Genital wart in Adult
See also in: AnogenitalAlerts and Notices
Synopsis
Transmission of HPV infection can occur through either direct contact, autoinoculation, or fomite transfer. The average incubation period for warts ranges from 2-3 months but can extend to 1 year. Most lesions are symptomless; however, associated symptoms can include itching, bleeding, and dyspareunia.
The highest risk population for HPV infection is sexually active women younger than 26 years. However, HPV infection can affect patients of any sex and a wide span of ages from infants to the elderly.
During pregnancy, condyloma acuminata can demonstrate rapid growth. The presence of condyloma acuminata has been associated with higher cesarean delivery rates. There is a small risk of transmission to the infant, with studies estimating the risk of maternal-child transmission with development of disease in the child to be 1 in 1500.
In immunosuppressed patients, warts proliferate due to suppressed cellular immunity and carry a risk of carcinogenesis. An increased prevalence of anogenital warts is noted in this population. Recurrences are common and response to treatment is impaired.
Related topic: oral mucosal wart
Codes
ICD10CM:A63.0 – Anogenital (venereal) warts
SNOMEDCT:
240542006 – Condyloma acuminatum
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
There are many verrucous-looking lesions of the genitals:- Pearly penile papules – Appear in parallel rows on the corona glandis or frenulum of the penis.
- Acrochordons
- Lichen planus
- Lichen nitidus
- Molluscum contagiosum – Shiny papules 2-5 mm in diameter with central umbilication.
- Seborrheic keratoses
- Melanocytic nevi
- Fordyce spots – Sebaceous glands.
- Psoriasis
- Nodules of scabies
- Epidermal nevus
- Condyloma lata (secondary syphilis) – Lesions tend to be flatter and smoother than condyloma acuminata.
- Vestibular papillae (also known as vulvar papillomatosis, a normal variant of female external genitalia) – Softer than condyloma, and symmetrically or linearly distributed compared to irregular distribution of condyloma; base of individual lesions remains separate compared to coalescing of superficial projections seen in condyloma.
- Herpes simplex virus (HSV) – Particularly in immunocompromised individuals.
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Management Pearls
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Therapy
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References
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Last Reviewed:09/23/2021
Last Updated:09/23/2021
Last Updated:09/23/2021
Patient Information for Genital wart in Adult
Overview
Genital warts (condyloma acuminata) are caused by the human papillomavirus (HPV), which has over 100 different strains. Subtypes number 6 and 11 cause 90% of genital warts and are considered low risk because they very rarely will cause genital or anal cancer. On the other hand, subtypes 16 and 18, for example, are considered high risk because, although they rarely cause genital warts, they can lead to cervical or anal precancer and cancer.HPV is spread by skin-to-skin contact during sexual activity; there does not need to be vaginal or anal intercourse to spread the infection. Most people who become infected with HPV will not have symptoms and will clear the infection on their own. For people who do develop genital warts, there are many options for treatment, all of which are meant to remove the visible warts. There is no cure for genital warts.
Who’s At Risk
Genital warts are the most common sexually transmitted disease and affect millions of people throughout the world. It is estimated that 75-80% of sexually active men and women will be infected with HPV at some point in their lives. Approximately 15% of the United States population is infected with HPV. HPV infection occurs in people of all ages and both sexes. Your risk of acquiring the virus is higher if you have had many sexual partners and if you first had sexual intercourse at a young age. Over 50% of girls will get HPV within 2 years of becoming sexually active.HPV is spread through skin-to-skin contact and does not require actual intercourse to be passed from one person to another. A person can be infected without any visible signs of infection and, therefore, can pass the infection on without knowing it. Condoms can decrease the risk of spreading the virus, but they do not completely prevent transmission.
Signs & Symptoms
Genital warts appear as skin-colored, round bumps of varying sizes. They can be smooth and flat or cauliflower-like with a small stalk. They can be seen on the labia, vagina, penis, scrotum, anus, skin around the anus, and urethra. Warts usually do not cause any symptoms, although the warts can bleed and become painful with intercourse if they are located within the vagina.Self-Care Guidelines
You can decrease your risk of getting genital warts by using condoms, having few sexual partners, or by abstaining from sexual activity. Unfortunately, condoms do not completely protect against HPV, and an infected person can spread the virus even if he/she does not have any visible warts.When to Seek Medical Care
Many people with a healthy immune system who get genital warts will clear the virus on their own without treatment. However, this does not occur immediately. If you have visible warts, see your doctor for treatment to remove the warts and to reduce the chance of passing the virus to other partners. Also, if your partner has been diagnosed with genital warts, you should be checked for infection.For women, it is important to have a Pap smear and general gynecologic examination, usually every year, to look for any signs of abnormal cervical cells, which can be the first sign of cervical cancer.
Treatments
There is no cure for genital warts. The goal of treatment is to remove visible warts and decrease the risk of spreading the virus. There are many different treatments that your doctor may recommend, none of which are 100% effective. Most treatment types will get rid of the warts in 60–90% of cases, however.Some treatments are applied by the patient. These include the following:
- Imiquimod 3.75% cream (Zyclara) – Imiquimod works by boosting your immune system to kill the virus. Apply once daily for up to 8 weeks. This medication may weaken condoms, and you should avoid sexual activity while the cream is on your skin. Do not use imiquimod during pregnancy.
- Imiquimod 5% cream (Aldara) – Apply once daily (at bedtime) 3 times a week for up to 16 weeks.
- Podofilox 0.5% gel or solution (Condylox) – This should not be used during pregnancy.
- Podophyllin resin, 15–25% solution – This should not be used during pregnancy.
- Trichloroacetic acid
- Cryotherapy – Liquid nitrogen is used to freeze the warts.
- Surgical removal – This may need to be performed by a specialist with local anesthesia; usually for large amounts of warts.
- Laser treatment – Carbon dioxide laser treatment is useful for a large amount of urethral or vaginal warts.
The HPV vaccine protects against cancers caused by HPV. A 2-dose schedule is recommended for boys and girls who start the vaccine between the ages of 9 and 14, while a 3-dose schedule is recommended for those who initiate the vaccine series between the ages of 15 and 45 and for patients with HIV infection or other immunocompromising conditions regardless of age. If you are over the age of 26, discuss the possibility of vaccination with your doctor.
References
Bolognia, Jean L., ed. Dermatology, pp.1224-1228, 1698-1699. New York: Mosby, 2003.
Cutts FT, Franceschi S, Goldie S, et al. Human papillomavirus and HPV vaccines: a review. Bull World Health Organ. 2007 Sep;85(9):719-26.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1086, 2121, 2440, 2460. New York: McGraw-Hill, 2003.
Kodner CM, Nasraty S. Management of genital warts. Am Fam Physician. 2004 Dec 15:70(12):2335-42.
Ogunmodede F, Yale SH, Krawisz B, Tyler GC, Evans AC. Clin Med Res. 2007 Dec;5(4):210-7.
Rosen T. Sexually transmitted diseases 2006: a dermatologist's view. Cleve Clin J Med. 2006 Jun;73(6):537-8, 542, 544-5.
Widdice LE, Kahn JA. Usine the new HPV vaccines in clinical practice. Cleve Clin J Med. 2006 Oct;73(10):929-35.
Genital wart in Adult
See also in: Anogenital