Condylomata acuminata

Genital warts are caused by different strains of human papilloma virus - especially HPV types 6 and 11, which cause over 90% of the genital warts (1).

Genital wart is the most common viral sexually transmitted infection in the UK (1). The incidence of genital warts is increasing at present and the condition is more common than genital herpes simplex infection, but less common than gonorrhoea. Highest rates of diagnosis are seen in young women and men under 24 years (1).

The mean incubation period is about 3 months. However, it is quite variable and may range from 3 weeks to 8 months (1).

The majority of patients with genital HPV have no symptoms or physical findings (2)

• however, occasionally, pain, irritation, pruritus, dysuria, or bleeding may occur. Large internal warts may cause obstructive symptoms such as painful intercourse (vaginal or anal), urinary retention, or rectal pain
• genital warts are the most common visible manifestation of HPV infection and affect approximately 1% of the population with 90% of genital warts caused by HPV types 6 and 11
• warts may be seen on the vulva, vagina, cervix, penis (glans, meatus, shaft), and scrotum. Both women and men can have involvement of the perineum as well as the anal and oral cavities
  • in women, the vulva is the most common area affected, but up to 50% of patients have warts in multiple sites and up to 25% of patients have perianal lesions
• warts vary in presentation
  • classic genital warts (condyloma acuminata) appear as verrucous or cauliflower-like papules, whereas thick, horny keratotic warts and flat warts may also occur
• diagnosis of genital warts is made by careful inspection of the genitalia
  • use of a magnifying glass or colposcope may aid in diagnosis
  • application of acetic acid or vinegar produces acetowhite changes of the surfaces of genital warts, but these findings may be seen in non-HPV-related cases of inflammation or microtrauma
  • biopsy is indicated when genital lesions are atypical in appearance; pigmented, indurated, or fixed; resistant to standard treatments; or occurs in patients who are older (>40 years of age) or immunocompromised. HPV-infected warts show epithelial hyperplasia and koilocytes (epithelial cells with koilocytosis are enlarged cells with perinuclear halos and small hyperchromatic nuclei)

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Reference:

• (1) DOH (UK). The 'Green Book' chapter on Human papillomavirus (HPV) 2008 (accessed 25/06/09)
• (2) Forcier M, Musacchio N.An overview of human papillomavirus infection for the dermatologist: disease, diagnosis, management, and prevention. Dermatol Ther. 2010 Sep-Oct;23(5):458-76.