Anogenital warts (condylomata acuminata) are the most common viral sexually transmitted disease in the United States. Although condylomata affect both genders, data from office visits for warts obtained from the 1994 to 1998 National Ambulatory Medical Care Survey showed that women accounted for 67 percent of the patient population .
Condylomata acuminata in children are discussed separately. (See "Vulvovaginal complaints in the prepubertal child", section on 'Condylomata acuminata'.)
ETIOLOGY AND ASSOCIATION WITH MALIGNANCY
Condyloma acuminatum is caused by human papilloma virus (HPV) infection. HPV encompasses a family of highly infectious and primarily sexually transmitted double-stranded DNA viruses. The incubation period after exposure ranges from three weeks to eight months. Most infections are transient and cleared within two years .
Individuals with condylomata acuminata are at an increased risk for anogenital cancers [3,4]. In a large Danish cohort study of 16,155 men and 32,933 women, individuals who were diagnosed with condylomata acuminata were at increased risk for anogenital and head and neck cancers for greater than ten years following the diagnosis (anal [SIR for men, 21.5; SIR for women, 7.8], vulvar [SIR, 14.8], vaginal [SIR, 5.9], cervical [SIR, 1.5], penile [SIR, 8.2], and head and neck cancer [SIR, 2.8], including subsites of head and neck cancer with confirmed HPV association [SIR for men, 3.5; SIR for women, 4.8]) . (See "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing" and "Anal squamous intraepithelial lesions: Diagnosis, screening, prevention, and treatment".)
There are over 70 distinct HPV subtypes; approximately 35 types are specific for the anogenital epithelium and have varying potentials to cause malignant change, such as cervical or anal cancer (table 1) . (See "Virology of human papillomavirus infections and the link to cancer".) HPV serotypes 16 and 18 are most commonly associated with squamous cell carcinoma. Low-risk subtypes, such as HPV 6 and 11, do not integrate into the host genome and are most frequently associated with benign condyloma and low grade intraepithelial neoplasia (table 2). Intermediate risk subtypes can cause high grade dysplasia which persists but rarely progresses to the invasive stage. (See "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing".)