Genital Warts in Emergency Medicine Clinical Presentation
- Author: Delaram Ghadishah, MD; Chief Editor: William D James, MD more...
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.
Single or multiple papular eruptions may be seen. Eruptions can be pearly, filiform, fungating, cauliflower (shown in the image below), or plaquelike.
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.
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.
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.
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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