Clinical Types of Ano-Genital Warts: HPV Infection Manifestations

Jun 13, 2010
Hanish Babu

Papular Genital Warts on Glans Penis - Dr.Hanish Babu, MD

There are different clinical types of ano-genital warts, the commonest sexually transmitted disease of viral origin caused by the human papilloma virus.

More than 120 different genotypes of human papilloma virus are known, out of which around 50 of these are known to cause warts in the anogenital area. HPV 6 and 11 are the commonest HPV associated with anogenital warts.

Anogential warts and condyloma acuminata are used synonymously by most authorities, though clinically condyloma acuminata is only a variant of anogenital warts.

How Common are Anogenital Warts?

It is estimated that up to 30-50% of adults in the sexually active group are infected with HPV, though only 1-2% of these develop clinically apparent warts in the anogenital region. This means that sub clinical infection (where the virus is present within the skin and probably infectious without outwards disease expression) is quite common with the HPV.

The commonest age group affected with anogenotal warts is 19-22 years in women and 22-26 years in men. Anogenital warts are quite rare in children, and, if present, sexual abuse has to be ruled out in such cases.

Are Anogenital Warts Dangerous?

The majority of types of HPV that cause anogenital warts are harmless. Some types of HPV like the HPV 16 and 18 are associated with genital cancers, especially that of the cervix in females and glans penis in males.

It is still debatable whether treatment of anogenital warts actually reduces the incidence of malignancies in the affected. This is mainly due to the subclinical infections which may go undetected and untreated for a long period of time.

What are the Different Types of Ano-genital Warts?

Anogenital warts can be classified in different types according to the clinical appearances. These are condyloma acuminata, papular warts, keratotic warts, and flat topped papular warts.

Anogenital warts can also be classified as perianal warts, penile warts, vulvar warts, vaginal warts, urethral warts, prepucial warts and cervical warts depending upon the site of involvement.

Condyloma acuminata are pedunculated, cauliflower like growths which can sometimes grow to huge sizes, known as the giant condyloma acuminata of Buschke and Lowenstein. These may be flesh colored or grayish white and are mostly present in the moist mucous epithelium of the genital area.
Papular warts present as dome-shaped brownish or skin-colored bumps and are present on the skin of the genitals.
Keratotic anogenital warts resemble common warts elsewhere on the body. These and the flat topped papules, which are slightly raised bumps, appear on the shaft of the penis, vulva or around the perineal area.
Another type of anogenital wart, the Bowenoid papulosis, presents as darkly pigmented, dome shaped, smooth and flat topped bumps. These are mainly caused by HPV 16 and have a tendency for malignant changes. In males these appear on the shaft and glans of the penis while in females labia majora and minora, inguinal folds and the perianal skin are commonly affected.

Treatment preferences differ for different types of ano-genital warts. Freezing with liquid nitrogen (cryotherapy) and application of TCA (trichlor acetic acid) are more suitable to get rid of fleshy, pedunculated condyloma acuminata, while electrocautery is preferred for the firm, papular and keratotic genital warts and bowenoid papulosis.

Clinical Types of Ano-Genital Warts : Related Articles

References:

Usman N. Anogenital Warts in Sexually Transmitted Diseases and AIDS. Ed.Sharma VK, Viva Books, New Delhi, 2003
Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, neither Dr. Hanish Babu, MD nor Suite101 will be responsible for any consequences. The images provided are for illustration purpose only

Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...