Anogenital warts (condylomata acuminata)

Definition

• Anogenital warts (condylomata acuminata) are the clinical manifestation of a sexually transmitted infection with certain HPV types.

Occurrence & epidemiology

Epidemiology

• HPV is the most common sexually transmitted infection; most HPV infections clear spontaneously within 1–2 years.
• About 90 % of those who contract HPV do not develop genital warts.

Aetiopathogenesis

Aetiology and risk factors

• HPV types 6 and 11 cause about 90 % of genital warts; condylomas are benign, and the HPV types that cause cervical or anal cancer are different ones.
• Transmission occurs through direct skin-to-skin contact with an infected person, usually during sex.
• With reduced cell-mediated immunity, for example in pregnancy or HIV infection, genital warts may persist and spread widely.

Clinical features

Condylomata on the cervix

• Causative agents: HPV 6 and 11.
• At colposcopy they appear acetowhite with pointed, finger-like projections.

Condylomata on the vulva

• Pathogen: Condylomata acuminata are caused by low-risk HPV types, mainly 6 and 11.

• Warts appear after an incubation period of 1–6 months; in women they occur most commonly on the vulva, vaginal wall, cervix and perineum, and the urethra and anal region may also be affected.
• Lesions are papular, verrucous or sessile, flat or exophytic, and may coalesce into cauliflower-like plaques; they range from millimetre-sized papules to centimetre-sized masses and may bleed with friction.
• They are usually asymptomatic; some patients have itching, burning or discomfort.

Histology

• Histologically, HPV-related lesions show papillomatosis and koilocytosis.

Diagnosis

Typical imaging findings

• Colposcopy: A whitish, finely papillary, cauliflower-like growth with a lobulated surface sits on the cervix. It is soft, not ulcerated and does not bleed spontaneously; the surrounding epithelium is normal.
• Clinical finding: Numerous small, pointed, soft skin-coloured papules stand in beds perineally and perianally; some are cauliflower-like and lobulated. The surroundings are quiet, with no ulceration or induration.
• Clinical finding: A firm, verrucous exophytic growth with a fissured, partly crusted surface sits on the labium majus. It is clearly larger and firmer than ordinary condylomas and grows in depth; the surrounding tissue is displaced.
• Clinical finding: A palm-sized, cauliflower-like growth made of densely packed reddish fronds surrounds the anus. It grows on a broad base and pushes the surrounding skin apart; the surface is macerated but not ulcerated.

• The diagnosis is usually made by visual inspection.
• In atypical, bleeding, ulcerated or persistent warts, a biopsy serves to exclude carcinoma.
• After application of 3–5 % acetic acid, lesions turn white, which makes even small lesions easier to detect at colposcopy.

Keep learning in the app

Further reading (selection)

1. StatPearls: Condylomata Acuminata (Genital Warts) (NCBI Bookshelf)
2. MSD Manual Professional: Human Papillomavirus (HPV) Infection
3. Viral Infections of the Vulva: A Narrative Review (Life 2025, PubMed Central)
4. DocCheck Flexikon, Ektopie & Kondylome
5. DocCheck Flexikon, Bartholinitis

Cross-references