Genital Warts in Emergency Medicine Clinical Presentation

  • Author: Elizabeth Rubano, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 16, 2010
 

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 peniGenital 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.Genital wart in pubic area. Genital wart in pubic area.
    • 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. Genital warts. Small papilloma on the shaft of penGenital warts. Small papilloma on the shaft of penis. Courtesy of Tsu-Yi Chuang, MD, MPH. Genital warts. Small papilloma of the vulva. CourtGenital 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

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.

Coauthor(s)

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.

Specialty Editor Board

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, A Antoine Kazzi, MD, and Rasha A Hindiyeh, MD, to the development and writing of this article.

References

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

  2. [Guideline] Centers for Disease Control and Prevention, Workowski KA, Berman SM. HPV infection and genital warts. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep. Aug 4 2006;55(RR-11):62-7. [Full Text].

  3. [Guideline] Centers for Disease Control and Prevention. ACIP Provisional Recommendations for the Use of Quadrivalent HPV Vaccine. 2006. Accessed August 18, 2006. [Full Text].

  4. 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.

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

  6. [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. May 28 2010;59(20):626-9. [Medline]. [Full Text].

  7. [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. May 28 2010;59(20):630-2. [Medline]. [Full Text].

  8. American Academy of Dermatology. Genital Warts. 2006. Accessed June 6, 2006. 2006. [Full Text].

  9. [Guideline] Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines. 2002. Accessed June 6, 2006. [Full Text].

  10. Chan PD, Winkle PJ, Winkle CR. Condyloma acuminata. Current Clinical Strategies - Family Medicine. 2nd ed. 1995: 209-10.

  11. Congilosi SM, Madoff RD. Current therapy for recurrent and extensive anal warts. Dis Colon Rectum. Oct 1995;38(10):1101-7. [Medline].

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  13. Kresge KJ. Cervical cancer vaccines. Introduction of vaccines that prevent cervical cancer and genital warts may fore-shadow implementation and acceptability issues for a future AIDS vaccines. IAVI Rep. Nov-Dec 2005;9(5):1-5. [Medline].

  14. Mayeaux EJ, Harper MB, Barksdale W, Pope JB. Noncervical human papillomavirus genital infections. Am Fam Physician. Sep 15 1995;52(4):1137-46, 1149-50. [Medline].

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  16. Rosen T. Sexually transmitted diseases 2006: a dermatologist's view. Cleve Clin J Med. Jun 2006;73(6):537-8, 542, 544-5 passim. [Medline].

  17. Sykes NL Jr. Condyloma acuminatum. Int J Dermatol. May 1995;34(5):297-302. [Medline].

  18. Vandepapeliere P, Barrasso R, Meijer CJ, et al. Randomized controlled trial of an adjuvanted human papillomavirus (HPV) type 6 L2E7 vaccine: infection of external anogenital warts with multiple HPV types and failure of therapeutic vaccination. J Infect Dis. Dec 15 2005;192(12):2099-107. [Medline].

 
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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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