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Genital warts

Specialties > Sexual health

Background knowledge 🧠

Definition

  • Genital warts are growths or lumps that appear on the genitalia and anal region.
  • Caused by the human papillomavirus (HPV).
  • They can vary in size, number, and appearance.
  • Commonly transmitted through sexual contact.

Epidemiology

  • Prevalent among sexually active individuals.
  • High incidence in young adults aged 15-29.
  • HPV is the most common STI worldwide.
  • Risk factors include multiple sexual partners and unprotected sex.

Aetiology and pathophysiology

  • Caused by human papillomavirus (HPV), primarily types 6 and 11.
  • Transmission through direct skin-to-skin contact.
  • HPV infects the basal cells of the epithelium.
  • Induces cellular proliferation, leading to wart formation.
  • Can be asymptomatic or symptomatic.

Types

  • Condylomata acuminata: flesh-colored, cauliflower-like growths.
  • Flat warts: slightly raised, smooth, flesh-colored lesions.
  • Keratotic warts: thick, crusty lesions, less common.
  • Subclinical HPV infection: no visible warts, diagnosed via colposcopy or HPV DNA testing.

Clinical Features 🌡️

Symptoms

  • Painless growths on the genitalia, perineum, or anus.
  • Pruritus or discomfort in the affected area.
  • Bleeding or discharge from warts if irritated.
  • Possible dyspareunia (pain during intercourse).
  • Often asymptomatic, especially in subclinical cases.

Signs

  • Visible warts on genital examination.
  • Flesh-colored, papillomatous lesions.
  • Clusters of warts resembling cauliflower.
  • Flat, slightly raised lesions in subclinical HPV.
  • No systemic signs usually present.

Investigations 🧪

Tests

  • Clinical diagnosis based on appearance.
  • Biopsy if diagnosis is uncertain or to rule out malignancy.
  • HPV DNA testing for typing.
  • Colposcopy for subclinical lesions in females.
  • Consider testing for other STIs.

Management 🥼

Management

  • Topical treatments: imiquimod, podophyllotoxin, trichloroacetic acid.
  • Cryotherapy for freezing warts.
  • Electrosurgery or laser therapy for larger warts.
  • Surgical excision for resistant warts.
  • Counseling on safe sex practices and HPV vaccination.
  • Regular follow-up to monitor for recurrence.

Complications

  • Psychological distress and impact on sexual health.
  • Potential for malignant transformation in high-risk HPV types.
  • Recurrence after treatment is common.
  • Secondary infections if warts are irritated.
  • Strictures or scarring from aggressive treatments.

Prognosis

  • Good with appropriate treatment.
  • Recurrence is common, requiring multiple treatments.
  • HPV vaccination reduces risk of new infections.
  • Regular monitoring helps manage recurrences.
  • Prognosis varies with immune status of the patient.

Key points

  • HPV is the primary cause of genital warts.
  • Diagnosis is primarily clinical, supported by tests if needed.
  • Multiple treatment options available, often requiring combination.
  • HPV vaccination is effective in prevention.
  • Educate patients on safe sex practices to prevent spread.
  • Regular follow-up is essential to manage and prevent recurrences.

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Sexual health