Yi Chuang, MD, MPH.
Genital warts. Small papilloma of the vulva. Courtesy of Tsu-Yi Chuang, MD, MPH.
Genital warts. "Cauliflower" condyloma of the penis. Courtesy of Tsu-Yi Chuang, MD, MPH.
Genital warts. Small papilloma on the shaft of penis. Courtesy of Tsu-Yi Chuang, MD, MPH.
Genital warts. Small papilloma of the anus. Courtesy of Tsu-Yi Chuang, MD, MPH.
 
 
 
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