Genital warts are a sexually transmitted infection caused by certain
types of human papillomavirus (HPV). They are generally pink in
color and project out from the surface of the skin. Usually they
cause few symptoms, but can occasionally be painful. Typically they
appear one to eight months following exposure. Warts are the most
easily recognized symptom of genital
HPV types 6 and 11 are the typical cause of genital warts. It is
spread through direct skin-to-skin contact, usually during oral,
genital, or anal sex with an infected partner. Diagnosis is
generally based on symptoms and can be confirmed by biopsy. The
HPV that cause cancer are not the same as those that cause
HPV vaccines can prevent genital warts as may condoms.
Treatment options include creams such as podophyllin, imiquimod, and
Cryotherapy or surgery may also be an
option. After treatment warts often resolve within 6 months.
Without treatment, in up to a third of cases they resolve on their
About 1% of people in the
United States have genital warts. Many
people, however, are infected and do not have symptoms. Without
vaccination nearly all sexually active people will get some type of
HPV at one point in their lives. The disease has been known at
least since the time of
Hippocrates in 300 BC.
1 Signs and symptoms
2.2 Latency and recurrence
5.1 Physical ablation
5.2 Topical agents
9 External links
Signs and symptoms
Severe case of external genital warts on a female
Severe case of genital warts on a male
Small condylomata on scrotum
Genital warts may occur singly but are more often found in
clusters. They may be found anywhere in the anal or
genital area, and are frequently found on external surfaces of the
body, including the penile shaft, scrotum, or labia majora of the
vagina. They can also occur on internal surfaces like the opening to
the urethra, inside the vagina, on the cervix, or in the anus.
They can be as small as 1-5mm in diameter, but can also grow or spread
into large masses in the genital or anal area. In some cases they look
like small stalks. They may be hard ("keratinized") or soft. Their
color can be variable, and sometimes they may bleed.
In most cases, there are no symptoms of
HPV infection other than the
warts themselves. Sometimes warts may cause itching, redness, or
discomfort, especially when they occur around the anus. Although they
are usually without other physical symptoms, an outbreak of genital
warts may cause psychological distress, such as anxiety, in some
HPV is most commonly transmitted through penetrative sex. While HPV
can also be transmitted via non-penetrative sexual activity, it is
less transmissible than via penetrative sex. There is conflicting
evidence about the effect of condoms on transmission of low-risk HPV.
Some studies have suggested that they are effective at reducing
transmission. Other studies suggest that condoms are not effective
at preventing transmission of the low-risk
HPV variants that cause
genital warts. The effect of condoms on
HPV transmission may also be
gender-dependent; there is some evidence that condoms are more
effective at preventing infection of males than of females.
The types of
HPV that cause warts are highly transmissible. Roughly
three out of four unaffected partners of patients with warts develop
them within eight months. Other studies of partner concordance
suggest that the presence of visible warts may be an indicator of
HPV concordance rates are higher in couples
where one partner has visible warts.
Latency and recurrence
Although 90% of
HPV infections are cleared by the body within two
years of infection, it is possible for infected cells to undergo a
latency (quiet) period, with the first occurrence or a recurrence of
symptoms happening months or years later. Latent HPV, even with no
outward symptoms, is still transmissible to a sexual partner. If an
individual has unprotected sex with an infected partner, there is a
70% chance that he or she will also become infected.
In individuals with a history of previous
HPV infection, the
appearance of new warts may be either from a new exposure to HPV, or
from a recurrence of the previous infection. As many as one-third of
people with warts will experience a recurrence.
Anal or genital warts may be transmitted during birth. The presence of
wart-like lesions on the genitals of young children has been suggested
as an indicator of sexual abuse. However, genital warts can sometimes
result from autoinoculated by warts elsewhere on the body, such as
from the hands. It has also been reported from sharing of
swimsuits, underwear, or bath towels, and from non-sexual touching
during routine care such as diapering. Genital warts in children are
less likely to be caused by
HPV subtypes 6 and 11 than adults, and
more likely to be caused by
HPV types that cause warts elsewhere on
the body ("cutaneous types"). Surveys of pediatricians who are child
abuse specialists suggest that in children younger than 4 years old,
there is no consensus on whether the appearance of new anal or genital
warts, by itself, can be considered an indicator of sexual abuse.
Micrograph of a genital wart with the characteristic changes
(parakeratosis, koilocytes, papillomatosis). H&E stain.
The diagnosis of genital warts is most often made visually, but may
require confirmation by biopsy in some cases. Smaller warts may
occasionally be confused with molluscum contagiosum. Genital
warts, histopathologically, characteristically rise above the skin
surface due to enlargement of the dermal papillae, have parakeratosis
and the characteristic nuclear changes typical of
(nuclear enlargement with perinuclear clearing). DNA tests are
available for diagnosis of high-risk
HPV infections. Because genital
warts are caused by low-risk
HPV types, DNA tests cannot be used for
diagnosis of genital warts or other low-risk
Some practitioners use an acetic acid solution to identify smaller
warts ("subclinical lesions"), but this practice is controversial.
Because a diagnosis made with acetic acid will not meaningfully affect
the course of the disease, and cannot be verified by a more specific
test, a 2007 UK guideline advises against its use.
Gardasil (sold by Merck & Co.) is a vaccine that protects against
human papillomavirus types 6, 11, 16 and 18. Types 6 and 11 cause
genital warts, while 16 and 18 cause cervical cancer. The vaccine is
preventive, not therapeutic, and must be given before exposure to the
virus type to be effective, ideally before the beginning of sexual
activity. The vaccine is approved by the US Food and Drug
Administration for use in both males and females as early as 9 years
In the UK,
Cervarix in September 2012 for
reasons unrelated to safety.
Cervarix had been used routinely in
young females from its introduction in 2008, but was only effective
against the high-risk
HPV types 16 and 18, neither of which typically
There is no cure for HPV. Existing treatments are focused on the
removal of visible warts, but these may also regress on their own
without any therapy. There is no evidence to suggest that removing
visible warts reduces transmission of the underlying
HPV infection. As
many as 80% of people with
HPV will clear the infection within 18
A healthcare practitioner may offer one of several ways to treat
warts, depending on their number, sizes, locations, or other factors.
All treatments can potentially cause depigmentation, itching, pain, or
Treatments can be classified as either physically ablative, or topical
agents. Physically ablative therapies are considered more effective at
initial wart removal, but like all therapies have significant
Many therapies, including folk remedies, have been suggested for
treating genital warts, some of which have little evidence to suggest
they are effective or safe. Those listed here are ones mentioned
in national or international practice guidelines as having some basis
in evidence for their use.
Physically ablative methods are more likely to be effective on
keratinized warts. They are also most appropriate for patients with
fewer numbers of relatively smaller warts.
Simple excision, such as with scissors under local anesthesia, is
Liquid nitrogen cryosurgery is usually performed in an office visit,
at weekly intervals. It is effective, inexpensive, safe for pregnancy,
and does not usually cause scarring.
Electrocauterization (sometimes called "loop electrical excision
procedure" or LEEP) is procedure with a longer history of use, and is
Laser ablation has less evidence to suggest its use. It may be less
effective than other ablative methods. It is extremely expensive,
and often used as a last resort.
Formal surgical procedures, performed by a specialist under general
anesthesia, may be necessary for larger or more extensive warts,
intra-anal warts, or warts in children. It carries a greater risk
of scarring than other methods.
A 0.15–0.5% podophyllotoxin (also called podofilox) solution in a
gel or cream. It can be applied by the patient to the affected area
and is not washed off. It is the purified and standardized active
ingredient of the podophyllin (see below). Podofilox is safer and more
effective than podophyllin. Skin erosion and pain are
more commonly reported than with imiquimod and sinecatechins. Its
use is cycled (2 times per day for 3 days then 4–7 days off); one
review states that it should only be used for four cycles.
Imiquimod is a topical immune response cream, applied to the affected
area. It causes less local irritation than podofilox but may cause
fungal infections (11% in package insert) and flu-like symptoms (less
than 5% disclosed in package insert).
Sinecatechins is an ointment of catechins (55% epigallocatechin
gallate) extracted from green tea and other components. Mode of
action is undetermined. It appears to have higher clearance rates
than podophyllotoxin and imiquimod and causes less local irritation,
but clearance takes longer than with imiquimod.
Trichloroacetic acid (TCA) is less effective than cryosurgery, and
is not recommended for use in the vagina, cervix, or urinary
Interferon can be used; it is effective, but it is also expensive and
its effect is inconsistent.
A 5% 5-fluorouracil (5-FU) cream was used, but it is no longer
considered an acceptable treatment due to the side-effects.
Podophyllin, podofilox and isotretinoin should not be used during
pregnancy, as they could cause birth defects in the fetus.
HPV infections have an estimated prevalence in the US of
10–20% and clinical manifestations in 1% of the sexually active
adult population. US incidence of
HPV infection has increased
between 1975 and 2006. About 80% of those infected are between the
ages of 17–33. Although treatments can remove the warts, they do
not remove the HPV, so warts can recur after treatment (about 50–73%
of the time). Warts can also spontaneously regress (with or
Traditional theories postulated that the virus remained in the body
for a lifetime. However, studies using sensitive DNA techniques have
shown that through immunological response the virus can either be
cleared or suppressed to levels below what polymerase chain reaction
(PCR) tests can measure. One study testing genital skin for
HPV using PCR found a prevalence of 10%.
A condyloma acuminatum is a single genital wart, and condylomata
acuminata are multiple genital warts. The word roots mean "pointed
wart" (from Greek κόνδυλος, "knuckle", Greek -ωμα -oma,
"disease," and Latin acuminatum "pointed"). Although similarly named,
it is not the same as condyloma latum, which is a complication of
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V · T · D
eMedicine: derm/454 med/1037
Patient UK: Genital wart
Virus at Curlie (based on DMOZ)
Infectious skin disease: Viral cutaneous conditions, including viral
exanthema (B00–B09, 050–059)
Neonatal herpes simplex
Herpes B virus
B virus infection
Herpes zoster oticus
Disseminated herpes zoster
Modified varicella-like syndrome
Human herpesvirus 6/Roseolovirus
Cytomegalic inclusion disease
Farmyard pox: Milker's nodule
Bovine papular stomatitis
Yaba monkey tumor virus
Verrucae palmares et plantares
Papular purpuric gloves and socks syndrome
Merkel cell polyomavirus
Merkel cell carcinoma
Congenital rubella syndrome
Hand, foot and mouth disease
Boston exanthem disease
Asymmetric periflexural exanthem of childhood
Post-vaccination follicular eruption
Head and neck cancer
Head and neck cancer (HPV-positive oropharyngeal cancer)
Focal epithelial hyperplasia
Acrochordon (skin tags)
Cervical intraepithelial neoplasia
Cervical intraepithelial neoplasia (CIN)
Vaginal intraepithelial neoplasia (VAIN)
Vulvar intraepithelial neoplasia
Vulvar intraepithelial neoplasia (VIN)
Loop electrical excision procedure (LEEP)
Harald zur Hausen
Sexually transmitted infection
Sexually transmitted infection (STI) (primarily A50–A64, 090–099)
Chancroid (Haemophilus ducreyi)
Lymphogranuloma venereum (Chlamydia trachomatis)
Donovanosis or Granuloma Inguinale (Klebsiella granulomatis)
Gonorrhea (Neisseria gonorrhoeae)
Mycoplasma hominis infection
Mycoplasma hominis infection (Mycoplasma hominis)
Syphilis (Treponema pallidum)
Ureaplasma infection (Ureaplasma urealyticum)
Trichomoniasis (Trichomonas vaginalis)
Cervical cancer, vulvar cancer & Genital warts (condyloma), Penile
Anal cancer (
Human papillomavirus (HPV))
Hepatitis B (
Hepatitis B virus)
Herpes simplex (HSV1/HSV2)
Molluscum contagiosum (MCV)
Pelvic inflammatory disease
Pelvic inflammatory disease (PID)