Vulvar Disease pp 107-117 | Cite as

Genital Condyloma (HPV Infection)

  • Eduardo SchejterEmail author


Genital warts (condyloma acuminata) are very common. They are sexually transmitted. Ninety percent are caused by types 6 and 11 of the human papilloma virus (HPV). The epidemiology, clinical presentation, differential diagnosis, treatment, and prevention by HPV vaccine are presented.


  1. 1.
    Oriel JD. Natural history of genital warts. 1971. Sex Transm Infect. 2000;76(Suppl 1):S21.PubMedGoogle Scholar
  2. 2.
    Tay SK. Genital oncogenic human papillomavirus infection: a short review on the mode of transmission. Ann Acad Med Singap. 1995;24(4):598–601.PubMedGoogle Scholar
  3. 3.
    Pao CC, Tsai PL, Chang YL, Hsieh TT, Jin JY. Possible non-sexual transmission of genital human papillomavirus infections in young women. Eur J Clin Microbiol Infect Dis. 1993;12(3):221–2.CrossRefGoogle Scholar
  4. 4.
    Sonnex C, Strauss S, Gray JJ. Detection of human papillomavirus DNA on the fingers of patients with genital warts. Sex Transm Infect. 1999;75(5):317–9.CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med. 1997;102:3–8.CrossRefGoogle Scholar
  7. 7.
    World Health Organization. WHO Office of Information. Sexually transmitted infections increasing—250 million new infections annually. WHO Feature. 1990;152:1–6.Google Scholar
  8. 8.
    Shavit O, Raz R, Stein S, Chodick G, Schejter E, Cohen R, Shalev V. Evaluating the epidemiology and morbidity burden associated with human papillomavirus in Israel: accounting for CIN1 and genital warts in addition to CIN 2/3 and cervical cancer. Appl Health Econ Health Policy. 2012;10(2):87–97.CrossRefGoogle Scholar
  9. 9.
    Insinga RP, Dasbach EF, Myers ER. The health and economic burden of genital warts in a set of private health plans in the United States. Clin Infect Dis. 2003;36(11):1397–403.CrossRefGoogle Scholar
  10. 10.
    Koutsky LA, Galloway DA, Holmes KK. Epidemiology of genital human papillomavirus infection. Epidemiol Rev. 1988;10:122–63.CrossRefGoogle Scholar
  11. 11.
    Handsfield HH. Clinical presentation and natural course of anogenital warts. Am J Med. 1997;102(5A):16–20.CrossRefGoogle Scholar
  12. 12.
    Kjaer SK, Tran TN, Sparen P, Tryggvadottir L, Munk C, Dasbach E, Liaw KL, Nygård J, Nygård M. The burden of genital warts: a study of nearly 70,000 women from the general female population in the 4 Nordic countries. J Infect Dis. 2007;196(10):1447–54.CrossRefGoogle Scholar
  13. 13.
    Hansen BT, Kjaer SK, Munk C, Tryggvadottir L, Sparén P, Hagerup-Jenssen M, Liaw KL, Nygård M. Early smoking initiation, sexual behavior and reproductive health – a large population-based study of Nordic women. Prev Med. 2010;51(1):68–72.CrossRefGoogle Scholar
  14. 14.
    Schiffman M, Castle PE. Human papillomavirus: epidemiology and public health. Arch Pathol Lab Med. 2003;127:930–4.PubMedGoogle Scholar
  15. 15.
    Longworth MS, Laimins LA. Pathogenesis of human papillomaviruses in differentiating epithelia. Microbiol Mol Biol Rev. 2004;68(2):362–72.CrossRefGoogle Scholar
  16. 16.
    Chiasson MA, Ellerbrock TV, Bush TJ, Sun XW, Wright TC Jr. Increasedprevalence of vulvovaginal condyloma and vulvar intraepithelial neoplasia inwomen infected with the human immunodeficiency virus. Obstet Gynecol. 1997;89(5 Pt 1):690–4.CrossRefGoogle Scholar
  17. 17.
    Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110.PubMedGoogle Scholar
  18. 18.
    Cook LS, Koutsky LA, Holmes KK. Clinical presentation of genital warts amon circumcised and uncircumcised heterosexual men attending an urSTD clinic. Genitourin Med. 1993;69:262–4.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Sonnex C, Schofield JH, Kocjan G, et al. Anal human papillomavirus infection in heterosexuals with genital warts: prevalence and relation with sexual behaviour. Br Med J. 1991;303:1243.CrossRefGoogle Scholar
  20. 20.
    Lacey CJ, Woodhall SC, Wikstrom A, Ross J. 2012 European guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol. 2013;27(3):e263–70.CrossRefGoogle Scholar
  21. 21.
    Armstrong N, Foley G, Wilson J, Finan P, Sebag-Montefiore D. Successful treatment of a large Buschke-Lowenstein tumour with chemo-radiotherapy. Int J STD AIDS. 2009;20(10):732–4.CrossRefGoogle Scholar
  22. 22.
    Drolet M, Brisson M, Maunsell E, Franco EL, Coutlée F, Ferenczy A, Ratnam S, Fisher W, Mansi JA. The impact of anogenital warts on health-related quality oflife: a 6-month prospective study. Sex Transm Dis. 2011;38(10):949–56.CrossRefGoogle Scholar
  23. 23.
    Meisels A. Cytologic diagnosis of human papillomavirus. Influence of age and pregnancy stage. Acta Cytol. 1992;36(4):480–2.PubMedGoogle Scholar
  24. 24.
    Silverberg MJ, Thorsen P, Lindeberg H, Grant LA, Shah KV. Condyloma inpregnancy is strongly predictive of juvenile-onset recurrent respiratory papillomatosis. Obstet Gynecol. 2003;101(4):645–52.PubMedGoogle Scholar
  25. 25.
    Workowski KA. Centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2015;61(Suppl 8):S759–62.CrossRefGoogle Scholar
  26. 26.
    Blomberg M, Friis S, Munk C, Bautz A, Kjaer SK. Genital warts and risk of cancer: a Danish study of nearly 50,000 patients with genital warts. J Infect Dis. 2012;205(10):1544–53.CrossRefGoogle Scholar
  27. 27.
    Tyring SK. Molluscum contagiosum: the importance of early diagnosis and treatment. Am J Obstet Gynecol. 2003;189(3 Suppl):S12–6.CrossRefGoogle Scholar
  28. 28.
    Ambros RA, Malfetano JH, Carlson JA, Mihm MC Jr. Non-neoplastic epithelial alterations of the vulva: recognition assessment and comparisons of terminologies used among the various specialties. Mod Pathol. 1997;10(5):401–8.PubMedGoogle Scholar
  29. 29.
    Hoang LN, Park KJ, Soslow RA, Murali R. Squamous precursor lesions of the vulva: current classification and diagnostic challenges. Pathology. 2016;48(4):291–302.CrossRefGoogle Scholar
  30. 30.
    Lacey CJ, Goodall RL, Tennvall GR, Maw R, Kinghorn GR, Fisk PG, Barton S, Byren I, Perstop Pharma Genital Warts Clinical Trial Group. Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts. Sex Transm Infect. 2003;79(4):270–5.CrossRefGoogle Scholar
  31. 31.
    Haidopoulos D, Diakomanolis E, Rodolakis A, Vlachos G, Elsheikh A, Michalas S. Safety and efficacy of locally applied imiquimod cream 5% for the treatment of condylomata acuminata of the vulva. Arch Gynecol Obstet. 2004;270(4):240–3.CrossRefGoogle Scholar
  32. 32.
    Tatti S, Stockfleth E, Beutner KR, Tawfik H, Elsasser U, Weyrauch P, Mescheder A. Polyphenon E: a new treatment for external anogenital warts. Br J Dermatol. 2010;162(1):176–84.CrossRefGoogle Scholar
  33. 33.
    Tzellos TG, Sardeli C, Lallas A, Papazisis G, Chourdakis M, Kouvelas D. Efficacy, safety and tolerability of green tea catechins in the treatment ofexternal anogenital warts: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2011;25(3):345–53.CrossRefGoogle Scholar
  34. 34.
    Ting PT, Dytoc MT. Therapy of external anogenital warts and molluscum contagiosum: a literature review. Dermatol Ther. 2004;17:68–101.CrossRefGoogle Scholar
  35. 35.
    Andrews MD. Cryosurgery for common skin conditions. Am Fam Physician. 2004;69(10):2365–72.PubMedGoogle Scholar
  36. 36.
    Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloracetic acid. Sex Transm Dis. 1993;20:344–5.CrossRefGoogle Scholar
  37. 37.
    Yanofsky VR, Patel RV, Goldenberg G. Genital warts: a comprehensive review. J Clin Aesthet Dermatol. 2012;5(6):25–36.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Mayeaux EJ Jr, Dunton C. Modern management of external genital warts. J Low Genit Tract Dis. 2008;12(3):185–92. Review.CrossRefGoogle Scholar
  39. 39.
    Donovan B, Franklin N, Guy R, et al. Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data. Lancet Infect Dis. 2011;11:39.CrossRefGoogle Scholar
  40. 40.
    Joura EA, Garland SM, Paavonen J, Ferris DG, Perez G, Ault KA, Huh WK, Sings HL, James MK, Haupt RM, Future I and II Study Group. Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data. BMJ. 2012;344:e1401.CrossRefGoogle Scholar
  41. 41.
    Luna J, Plata M, Gonzalez M, Correa A, Maldonado I, Nossa C, Radley D, Vuocolo S, Haupt RM, Saah A. Long-term follow-up observation of the safety, immunogenicity, and effectiveness of Gardasil™ in adult women. PLoS One. 2013;8(12):e83431.CrossRefGoogle Scholar
  42. 42.
    Giuliano A, et al. Presented at: 25th International Papillomavirus Conference. May 2009. Abstract 0-01.07.Google Scholar
  43. 43.
    Garland SM, Kjaer SK, Muñoz N, Block SL, Brown DR, DiNubile MJ, Lindsay BR, Kuter BJ, Perez G, Dominiak-Felden G, Saah AJ, Drury R, Das R, Velicer C. Impact and effectiveness of the quadrivalent human papillomavirus vaccine: a systematic review of 10 years of real-world experience. Clin Infect Dis. 2016;63(4):519–27.CrossRefGoogle Scholar
  44. 44.
    Joura EA, Giuliano AR, Iversen OE, Bouchard C, Mao C, Mehlsen J, Moreira ED Jr, Ngan Y, Petersen LK, Lazcano-Ponce E, Pitisuttithum P, Restrepo JA, Stuart G, Woelber L, Yang YC, Cuzick J, Garland SM, Huh W, Kjaer SK, Bautista OM, Chan IS, Chen J, Gesser R, Moeller E, Ritter M, Vuocolo S, Luxembourg A, Broad Spectrum HPV Vaccine Study. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015;372(8):711–23.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Women’s Health Center, Maccabi Healthcare ServicesTel AvivIsrael

Personalised recommendations