warts%20-%20anogenital
WARTS - ANOGENITAL
Anogenital warts (condylomas) are caused by human papillomavirus (HPV) with >90% of the lesions caused by genotypes 6 & 11.
Patients who present with visible warts may also be infected with high-risk HPVs (eg types 16 & 18) which can cause subclinical lesions that are associated with intraepithelial neoplasia, cervical cancer and anogenital cancer.
Many HPV infections are subclinical, transient, and clear spontaneously within 12 months but may also remain latent and reactivate after several years.

Introduction

  • Patient usually presents with lesions in areas that are traumatized by sexual intercourse but may also occur at any site
    • Vagina, cervix, urethral meatus and anal canal
    • Perianal lesions may occur in both sexes but are most common in homosexual men
    • Warts in the anal canal are typically found in penetrative anal sex, though lesions may have developed secondary to collection in this area of genital secretions infected with human papillomavirus (HPV)
    • Extragenital lesions may be seen on the oral cavity, nasal cavity, larynx or conjunctivae

Etiology

  • Anogenital warts (condylomas) are caused by human papillomavirus (HPV) with >90% of the lesions caused by low-risk HPVs genotypes 6 and 11
    • Patients who present with visible warts may also be infected with high-risk HPVs (eg types 16, 18, 31, 33 and 35) which can cause subclinical lesions that are associated with high-grade squamous intraepithelial lesions, cervical cancer and anogenital cancer
    • Many HPV infections are subclinical, transient and clear spontaneously within 12 months but may also remain latent and reactivate after several years

Transmission

  • Most often by sexual contact
    • Risk of acquiring infection increases with multiple sexual partners
    • Direct skin-to-skin contact spreads the infection most efficiently
    • The virus is not transmitted via bodily fluids (eg semen, vaginal discharge) or blood
  • Autoinoculation can occur by scratching, shaving or traumatizing previously infected skin
  • Infection can be passed on even without visible signs of warts 
  • May also be transmitted perinatally (eg from hand warts)

Signs and Symptoms

  • Keratinized and firm on dry hairy skin while nonkeratinized and soft on warm, moist, non-hairy skin
  • Lesion(s) may be singular or more and usually occur as 5 to ≥15 lesions
    • May also be discrete lesions or multiple lesions that may coalesce into confluent plaques
    • Multifocal or multicentric
  • Lesions are often asymptomatic, some may cause little physical discomfort, may be disfiguring and psychologically distressing
  • May be associated with:
    • Pain
    • Pruritus
    • Irritation and soreness (especially around the anus)
    • Distortion of urine flow or bleeding from anus, urethra, or cervix may indicate internal lesions
    • Bleeding and infection if located at site prone to trauma and irritation
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