Highlights & Basics
- Genital warts are a very common STI.
- Caused by human papillomavirus (HPV) infection, most commonly HPV types 6 and 11.
- Peak incidence of genital HPV infection occurs in 16- to 25-year-olds.
- Diagnosis is made based on clinical presentation.
- Generally has a benign course and is not often associated with oncogenic potential.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Wart on shaft of penis
Close-up of penile wart
Venereal warts in the anal region of the perineum
Wart on shaft of penis
Condylomata lata: this photograph depicts the appearance of what was determined to be secondary syphilitic lesions, also known as "condylomata lata," on a patient's perineum
Extensive molluscum lesions on the flank of a young child; lesions are flesh- to pearly-colored with central dells
Clinical close-up image of seborrheic keratosis on the back of a 40-year-old man
Citations
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.[Abstract]
Ahmed AM, Madkan V, Tyring SK. Human papillomaviruses and genital disease. Dermatol Clin. 2006 Apr;24(2):157-65.[Abstract]
Meites E, Szilagyi PG, Chesson HW, et al. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):698-702.[Abstract][Full Text]
Beutner KR, Wiley DJ, Douglas JM, et al. Genital warts and their treatment. Clin Infect Dis. 1999 Jan;28 Suppl 1:S37-56.[Abstract]
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.[Abstract][Full Text]
1. Mansur CP. Human papillomaviruses. In: Tyring SK, ed. Mucocutaneous manifestations of viral diseases. New York, NY: Marcel Dekker; 2002:247-94.
2. Wikström A. Clinical and serological manifestations of genital human papillomavirus infection. Acta Derm Venereol Suppl (Stockh). 1995;193:1-85.[Abstract]
3. Wiley DJ, Douglas J, Beutner K, et al. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis. 2002 Oct 15;35(Suppl 2):S210-24.[Abstract][Full Text]
4. Czelusta AJ, Evans T, Arany I, et al. A guide to immunotherapy of genital warts: focus on interferon and imiquimod. BioDrugs. 1999 May;11(5):319-32.[Abstract]
5. Kirnbauer R, Lenz P, Okun MM. Human papillomavirus. In: Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology Vol 1. London: Mosby; 2003:1217-33.
6. Beutner KR, Reitano MV, Richwald GA, et al. External genital warts: report of the American Medical Association consensus conference. Clin Infect Dis. 1998 Oct;27(4):796-806.[Abstract]
7. Brown TJ, Yen-Moore A, Tyring SK. An overview of sexually transmitted diseases. Part II. Am Acad Dermatol. 1999 Nov;41(5 Pt 1):661-77.[Abstract]
8. McQuillan G, Kruszon-Moran D, Markowitz LE, et al. Prevalence of HPV in Adults Aged 18-69: United States, 2011-2014. NCHS Data Brief. 2017 Apr;(280):1-8.[Abstract][Full Text]
9. Centers for Disease Control and Prevention. Sexually transmitted infections prevalence, incidence, and cost estimates in the United States. January 2021 [internet publication].[Full Text]
10. Perez G, Lazcano-Ponce E, Hernandez-Avila M, et al. Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) L1 virus-like-particle vaccine in Latin American women. Int J Cancer. 2008 Mar 15;122(6):1311-8.[Abstract]
11. Public Health England. Sexually transmitted infections and screening for chlamydia in England, 2020. September 2021 [internet publication].[Full Text]
12. Severson J, Evans TY, Lee P, et al. Human papillomavirus infections: epidemiology, pathogenesis, and therapy. J Cutan Med Surg. 2001 Jan-Feb;5(1):43-60.[Abstract]
13. 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.[Abstract]
14. Bernard HU, Burk RD, Chen Z, et al. Classification of papillomaviruses (PVs) based on 189 PV types and proposal of taxonomic amendments. Virology. 2010 May 25;401(1):70-9.[Abstract][Full Text]
15. Doorbar J, Quint W, Banks L, et al. The biology and life-cycle of human papillomaviruses. Vaccine. 2012 Nov 20;30 Suppl 5:F55-70.[Abstract][Full Text]
16. Cuschieri KS, Cubie HA, Whitley MW, et al. Multiple high risk HPV infections are common in cervical neoplasia and young women in a cervical screening population. J Clin Pathol. 2004 Jan;57(1):68-72.[Abstract][Full Text]
17. Ahmed AM, Madkan V, Tyring SK. Human papillomaviruses and genital disease. Dermatol Clin. 2006 Apr;24(2):157-65.[Abstract]
18. Meyer T, Arndt R, Christophers E, et al. Association of rare human papillomavirus types with genital premalignant and malignant lesions. J Infect Dis. 1998 Jul;178(1):252-5.[Abstract]
19. Handsfield HH. Clinical presentation and natural course of anogenital warts. Am J Med. 1997 May 5;102(5A):16-20.[Abstract]
20. Nebesio CL, Mirowski GW, Chuang TY. Human papillomavirus: clinical significance and malignant potential. Int J Dermatol. 2001 Jun;40(6):373-9.[Abstract]
21. Tarkowski TA, Koumans EH, Sawyer M, et al. Epidemiology of human papillomavirus infection and abnormal cytologic test results in an urban adolescent population. J Infect Dis. 2004 Jan 1;189(1):46-50.[Abstract][Full Text]
22. Vetrano G, Lombardi G, Di Leone G, et al. Cervical intraepithelial neoplasia: risk factors for persistence and recurrence in adolescents. Eur J Gynaecol Oncol. 2007;28(3):189-92.[Abstract]
23. Wang SS, Schiffman M, Shields TS, et al. Seroprevalence of human papillomavirus-16, -18, -31, and -45 in a population-based cohort of 10000 women in Costa Rica. Br J Cancer. 2003 Oct 6;89(7):1248-54.[Abstract]
24. Munk C, Svare EI, Poll P, et al. History of genital warts in 10,838 women 20 to 29 years of age from the general population: risk factors and association with Papanicolaou smear history. Sex Transm Dis. 1997 Nov;24(10):567-72.[Abstract]
25. Burk RD, Ho GY, Beardsley L, et al. Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women. J Infect Dis. 1996 Oct;174(4):679-89.[Abstract]
26. Palefsky JM, Gillison ML, Strickler HD. Chapter 16: HPV vaccines in immunocompromised women and men. Vaccine. 2006 Aug 31;24 Suppl 3:S3/140-6.[Abstract]
27. Palefsky J. Human papillomavirus infection in HIV-infected persons. Top HIV Med. 2007 Aug-Sep;15(4):130-3.[Abstract]
28. Henderson Z, Irwin KL, Montaño DE, et al. Anogenital warts knowledge and counseling practices of US clinicians: results from a national survey. Sex Transm Dis. 2007 Sep;34(9):644-52.[Abstract]
29. Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age: recommendations of ages 18 years or younger, United States, 2024. Nov 2023 [internet publication].[Full Text]
30. Centers for Disease Control and Prevention. Adult immunization schedule by age: recommendations of ages 19 years or older, United States, 2024. Nov 2023 [internet publication].[Full Text]
31. Meites E, Szilagyi PG, Chesson HW, et al. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):698-702.[Abstract][Full Text]
32. The American College of Obstetricians and Gynecologists. Committee opinion no. 809: human papillomavirus vaccination. Aug 2020 [internet publication].[Full Text]
33. Markowitz LE, Dunne EF, Saraiya M, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014 Aug 29;63(rr-05):1-30.[Abstract][Full Text]
34. Albero G, Castellsagué X, Giuliano AR, et al. Male circumcision and genital human papillomavirus: a systematic review and meta-analysis. Sex Transm Dis. 2012 Feb;39(2):104-13.[Abstract]
35. Garland SM, Kjaer SK, Muñoz N, et al. Impact and effectiveness of the quadrivalent human papillomavirus vaccine: a systematic review of 10 years of real-world experience. Clin Infect Dis. 2016 Aug 15;63(4):519-27.[Abstract][Full Text]
36. Mariani L, Vici P, Suligoi B, et al. Early direct and indirect impact of quadrivalent HPV (4HPV) vaccine on genital warts: a systematic review. Adv Ther. 2015 Jan;32(1):10-30.[Abstract][Full Text]
37. Ali H, Donovan B, Wand H, et al. Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data. BMJ. 2013 Apr 18;346:f2032.[Abstract][Full Text]
38. Brodell LA, Mercurio MG, Brodell RT. The diagnosis and treatment of human papillomavirus-mediated genital lesions. Cutis. 2007 Apr;79(4 Suppl):5-10.[Abstract]
39. Steinberg JL, Cibley LJ, Rice PA. Genital warts: diagnosis, treatment, and counseling for the patient. Curr Clin Top Infect Dis. 1993;13:99-122.[Abstract]
40. Beutner KR, Wiley DJ, Douglas JM, et al. Genital warts and their treatment. Clin Infect Dis. 1999 Jan;28 Suppl 1:S37-56.[Abstract]
41. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.[Abstract][Full Text]
42. Habif TP, Campbell JL, Dinulos J, et al. Skin disease diagnosis and treatment. Philadelphia, PA: Elsevier Mosby; 2005:165-9.
43. Wolff K, Johnson RA, Suurmond D. Fitzpatrick's color atlas and synopsis of clinical dermatology. New York, NY: McGraw-Hill; 2005:204-5, 224, 762-4, 893-7, 1034.
44. McCalmont TH. Adnexal neoplasms. In: Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology Vol 2. London, UK: Mosby; 2003:1747-8.
45. National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: human papillomavirus disease. 2021 [internet publication].[Full Text]
46. Clinical Effectiveness Group, British Association for Sexual Health and HIV (BASHH). United Kingdom national guidelines on the management of anogenital warts 2015. Apr 2015 [internet publication].[Full Text]
47. Tyring SK, Edwards L, Friedman DJ, et al. Safety and efficacy of 0.5% podofilox gel in the treatment of anogenital warts. Arch Dermatol. 1998 Jan;134(1):33-8.[Abstract][Full Text]
48. Gotovtseva EP, Kapadia AS, Smolensky MH, et al. Optimal frequency of imiquimod (aldara) 5% cream for the treatment of external genital warts in immunocompetent adults: a meta-analysis. Sex Transm Dis. 2008 Apr;35(4):346-51.[Abstract]
49. Tatti S, Stockfleth E, Beutner KR, et al. Polyphenon E: a new treatment for external anogenital warts. Br J Dermatol. 2010 Jan;162(1):176-84.[Abstract]
50. Gross G, Meyer KG, Pres H, et al. A randomized, double-blind, four-arm parallel-group, placebo-controlled Phase II/III study to investigate the clinical efficacy of two galenic formulations of Polyphenon E in the treatment of external genital warts. J Eur Acad Dermatol Venereol. 2007 Nov;21(10):1404-12.[Abstract]
51. Stockfleth E, Beti H, Orasan R, et al. Topical Polyphenon E in the treatment of external genital and perianal warts: a randomized controlled trial. Br J Dermatol. 2008 Jun;158(6):1329-38.[Abstract]
52. Tatti S, Swinehart JM, Thielert C, et al. Sinecatechins, a defined green tea extract, in the treatment of external anogenital warts; a randomized controlled trial. Obstet Gynecol. 2008 Jun;111(6):1371-9.[Abstract]
53. Bertolotti A, Dupin N, Bouscarat F, et al. Cryotherapy to treat anogenital warts in nonimmunocompromised adults: systematic review and meta-analysis. J Am Acad Dermatol. 2017 Sep;77(3):518-26.[Abstract]
54. Godley MJ, Bradbeer CS, Gellen M, et al. Cryotherapy compared with trichloroacetic acid in treating genital warts. Genitourin Med. 1987 Dec;63(6):390-2.[Abstract]
55. Ying Z, Li X, Dang H. 5-aminolevulinic acid-based photodynamic therapy for the treatment of condylomata acuminata in Chinese patients: a meta-analysis. Photodermatol Photoimmunol Photomed. 2013 Jun;29(3):149-59.[Abstract]
56. Czelusta A, Yen-Moore A, Van der Straten M, et al. An overview of sexually transmitted diseases. Part III. Sexually transmitted diseases in HIV-infected patients. J Am Acad Dermatol. 2000 Sep;43(3):409-32.[Abstract]
57. Gormley RH, Kovarik CL. Human papillomavirus-related genital disease in the immunocompromised host: part II. J Am Acad Dermatol. 2012 Jun;66(6):883.e1-17; quiz 899-900.[Abstract]
58. Orlando G, Fasolo MM, Beretta R, et al. Combined surgery and cidofovir is an effective treatment for genital warts in HIV-infected patients. AIDS. 2002 Feb 15;16(3):447-50.[Abstract][Full Text]
59. Orlando G, Fasolo MM, Signori R, et al. Impact of highly active antiretroviral therapy on clinical evolution of genital warts in HIV-1 infected patients. AIDS. 1999 Feb 4;13(2):291-3.[Abstract][Full Text]
60. Gilson RJ, Shupack JL, Friedman-Kien AE, et al. A randomized, controlled, safety study using imiquimod for the topical treatment of anogenital warts in HIV-infected patients. Imiquimod Study Group. AIDS. 1999 Dec 3;13(17):2397-404.[Abstract]
61. Petersen CS, Weismann K. Quercetin and kaempherol: an argument against the use of podophyllin? Genitourin Med. 1995 Apr;71(2):92-3.[Abstract]
62. Chuang TY, Ilstrup DM, Perry HO, et al. Condyloma acuminatum in Rochester, Minnesota, 1950-1978. II. Anaplasias and unfavorable outcomes. Arch Dermatol. 1984 Apr;120(4):476-83.[Abstract]
63. Snoeck R, Van Ranst M, Andrei G, et al. Treatment of anogenital papillomavirus infections with an acyclic nucleoside phosphonate analogue. N Engl J Med. 1995 Oct 5;333(14):943-4.[Abstract]
64. Orlando G, Fasolo MM, Beretta R, et al. Intralesional or topical cidofovir (HPMPC, VISTIDE) for the treatment of recurrent genital warts in HIV-infected patients. AIDS. 1999 Oct 1;13(14):1978-80.[Abstract]
65. Schurmann D, Bergmann F, Temmesfeld-Wollbrück B, et al. Topical cidofovir is effective in treating extensive penile condyloma acuminata. AIDS. 2000 May 26;14(8):1075-6.[Abstract]
66. Zabawski EJ, Cockerell CJ. Topical and intralesional cidofovir: a review of pharmacology and therapeutic effects. J Am Acad Dermatol. 1998 Nov;39(5 Pt 1):741-5.[Abstract]
67. National Institute for Health and Care Excellence. Reducing sexually transmitted infections. June 2022 [internet publication].[Full Text]
68. Woodward C, Fisher MA. Drug treatment of common STDs: Part II. Vaginal infections, pelvic inflammatory disease and genital warts. Am Fam Physician. 1999 Oct 15;60(6):1716-22.[Abstract]
69. Khawaja HT. Podophyllin versus scissor excision in the treatment of perianal condylomata acuminata: a prospective study. Br J Surg. 1989 Oct;76(10):1067-8.[Abstract]
70. NHS. Who should have the HPV vaccine? May 2019 [internet publication].[Full Text]
71. Hawkes AP, Kronenberger CB, MacKenzie TD, et al. Cervical cancer screening: American College of Preventive Medicine practice policy statement. Am J Prev Med. 1996 Sep-Oct;12(5):342-4.[Abstract]
72. Institute of Medicine Committee on Prevention and Control of Sexually Transmitted Diseases. The hidden epidemic: confronting sexually transmitted diseases. Washington DC: National Academy Press; 1997.
73. Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2021. Apr 2023 [internet publication].[Full Text]
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