- • Gray or flesh-colored, pedunculated, and moist
papules on the penis, urethra, vulva, cervix, anus, or perineal
and perianal areas.
- • One or several grouped lesions may be present,
ranging in size from a few millimeters to several centimeters.
- • Symptoms may include burning, itching, pain, and
fullness (urethra, vagina, or anus); however, many patients are
Human papillomavirus (HPV) is one of the most common sexually
transmitted diseases (STDs) and is the cause of genital warts (condylomata
acuminata), anogenital dysplasia, and invasive cancer. Oral warts
may also occur as a direct consequence of HPV infection during sexual
activity. At least 75% of sexually active men and women
acquire one or more genital HPV types at some point in their lifetime.
The incubation period from HPV infection to condyloma is usually 3–4
months, with a range of 1 month to 2 years, but many infected persons
have subclinical disease or have regression of disease before it
becomes clinically apparent. HIV-infected patients have a higher
prevalence of genital warts than HIV-uninfected patients. These
may proliferate further during immune reconstitution following the
initiation of antiretroviral therapy.
There are more than 100 different HPV types; 40 of these can
cause anogenital lesions. HPV types 6 and 11 are most commonly associated
with genital warts; these types have a low risk of malignant transformation.
Other types (eg, 16, 18, 31, 33, and 35) have a strong association
with cervical and other anogenital cancers. Thus, genital warts
lie on one spectrum of a continuum of HPV-associated disease, with
warts being one variant of low-grade disease that has little risk
of malignant potential. High-grade HPV-associated disease such as
cervical intraepithelial neoplasia (CIN) types 2 and 3 are likely
the direct precursors to invasive cancer and are the target of screening
programs that utilize the Papanicolaou (Pap) test.
Chin-Hong PV, Palefsky JM. Natural history and
clinical management of anal human papillomavirus disease in men
and women infected with human immunodeficiency virus. Clin Infect Dis
(Excellent review of anal HPV disease and HIV
Conley LJ, Ellerbrock TV, Bush TJ, et al. HIV-1 infection and
risk of vulvovaginal and perianal condylomata acuminata and intraepithelial
neoplasia: A prospective cohort study. Lancet
study showing that HIV-infected women may be 16 times more likely
to develop HPV-related anovaginal disease, including invasive vulvar
carcinoma, than HIV-uninfected women.)
Massad LS, Silverberg MJ, Springer G, et al. Effect of antiretroviral
therapy on the incidence of genital warts and vulvar neoplasia among
women with the human immunodeficiency virus. Am
J Obstet Gynecol
(Multicenter prospective study showing that warts
and vulvar intraepithelial neoplasia are common among women with
HIV infection, and highly active antiretroviral therapy decreased
Most anogenital HPV is believed to be acquired via sexual transmission.
Following acquisition of infection, HPV infection is established
initially in the ...