Overview
- Also known as Condylomata acuminata
- Benign proliferative growths occurring in:
- Genital areas
- Perineal areas
- Anal and perianal areas
- Urethral meatus
- Vagina and cervix
- Anal canal
- Most common viral sexually transmitted infection
- Usually caused by low-risk HPV genotypes 6 and 11
Transmission
Causative Agent
- Human papillomavirus (HPV)
- Most commonly genotypes 6 and 11
- Low-risk non-oncogenic types
- Different from high-risk cancer-causing types
Transmission Routes
- Direct skin-to-skin contact
- Contact with clinical or subclinical HPV
- Contact with genital secretions
- Sexual contact (most common)
- Perinatal transmission (rare)
- From hand warts (rare)
- Orogenital transmission
- Contact with contaminated surfaces
Diagnosis
Clinical Presentation
Symptoms
- Usually asymptomatic
- Single or multiple lesions
- Occur in areas of high friction
- Pain if lesions become friable
- Pain from local trauma irritation
- Bleeding due to local trauma
Urinary Symptoms
- Terminal haematuria
- Abnormal urine stream
- Indicates lesions in distal urethra/meatus
Examination Findings
Typical Appearance
- Soft cauliflower-like growths (most common)
- Varying sizes
- Less commonly: flat, plaque-like, or pigmented
- Color variations: whitish, flesh-colored, hyperpigmented, erythematous
- Usually < 10 mm diameter
- May coalesce into large plaques
Special Considerations
- Larger plaques common in immunosuppressed individuals
- More extensive in people with diabetes
- Rarely: large warts with secondary infection and maceration
- Immunosuppression may lead to more rapid growth
Differential Diagnosis
Normal Variants
- Pearly penile papules
- Normal anatomical structures
- Not sexually transmitted
- Require no treatment
Infectious Conditions
- Molluscum contagiosum
- Condylomata lata (secondary syphilis)
- Other viral infections
Neoplastic & Other
- Carcinoma in situ
- Skin tags
- Seborrhoeic keratoses
- Epidermoid cysts
- Sebaceous cysts
Diagnostic Tips
- Clinical diagnosis usually sufficient
- Biopsy if diagnosis uncertain
- Consider biopsy if:
- Atypical appearance
- Pigmented lesions
- Immunosuppressed patient
- Treatment failure
- Suspected malignancy
Management
Referral Recommendation
If possible, refer all people with anogenital warts to a sexual health specialist for comprehensive management.
Essential Screening
STI Screening
- Screen for co-existing sexually transmitted infections
- Essential in people younger than 25 years
- Required for those with other genital symptoms
- Consider HIV testing in appropriate cases
Treatment Options
No Treatment
- Reasonable option for many patients
- 30% resolve spontaneously within 6 months
- Consider if minimal symptoms
- Patient preference important
Self-Applied Treatments
- Podophyllotoxin
- Imiquimod
- Sinecatechins
- Patient-applied at home
- Good for motivated patients
Specialist Application
- Trichloroacetic acid (TCA) 80-90%
- Clinic-based treatment
- Requires trained healthcare professional
- Precise application needed
Ablative Methods
- Cryotherapy
- Surgical excision
- Electrocautery
- Immediate results
- Requires local anesthesia for some methods
Treatment Selection Factors
| Factor | Consideration |
|---|---|
| Wart characteristics | Size, number, location, morphology |
| Patient factors | Immunocompetence, pregnancy, preferences |
| Treatment availability | Access to specialist services |
| Cost considerations | Treatment expenses and insurance coverage |
| Provider experience | Familiarity with treatment modalities |
Complications
Oncogenic Risk
- Possible co-infection with high-risk HPV types
- High-risk types associated with anogenital cancer
- Regular screening recommended
- HPV vaccination for prevention
Psychological Impact
- Disfigurement concerns
- Anxiety and distress
- Impact on sexual relationships
- Body image issues
Treatment Complications
- Persistent hypo- or hyper-pigmentation from ablative therapy
- Hypertrophic scarring
- Bleeding from surgical removal
- Infection at treatment site
- Scarring from various treatments
Recurrence & Follow-up
Recurrence Rates
- High recurrence rates common (20-30%)
- Due to persistent subclinical infection
- New infections also possible
- Regular follow-up recommended
- Patient education about recurrence risk
Prevention & Patient Education
Transmission Prevention
- Condom use reduces but doesn't eliminate risk
- Avoid sexual contact during visible warts
- Partner notification important
- Regular STI screening for partners
HPV Vaccination
- Protects against HPV types 6 and 11
- Recommended for adolescents
- May be beneficial in some adults
- Does not treat existing infection
Patient Support
- Address psychological concerns
- Provide accurate information
- Manage expectations about treatment
- Support groups and counseling
Key Counseling Points
- Genital warts are common and treatable
- Not usually associated with cancer
- Spontaneous resolution possible
- Recurrence doesn't mean treatment failure
- Regular follow-up important
- Partner examination recommended