Overview
Also known as condylomata accuminata, genital warts are a sexually transmitted infection (STI) resulting in anogenital fleshy growths due to human papillomavirus, particularly types 6 and 11. Transmission is often via direct skin-to-skin contact, however, other routes such as oro-genital transmission and autoinoculation are possible.
Human papillomaviruses infect keratinocytes in the skin by entering skin/mucosal abrasions. Upon entering, it may remain latent until lesions appear.
Epidemiology
- The lifetime risk of genital warts in sexually active people may be ~10%.
- The peak age of prevalence is 20–24 years
- In 2019, there were around 50,000 new diagnoses of genital warts in England
Risk Factors
Risk factors include:
- High-risk sexual activity
- Unprotected anal or vaginal sex
- Multiple sexual partners
- High-risk sexual practices (e.g. chemsex)
- Other sexually transmitted infections (STIs) including syphilis, Chlamydia, gonorrhoea, and herpes
- Sex work
- Immunocompromised states
Presentation
Genital warts present as lesions that:
- Are small (a few cm to mm)
- Are fleshy and protruding, and their colour can vary such as flesh-coloured, white, erythematous, or hyperpigmented
- Are in the genital, perineal, anal, and perianal areas. They may also occur in the urethral meatus, vagina and cervix, and anal canal.
- May bleed, be painful, or pruritic.
Diagnosis
The diagnosis of genital warts is usually clinical. A biopsy may be performed if the diagnosis is uncertain or the lesions are atypical (e.g. tethered to underlying skin, bleeding, ulcerated, or pigmented).
Management
Overview
1st-line: depends on location and type:
- Non-keratinised and multiple warts: topical podophyllum
- Keratinised and few/solitary warts: cryotherapy
2nd-line: topical imiquimod
Prognosis
- Anogenital warts are benign and often do not cause problems
- They can resolve spontaneously in up to 3/10 people within 6 months
