Condylomata acuminata (anogenital warts) in adults: Epidemiology, pathogenesis, clinical features, and diagnosis
- Noah Scheinfeld, MD
Noah Scheinfeld, MD
- Assistant Clinical Professor of Dermatology
- Weill Cornell Medical College
Human papillomavirus (HPV) is a common cause of cutaneous and mucosal infection. Condylomata acuminata (CA, singular: condyloma acuminatum), also known as anogenital warts, are manifestations of HPV infection that occur in a subset of individuals with anogenital infection. External CA typically manifest as soft papules or plaques on the external genitalia, perianal skin, perineum, or groin (picture 1A-H). HPV types 6 and/or 11 are detected in most cases of CA.
The etiology, epidemiology, clinical features, and diagnosis of external CA will be reviewed here. Greater detail on HPV infection and discussions of pediatric CA, treatment of CA, and the relationship between HPV infection and cancer are provided separately. (See "Human papillomavirus infections: Epidemiology and disease associations" and "Condylomata acuminata (anogenital warts) in children" and "Treatment of vulvar and vaginal warts" and "Condylomata acuminata (anogenital warts): Management of external condylomata acuminata in men" and "Virology of human papillomavirus infections and the link to cancer".)
Human papillomavirus (HPV) is a group of nonenveloped, double-stranded DNA viruses belonging to the family Papillomaviridae. Investigators have identified over 200 types of HPV, more than 40 of which can be transmitted through sexual contact and infect the anogenital region [1,2]. The virology of HPV is reviewed in detail separately. (See "Human papillomavirus infections: Epidemiology and disease associations", section on 'Microbiology'.)
HPV types are divided into low-risk and high-risk types based upon associated risk for cancer. The low-risk types HPV 6 and/or HPV 11 are detected in around 90 percent of anogenital warts, although coinfection with other low-risk or high-risk types of HPV is common. For example, in an analysis of 8800 women in the placebo arms of two randomized trials assessing the efficacy of a quadrivalent vaccine, 298 (3 percent) developed anogenital warts, and HPV 6 and/or HPV 11 were detected in 447 of 520 examined warts (86 percent) . High-risk HPV types, such as HPV 16, 18, 52, and 56, were detected in 191 warts (31 percent). (See "Virology of human papillomavirus infections and the link to cancer", section on 'HPV Genotypes and risk of cancer'.)
Human papillomavirus (HPV) is transmitted through contact with infected skin or mucosa. The virus invades the cells of the epidermal basal layer through microabrasions. Anogenital HPV infection is almost always acquired through sexual contact. Warts are not required for transmission but are highly infectious because of their high viral load.
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- RISK FACTORS
- CLINICAL MANIFESTATIONS
- CLINICAL COURSE
- ASSOCIATION WITH MALIGNANCY
- Physical examination
- ADDITIONAL EVALUATION
- Other sexually transmitted diseases
- Internal involvement
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS