Genital Warts human papilloma virus human papillomavirus More than 30 types of HPV can infect the genital tract , human papillomavirus , human papilloma virusMost HPV infections are asymptomatic, unrecognized, or subclinical , human papillomavirus , human papilloma virusVisible genital warts usually are caused by HPV types 6 or 11 , human papillomavirus , human papilloma virus11 , human papillomavirus , human papilloma virusOther HPV types in human papilloma virus the anogenital region (e.g., types 16, 16, 18, 31, 33, and 35) have been strongly associated with cervical neoplasia , human papillomavirus , human papilloma virusDiagnosis of genital warts can be confirmed by biopsy, although biopsy biopsy is needed only under certain circumstances (e.g., if human papilloma virus human papillomavirus the diagnosis is uncertain; the lesions do not respond to standard therapy; the disease worsens worsens during therapy; human papillomavirus the patient is immunocompromised; or warts are pigmented, pigmented, indurated, fixed, and ulcerated) human papilloma virus , human papillomavirus , human papilloma virusNo data support the use of type-specific HPV nucleic acid tests in the routine diagnosis or management of visible genital warts , human papillomavirus , human papilloma virus In addition to the external genitalia genitalia (i.e., human human papilloma virus human papillomavirus the penis, vulva, scrotum, perineum, and perianal skin) , genital warts can occur on the uterine cervix and in the vagina, urethra, anus, and mouth; these warts are sometimes symptomatic , human papillomavirus , human papilloma virusIntra-anal warts warts human papilloma virus are seen predominantly in patients who have had receptive anal intercourse; these these warts human papillomavirus are distinct from perianal warts, which can occur in men and women who do not have a history of anal anal sex , human papillomavirus , human papilloma virusIn addition to human papilloma virus the genital area, HPV types 6 and 11 have been associated with conjunctival, nasal, oral, and laryngeal warts , human papillomavirus , human papilloma virusHPV types 6 6 and 11 rarely human papillomavirus are associated with invasive squamous squamous cell carcinoma of human papilloma virus the external genitalia , human papillomavirus , human papilloma virusDepending on the size and anatomic location, genital warts can be painful, friable, and pruritic, although they are commonly asymptomatic , human papillomavirus , human papilloma virus HPV types 16, 18, 31, 33, 33, and 35 human papilloma papilloma virus human papillomavirus are found occasionally in visible genital warts and have been associated with external genital (i.e., vulvar, penile, and anal) squamous intraepithelial neoplasia (i.e., squamous cell carcinoma in situ, bowenoid papulosis, Erythroplasia Erythroplasia of Queyrat, or Bowen's disease of human papilloma virus the genitalia) , human papillomavirus , human papilloma virusThese HPV types also have have been associated with vaginal, anal, and cervical intraepithelial dysplasia and squamous cell carcinoma , human papillomavirus , human papilloma virusPatients who have visible genital warts warts can be infected simultaneously with multiple HPV types , human papillomavirus , human papilloma virushuman papilloma virus human papillomavirus Treatment The primary goal of treating visible genital warts is the removal of symptomatic warts , human papillomavirus , human papilloma virusIn most most patients, treatment can induce wart-free periods , human papillomavirus , human papilloma virusperiods , human papillomavirus , human papilloma virusIf left untreated, visible genital warts may resolve on their own, remain unchanged, or increase in size or number , human papillomavirus , human papilloma virusDetermining whether treatment of genital warts will reduce transmission is difficult, because no laboratory human papilloma virus laboratory marker of infectivity has been established human papillomavirus established and because clinical studies evaluating human papilloma virus human papillomavirus the persistence of HPV DNA in genital tissue after treatment have shown variable results , human papillomavirus , human papilloma virusExisting data indicate that currently available therapies for for genital warts may reduce, but probably do not eradicate, infectivity , human papillomavirus , human papilloma virusWhether human papilloma virus the reduction in viral DNA DNA human papillomavirus that results from current treatment regimens impacts future transmission remains unclear , human papillomavirus , human papilloma virusNo evidence indicates that either the human papilloma virus the presence of genital warts or their treatment is associated with the development of cervical cancer , human papillomavirus , human papilloma virus Regimens Treatment of genital warts should be guided by the preference of of human papillomavirus the patient, the available available resources, and human papilloma virus the experience of the health-care provider , human papillomavirus , human papilloma virusNo definitive evidence suggests that any of the available treatments is superior to the others, and no single treatment is ideal for all patients or or all warts , human papillomavirus , human papilloma virushuman papilloma virus The use of of locally developed and monitored treatment algorithms has been associated with improved clinical outcomes and should be encouraged , human papillomavirus , human papilloma virusBecause of uncertainty regarding human papillomavirus the effect of treatment on future transmission transmission and human papilloma virus the possibility for spontaneous resolution, an acceptable alternative for some patients is to forego treatment and await await spontaneous resolution , human papillomavirus , human papilloma virushuman papillomavirus Most patients have <10 genital warts, with a total wart area of of 0.5--1.0 cm2 , human papillomavirus , human papilloma virusThese warts respond to most treatment modalities , human papillomavirus , human papilloma virusFactors human papilloma virus that may influence selection of treatment include wart size, wart number, anatomic site of wart, wart morphology, patient preference, cost of of treatment, convenience, convenience, adverse effects, and provider experience , human papillomavirus , human papilloma virusMany patients require a course of therapy rather than a single treatment , human papillomavirus , human papilloma virusIn general, warts located on moist surfaces and/or in intertriginous areas respond better to topical treatment human papilloma virus treatment than do warts on drier surfaces , human papillomavirus , human papilloma virushuman papilloma virus human papillomavirus |