View source for Genital wart

{{short description|Sexually transmitted infection caused by certain types of human papillomaviruses}}
{{pp|small=yes}}
{{Infobox medical condition (new)
| name            = Genital warts
| synonyms        = Condylomata acuminata, venereal warts, anal warts, anogenital warts
| image           = SOA-Condylomata-acuminata-around-anus.jpg
| caption         = Severe case of genital warts around the anus of a female
| field           = [[Infectious disease (medical specialty)|Infectious disease]]<ref name=Andrew2020/>
| symptoms        = [[papule|Small bumps]] in skin of genital area, varying sizes and shapes but typically protrude out, burning, itch<ref name=Trip2022/><ref name=Fer2018/>
| complications   =
| onset           = 1-8 months following exposure<ref name=AFP2010/>
| duration        =
| types           =
| causes          = HPV types 6 and 11<ref name=CDC2010/>
| risks           =
| diagnosis       = Based on symptoms, can be confirmed by [[tissue biopsy|biopsy]]<ref name=CDC2010/>
| differential    = [[Molluscum contagiosum]], [[skin tag]], [[condylomata lata]], [[squamous-cell carcinoma]]<ref name=Fer2018/>
| prevention      = [[HPV vaccine]], [[condoms]]<ref name=AFP2010/><ref name=NHS2017/>
| treatment       = Medications, [[cryotherapy]], surgery<ref name=CDC2010/>
| medication      = [[Podophyllin]], [[imiquimod]], [[trichloroacetic acid]]<ref name=CDC2010/>
| prognosis       =
| frequency       = ~1% (US)<ref name=AFP2010/>
| deaths          =
}}
<!-- Definition and symptoms -->
'''Genital warts''' are a [[sexually transmitted infection]] [[Human papillomavirus infection|caused by certain types of human papillomavirus (HPV)]].<ref name=Andrew2020>{{cite book |last1=James |first1=William D. |last2=Elston |first2=Dirk |last3=Treat |first3=James R. |last4=Rosenbach |first4=Misha A. |last5=Neuhaus |first5=Isaac |title=Andrews' Diseases of the Skin: Clinical Dermatology |date=2020 |publisher=Elsevier |location=Edinburgh |isbn=978-0-323-54753-6 |pages=406–410 |edition=13th |chapter-url=https://books.google.com/books?id=UEaEDwAAQBAJ&pg=PA406 |language=en |chapter=19. Viral diseases: genital warts  }}</ref> They may be flat or project out from the surface of the skin, and their color may vary; brownish, white, pale yellow, pinkish-red, or gray.<ref name=Andrew2020/><ref name=Trip2022>{{cite book |last1=Tripathi |first1=Anuj |last2=Sahu |first2=Utkarsha |editor1-last=Khare |editor1-first=Prashant |editor2-last=Jain |editor2-first=Ashish |title=Immunopathology, Diagnosis and Treatment of HPV induced Malignancies |date=2022 |publisher=Elsevier |location=London |isbn=978-0-323-98644-1 |pages=1–13 |chapter-url=https://books.google.com/books?id=IthOEAAAQBAJ&pg=PA1 |language=en |chapter=1. An overview of HPV: causes, symptoms, and clinical manifestations  }}</ref><ref name=Fer2018>{{cite book|last1=Ferri|first1=Fred F.|title=Ferri's Clinical Advisor 2018|date=2018|publisher=Elsevier|location=Philadelphia|isbn=9780323529570|page=1376|chapter-url=https://books.google.com/books?id=wGclDwAAQBAJ&pg=PA1376|chapter=1. Diseases and disorders|language=en}}</ref> There may be a few individual warts or several, either in a cluster or merged together to look cauliflower-shaped.<ref name=Trip2022/><ref name=Goldman2020>{{cite book |last1=Madoff |first1=Robert D. |last2=Melton-Meax |first2=Genevieve B. |editor1-last=Goldman |editor1-first=Lee |editor2-last=Schafer |editor2-first=Andrew I. |title=Goldman-Cecil Medicine |date=2020 |publisher=Elsevier |location=Philadelphia |isbn=978-0-323-55087-1 |page=938 |edition=26th |volume=1 |chapter-url=https://books.google.com/books?id=7pKqDwAAQBAJ&pg=PA938 |language=en |chapter=136. Diseases of the rectum and anus: anal warts }}</ref> They can be itchy and feel burning.<ref name=Trip2022/> Usually they cause few [[Signs and symptoms|symptoms]], but can occasionally be painful.<ref name=CDC2010/> Typically they appear one to eight months following exposure.<ref name=AFP2010/> [[Wart]]s are the most easily recognized symptom of genital HPV infection.<ref name=AFP2010/>

<!-- Cause and diagnosis-->
HPV types 6 and 11 are responsible for causing majority of genital warts whereas HPV types 16, 18, 31, 33, and 35 are also occasionally found.<ref name=CDC2010>{{cite web|title=CDC - Genital Warts - 2010 STD Treatment Guidelines|url=https://www.cdc.gov/std/treatment/2010/genital-warts.htm|website=www.cdc.gov|access-date=2 January 2018|language=en-us|date=28 January 2011|archive-url=https://web.archive.org/web/20180708133714/https://www.cdc.gov/std/treatment/2010/genital-warts.htm|archive-date=8 July 2018}}</ref> It is spread through direct skin-to-skin contact, usually during [[oral sex|oral]], [[Non-penetrative sex#Manual sex|manual]], [[sexual intercourse|vaginal]], or [[anal sex]] with an infected partner.<ref name=AFP2010/><ref>{{cite book| last1 = Hoyle | first1 = Alice | last2 = McGeeney | first2 = Ester |title=Great Relationships and Sex Education|publisher=Taylor and Francis|year=2019|access-date=July 11, 2023|isbn=978-1-35118-825-8|url=https://books.google.com/books?id=KE7ADwAAQBAJ&pg=PT261}}</ref> Diagnosis is generally based on symptoms and can be confirmed by [[tissue biopsy|biopsy]].<ref name=CDC2010/> The types of HPV that cause cancer are not the same as those that cause warts.<ref name=NCI2017>{{cite web|last=US National Cancer Institute|title=HPV and Cancer|url=http://www.cancer.gov/cancertopics/factsheet/Risk/HPV|access-date=2 January 2018}}</ref>

<!-- Prevention and treatment -->
Some [[HPV vaccine]]s can prevent genital warts as may [[condoms]], with the quadrivalent and nonavalent vaccines providing virtually complete protection.<ref name=WHOcurrentdata>{{Cite web|title=Human papillomavirus vaccines (HPV)|url=https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV)|website=World Health Organization|access-date=1 October 2024 |archive-date=7 August 2024|archive-url=https://web.archive.org/web/20240807031253/https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV) |url-status=live}}</ref><ref name=AFP2010/><ref name=NHS2017>{{cite web|title=Genital warts|url=https://www.nhs.uk/conditions/genital-warts/|website=NHS|access-date=2 January 2018|date=21 August 2017}}</ref> Treatment options include creams such as [[podophyllin]], [[imiquimod]], and [[trichloroacetic acid]].<ref name=CDC2010/> [[Cryotherapy]] or surgery may also be an option.<ref name=CDC2010/> After treatment warts often resolve within six months.<ref name=AFP2010/> Without treatment, in up to a third of cases they resolve on their own.<ref name=AFP2010/>

<!-- Epidemiology, and culture -->
About 1% of people in the United States have genital warts.<ref name=AFP2010>{{cite journal|last=Juckett|first=G|author2=Hartman-Adams, H|title=Human papillomavirus: clinical manifestations and prevention.|journal=American Family Physician|date=Nov 15, 2010|volume=82|issue=10|pages=1209–13|pmid=21121531}}</ref> Many people, however, are infected and do not have symptoms.<ref name=AFP2010/> Without [[vaccination]] nearly all sexually active people will get some type of HPV at one point in their lives.<ref name=NCI2017/><ref name=CDC2017Fact>{{cite web|last=US Centers for Disease Control|title=Genital HPV Infection - Fact Sheet|url=https://www.cdc.gov/std/hpv/stdfact-hpv.htm|access-date=16 November 2017}}</ref> The disease has been known at least since the time of [[Hippocrates]] in 300 BC.<ref>{{cite book|last1=Syrjänen|first1=Kari J.|last2=Syrjänen|first2=Stina M.|title=Papillomavirus infections in human pathology|date=2000|publisher=Wiley|location=Chichester [u.a.]|isbn=9780471971689|page=1}}</ref>

==Signs and symptoms==
[[File:SOA-Condylomata-acuminata-female.jpg|thumb|120px|Severe case of genital warts on a [[vulva]]]]
[[File:SOA-Condylomata-acuminata-man.jpg|thumb|120px|Severe case of genital warts on a [[Human penis|penis]]]]
[[File:Small condylomata on testicles.jpg|thumb|120px|Small condylomata on a scrotum]]

They may be found anywhere in the [[Human anus|anal]] or [[Sex organ|genital area]], and are frequently found on external surfaces of the body, including the [[Body of penis|penile shaft]], [[scrotum]], or [[labia majora]]. They can also occur on internal surfaces like the [[urethral meatus|opening to the urethra]], inside the [[vagina]], on the [[cervix]], or in the [[Human anus|anus]].<ref>{{Cite web|url=https://www.uptodate.com/contents/condylomata-acuminata-anogenital-warts-in-adults-epidemiology-pathogenesis-clinical-features-and-diagnosis|title=Condylomata acuminata (anogenital warts) in adults: Epidemiology, pathogenesis, clinical features, and diagnosis|last=Scheinfeld|first=Noah|date=2017-01-04|website=UpToDate|access-date=2018-01-01|url-access=subscription }}</ref>

They can be as small as 1–5&nbsp;mm in diameter, but can also grow or spread into large masses in the genital or anal area. In some cases they look like small stalks. They may be hard ("[[keratin]]ized") or soft. Their color can be variable, and sometimes they may bleed.<ref>{{cite web |url=https://www.lecturio.com/concepts/condylomata-acuminata-genital-warts/| title=Condylomata Acuminata (Genital Warts)
|website=The Lecturio Medical Concept Library |access-date= 10 July 2021}}</ref>

In most cases, there are no symptoms of HPV infection other than the warts themselves. Sometimes warts may cause itching, redness, or discomfort, especially when they occur around the anus. Although they are usually without other physical symptoms, an outbreak of genital warts may cause psychological distress, such as [[anxiety]], in some people.<ref name=JEADV-2012>{{cite journal|last=Lacey|first=CJ|author2=Woodhall, SC |author3=Wikstrom, A |author4= Ross, J |title=2012 European guideline for the management of anogenital warts.|journal=Journal of the European Academy of Dermatology and Venereology|date=Mar 12, 2012|pmid=22409368|doi=10.1111/j.1468-3083.2012.04493.x |volume=27 |issue=3 |pages=e263-70|doi-access=free}}<!--|access-date=3 August 2013 --></ref>
<!-- put [[Giant condyloma acuminatum]] in here? -->
<!-- TODO: describe difference between acuminata and planum, from AFP2010 -->

==Causes==

===Transmission===
HPV is most commonly transmitted through [[sexual penetration|penetrative sex]]. While HPV can also be transmitted via non-penetrative sexual activity, it is less transmissible than via penetrative sex. There is conflicting evidence about the effect of [[condoms]] on transmission of low-risk HPV. Some studies have suggested that they are effective at reducing transmission.<ref name=Lancet-2010>{{cite journal|last=Veldhuijzen|first=NJ|author2=Snijders, PJ |author3=Reiss, P |author4=Meijer, CJ |author5= van de Wijgert, JH |title=Factors affecting transmission of mucosal human papillomavirus.|journal=The Lancet Infectious Diseases|date=December 2010|volume=10|issue=12|pages=862–74|pmid=21075056|doi=10.1016/s1473-3099(10)70190-0}}</ref> Other studies suggest that condoms are not effective at preventing transmission of the low-risk HPV variants that cause genital warts. The effect of condoms on HPV transmission may also be sex-dependent; there is some evidence that condoms are more effective at preventing infection of males than of females.<ref name=JAAD-I-2012 />

The types of HPV that cause warts are highly transmissible. Roughly three out of four unaffected partners of patients with warts develop them within eight months.<ref name=JAAD-I-2012>{{cite journal|last=Gormley|first=RH|author2=Kovarik, CL|title=Human papillomavirus-related genital disease in the immunocompromised host: Part I.|journal=Journal of the American Academy of Dermatology|date=June 2012|volume=66|issue=6|pages=867.e1–14; quiz 881–2|pmid=22583720|doi=10.1016/j.jaad.2010.12.050}}</ref>  Other studies of partner concordance suggest that the presence of visible warts may be an indicator of increased infectivity; HPV concordance rates are higher in couples where one partner has visible warts.<ref name=Lancet-2010 />

===Latency and recurrence===
Although 90% of HPV infections are cleared by the body within two years of infection, it is possible for infected cells to undergo a latency (quiet) period, with the first occurrence or a recurrence of symptoms happening months or years later.<ref name=AFP2010/> Latent HPV, even with no outward symptoms, is still transmissible to a sexual partner. If an individual has unprotected sex with an infected partner, there is a 70% chance that he or she will also become infected.{{citation needed|date=May 2021}}

In individuals with a history of previous HPV infection, the appearance of new warts may be either from a new exposure to HPV, or from a recurrence of the previous infection. As many as one-third of people with warts will experience a recurrence.<ref>{{cite journal|last=Cardoso|first=JC|author2=Calonje, E|title=Cutaneous manifestations of human papillomaviruses: a review.|journal=Acta Dermatovenerologica Alpina, Pannonica et Adriatica|date=September 2011|volume=20|issue=3|pages=145–54|pmid=22131115}}<!--|access-date=3 August 2013--></ref>

===Children===
Anal or genital warts may be [[vertical transmission|transmitted during birth]]. The presence of wart-like lesions on the genitals of young children has been suggested as an indicator of sexual abuse. However, genital warts can sometimes result from [[autoinoculation]] by warts elsewhere on the body, such as from the hands.<ref name=UK-guideline-2007>{{cite web|title=United Kingdom National Guideline on the Management of Anogenital Warts, 2007|publisher=British Association for Sexual Health and HIV|access-date=3 August 2013|url=http://www.bashh.org/documents/86/86.pdf|archive-url=https://web.archive.org/web/20150923182511/http://www.bashh.org/documents/86/86.pdf|archive-date=23 September 2015}}</ref>  It has also been reported from sharing of swimsuits, underwear, or bath towels, and from non-sexual touching during routine care such as diapering. Genital warts in children are less likely to be caused by HPV subtypes 6 and 11 than adults, and more likely to be caused by HPV types that cause warts elsewhere on the body ("cutaneous types"). Surveys of pediatricians who are child abuse specialists suggest that in children younger than 4 years old, there is no consensus on whether the appearance of new anal or genital warts, by itself, can be considered an indicator of sexual abuse.<ref name=Peds-Rev-2011>{{cite journal|last=Sinclair|first=KA|author2=Woods, CR |author3=Sinal, SH |s2cid=207170959|title=Venereal warts in children.|journal=Pediatrics in Review|date=March 2011|volume=32|issue=3|pages=115–21; quiz 121|pmid=21364015|doi=10.1542/pir.32-3-115}}</ref>

==Diagnosis==
[[Image:Anal condyloma (3).jpg|thumb|right|[[Micrograph]] of a genital wart with the characteristic changes ([[parakeratosis]], [[koilocyte]]s, [[papillomatosis]]). [[H&E stain]].]]
The diagnosis of genital warts is most often made visually, but may require confirmation by [[biopsy]] in some cases.<ref name=CDC-MMWR2010>{{cite book|last1=Workowski|first1=K|last2=Berman|first2=S|title=Sexually Transmitted Diseases Treatment Guidelines, 2010|publisher=United States Centers for Disease Control| url=https://www.cdc.gov/mmwr/pdf/rr/rr5912.pdf|page=70}}</ref> Smaller warts may occasionally be confused with [[molluscum contagiosum]].<ref name=Peds-Rev-2011 />
<!-- ===Histological=== -->
Genital warts, [[histopathology|histopathologically]], characteristically rise above the skin surface due to enlargement of the [[dermal papillae]], have [[parakeratosis]] and the characteristic nuclear changes typical of [[HPV]] infections (nuclear enlargement with perinuclear clearing).
<!-- ===Clinical==
talk about acetate diagnosis in clinical setting here
-->
DNA tests are available for diagnosis of high-risk HPV infections. Because genital warts are caused by low-risk HPV types, DNA tests cannot be used for diagnosis of genital warts or other low-risk HPV infections.<ref name=AFP2010/>

Some practitioners use an [[acetic acid]] solution to identify smaller warts ("subclinical lesions"), but this practice is controversial.<ref name=JEADV-2012 /> Because a diagnosis made with acetic acid will not meaningfully affect the course of the disease, and cannot be verified by a more [[specificity (statistics)|specific]] test, a 2007 UK guideline advises against its use.<ref name=UK-guideline-2007 />

==Prevention==
{{Main|HPV vaccine|Condoms}}

===HPV vaccines===

HPV vaccines have excellent safety profiles and are highly efficacious, or have met immunobridging standards.<ref name="WHO2022">{{cite journal|vauthors=((World Health Organization))|title=Human papillomavirus vaccines: WHO position paper (2022 update)|journal=[[Weekly Epidemiological Record]]|volume=97|issue=50|pages=645–672|date=December 2022|hdl=10665/365351|author-link=World Health Organization|hdl-access=free}}</ref> {{rp|p=668}} They prevent genital warts, with the quadrivalent and nonavalent vaccines providing virtually complete protection.<ref name=WHOcurrentdata/> As of 2022, 125 countries include HPV vaccine in their routine vaccinations for girls, and 47 countries recommend them for boys, as well.<ref name="WHO2022" />{{rp|p=654}}

There exists the nonavalent vaccine, Gardasil 9. The quadrivalent [[Gardasil]] (sold by [[Merck & Co.]]) is a [[vaccine]] that protects against [[Human papillomavirus infection|infection by HPV types 6, 11, 16 and 18]]. Types 6 and 11 cause genital warts, while 16 and 18 cause [[cervical cancer]]. The vaccine is preventive, not therapeutic, and must be given before exposure to the virus type to be effective, ideally before the beginning of sexual activity. The vaccine is approved by the [[United States|US]] [[Food and Drug Administration]] for use in both males and females as early as 9 years of age.<ref name=FDA-Gardasil>{{cite web|last=United States Food and Drug Administration|title=Gardasil|url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM094042|archive-url=https://web.archive.org/web/20090710001452/http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM094042|url-status=dead|archive-date=July 10, 2009|work=Approved Products|access-date=1 January 2013}}</ref>

In the UK, Gardasil replaced [[Cervarix]] in September 2012<ref name=UK-DH-policy>{{cite web|last=UK Department of Health|title=Your guide to the HPV vaccination from September 2012|url=http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_133345|access-date=1 January 2013}}</ref> for reasons unrelated to safety.<ref name=MHRA-safety>{{cite web|last=UK Medicines and Healthcare products Regulatory Agency|title=Human papillomavirus vaccine Cervarix: safety review shows balance of risks and benefits remains clearly positive|url=http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON207191|access-date=1 January 2013|archive-url=https://web.archive.org/web/20130403020036/http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON207191|archive-date=3 April 2013}}</ref> Cervarix had been used routinely in young females from its introduction in 2008, but was only effective against the high-risk HPV types 16 and 18, neither of which typically causes warts.{{citation needed|date=May 2021}}
<!-- TODO: make mention of how condoms are not completely effective at preventing transmission, per AFP2010 -->

===Condoms===

There is conflicting evidence about the effect of [[condoms]] on transmission of low-risk HPV. Some studies have suggested that they are effective at reducing transmission.<ref name=Lancet-2010/> Other studies suggest that condoms are not effective at preventing transmission of the low-risk HPV variants that cause genital warts. The effect of condoms on HPV transmission may also be sex-dependent; there is some evidence that condoms are more effective at preventing infection of males than of females.<ref name=JAAD-I-2012 />

==Management==
There is no cure for HPV. Existing treatments are directed towards the removal of visible warts, but these may also regress on their own without any therapy.<ref name=JEADV-2012 /> There is no evidence to suggest that removing visible warts reduces transmission of the underlying HPV infection. As many as 80% of people with HPV will clear the infection within 18 months.<ref name=JAAD-I-2012 />

A healthcare practitioner may offer one of several ways to treat warts, depending on their number, sizes, locations, or other factors. All treatments can cause depigmentation, itching, pain, or [[scar]]ring.<ref name=JEADV-2012 /><ref name=FamilyManagement>{{cite journal |vauthors=Kodner CM, Nasraty S |title=Management of genital warts |journal=Am Fam Physician |volume=70 |issue=12 |pages=2335–2342 |date=December 2004 |pmid=15617297 |url=http://www.aafp.org/afp/20041215/2335.html |access-date=2009-05-30 |archive-date=2008-07-20 |archive-url=https://web.archive.org/web/20080720031349/http://www.aafp.org/afp/20041215/2335.html }}</ref>

Treatments can be classified as either physically [[ablation|ablative]], or [[topical medication|topical]] agents. Physically ablative therapies are considered more effective at initial wart removal, but like all therapies have significant recurrence rates.<ref name=JEADV-2012 /><ref name=UK-guideline-2007 />

Many therapies, including [[folk remedies]], have been suggested for treating genital warts, some of which have little [[evidence-based medicine|evidence]] to suggest they are effective or safe.<ref name=Armamentarium>{{cite journal|last=Lipke|first=MM|title=An armamentarium of wart treatments.|journal=Clinical Medicine & Research|date=December 2006|volume=4|issue=4|pages=273–93|pmid=17210977|doi=10.3121/cmr.4.4.273|pmc=1764803}}</ref> Those listed here are ones mentioned in national or international practice guidelines as having some basis in evidence for their use.{{citation needed|date=May 2021}}

===Physical ablation===
Physically ablative methods are more likely to be effective on keratinized warts. They are also most appropriate for patients with fewer numbers of relatively smaller warts.<ref name=UK-guideline-2007 />
* Simple excision, such as with scissors under [[local anesthesia]], is highly effective.<ref name=JEADV-2012 />
* [[Liquid nitrogen]] [[cryosurgery]] is usually performed in an office visit, at weekly intervals. It is effective, inexpensive, safe for pregnancy, and does not usually cause scarring.<ref name=JEADV-2012 />
* [[Electrocauterization]] (sometimes called "loop electrical excision procedure" or LEEP) is a procedure with a long history of use and is considered effective.<ref name=JEADV-2012 />
* Laser ablation has less evidence to suggest its use. It may be less effective than other ablative methods.<ref name=UK-guideline-2007 /> It is extremely expensive, and often used as a last resort.<ref name=ModernManagement/>
* Formal surgical procedures, performed by a [[surgeon|specialist]] under general anesthesia or [[spinal anesthesia]] may be necessary for larger or more extensive warts, intra-anal warts, or warts in children.<ref name=JEADV-2012 /> It carries a greater risk of scarring than other methods.<ref name=FamilyManagement/>

===Topical agents===
* A 0.15–0.5% [[podophyllotoxin]] (also called podofilox) solution in a gel or cream. It can be applied by the patient to the affected area and is not washed off. It is the purified and standardized active ingredient of [[podophyllin]] (see below). Podofilox is safer and more effective than podophyllin.<ref name=OpenAccess2006/> Skin erosion and pain are more commonly reported than with imiquimod and sinecatechins.<ref name=GreenTea/> Its use is cycled (two times per day for 3 days then 4–7 days off); one review states that it should only be used for four cycles.<ref name=OpenAccess2006/>
* [[Imiquimod]] is a topical immune response cream, applied to the affected area. It causes less local irritation than podofilox but may cause fungal infections (11% in package insert) and flu-like symptoms (less than 5% disclosed in package insert).<ref name=GreenTea/> It does not significantly impact the occurrence of new warts or the systemic reactions.<ref>{{Cite journal |last1=Grillo-Ardila |first1=Carlos F |last2=Angel-Müller |first2=Edith |last3=Salazar-Díaz |first3=Luis C |last4=Gaitán |first4=Hernando G |last5=Ruiz-Parra |first5=Ariel I |last6=Lethaby |first6=Anne |date=2014-11-01 |title=Imiquimod for anogenital warts in non-immunocompromised adults |url=http://dx.doi.org/10.1002/14651858.cd010389.pub2 |journal=Cochrane Database of Systematic Reviews |issue=11 |article-number=CD010389 |doi=10.1002/14651858.cd010389.pub2 |pmid=25362229 |issn=1465-1858|pmc=10777270 }}</ref>
* [[Sinecatechins]] is an ointment of [[catechin]]s (55% [[epigallocatechin gallate]]<ref name=ModernManagement/>) extracted from [[green tea]] and other components. Mode of action is undetermined.<ref>{{cite web|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021902s002lbl.pdf|archive-url=https://web.archive.org/web/20160201173810/http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021902s002lbl.pdf|url-status=dead|archive-date=February 1, 2016|title=Veregen label information|access-date=2013-01-01}}</ref> It appears to have higher clearance rates than podophyllotoxin and imiquimod and causes less local irritation, but clearance takes longer than with imiquimod.<ref name=GreenTea>{{cite journal |vauthors=Meltzer SM, Monk BJ, Tewari KS |title=Green tea catechins for treatment of external genital warts |journal=Am. J. Obstet. Gynecol. |volume=200 |issue=3 |pages= 233.e1–7 |date=March 2009 |pmid=19019336 |doi=10.1016/j.ajog.2008.07.064 |s2cid=31437162 |url=http://www.escholarship.org/uc/item/6g70h18h}}</ref>
* [[Trichloroacetic acid]] (TCA) is less effective than [[cryosurgery]],<ref name=OpenAccess2006/> and is not recommended for use in the vagina, cervix, or urinary meatus.<ref name=ModernManagement/>
* [[Interferon]] can be used; it is effective, but it is also expensive and its effect is inconsistent.<ref name=OpenAccess2006/>

====Discontinued====
* A 5% 5-[[fluorouracil]] (5-FU) cream was used, but it is no longer considered an acceptable treatment due to the side-effects.<ref name=ModernManagement>{{cite journal |vauthors=Mayeaux EJ, Dunton C |title=Modern management of external genital warts |journal=J Low Genit Tract Dis |volume=12 |issue=3 |pages= 185–192 |date=July 2008 |pmid=18596459 |doi=10.1097/LGT.0b013e31815dd4b4 |s2cid=33302840 }}</ref>

Podophyllin, podofilox and [[isotretinoin]] should not be used during [[pregnancy]], as they could cause [[birth defect]]s in the [[fetus]].

===Oral agents===
{{Anchor|Recalcitrant condylomata acuminata}}
[[Isotretinoin#Medical uses|Isotretinoin]] taken orally has been shown to treat '''recalcitrant condylomata acuminata''' (RCA) of the cervix.

==Epidemiology==
Genital HPV infections have an estimated prevalence in the US of 10–20% and clinical manifestations in 1% of the sexually active adult population.<ref name=OpenAccess2006/> US incidence of HPV infection has increased between 1975 and 2006.<ref name=OpenAccess2006/>  About 80% of those infected are between the ages of 17 and 33.<ref name=OpenAccess2006/> Although treatments can remove warts, they do not remove the HPV, so warts can recur after treatment (about 50–73% of the time<ref name=CDC2004>CDC. (2004). [https://www.cdc.gov/std/HPV/2004HPV%20report.pdf REPORT TO CONGRESS: Prevention of Genital Human Papillomavirus Infection].</ref>). Warts can also spontaneously regress (with or without treatment).<ref name=OpenAccess2006/>

Traditional theories postulated that the virus remained in the body for a lifetime. However, studies using sensitive DNA techniques have shown that through [[immunological response]], the virus can either be cleared or suppressed to levels below what [[polymerase chain reaction]] (PCR) tests can measure. One study testing genital skin for subclinical HPV using PCR found a prevalence of 10%.<ref name=OpenAccess2006>{{cite journal |vauthors=Scheinfeld N, Lehman DS |title=An evidence-based review of medical and surgical treatments of genital warts |journal=Dermatol. Online J. |volume=12 |issue=3 |page= 5 |year=2006 |pmid=16638419 |url=http://dermatology.cdlib.org/123/reviews/warts/scheinfeld.html}}</ref>

==Etymology==
A ''condyloma acuminatum'' is a single genital wart, and ''condylomata acuminata'' are multiple genital warts. The word roots mean 'pointed wart' (from Greek κόνδυλος 'knuckle', Greek -ωμα ''[[wikt:-oma|-oma]]'' 'disease', and Latin ''[[wikt:acuminatus|acuminatum]]'' 'pointed'). Although similarly named, it is not the same as [[condylomata lata|condyloma latum]], which is a complication of secondary [[syphilis]].{{citation needed|date=May 2021}}

==References==
{{reflist|30em}}

== External links ==
{{Medical resources
|  ICD11 = {{ICD11|1A95}}
|  ICD10 = {{ICD10|A|63|0|a|50}}
|  ICD9 = {{ICD9|078.11}}
|  ICDO =
|  OMIM =
|  DiseasesDB = 29120
|  MedlinePlus = 000886
|  eMedicineSubj = derm
|  eMedicineTopic = 454
|  eMedicine_mult = {{eMedicine2|med|1037}}
}}

{{Viral cutaneous conditions}}
{{Human papillomavirus}}{{STD and STI}}

{{DEFAULTSORT:Genital Wart}}
[[Category:Infections with a predominantly sexual mode of transmission]]
[[Category:Papillomavirus-associated diseases]]
[[Category:Virus-related cutaneous conditions]]
[[Category:Infectious causes of cancer]]
[[Category:Wikipedia medicine articles ready to translate]]