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Clinical Summary

Genital warts are caused by human papillomavirus (HPV). Typical eruptions are flesh-colored with a cauliflower-like appearance, but they may also be flat, sessile, or pedunculated. They can develop anywhere in the anogenital area. Although usually asymptomatic, they may be pruritic. They range in size from a few millimeters to several centimeters.

Management and Disposition

Genital warts typically do not require emergent treatment, and patients may be referred for outpatient follow-up. Almost half of lesions will resolve without treatment, usually over the course of several months. Topical caustic agents can be prescribed if treatment is initiated in the emergency department. Options include imiquimod cream (applied three times weekly for up to 16 weeks), podophyllotoxin (applied twice daily for 3 days followed by no therapy for 4 days; repeat cycle up to four times), and sinecatechins (applied three times daily for up to 16 weeks).

FIGURE 9.31

Genital Warts—Female. Verrucous lesions of the posterior fourchette in a patient with condyloma acuminata. (Photo contributor: H. Hunter Handsfield, MD. From Handsfield HH, ed. Atlas of Sexually Transmitted Diseases, 3rd ed. New York, NY: McGraw Hill; 2011.)

FIGURE 9.32

Genital Warts—Male. Typical appearance of condyloma acuminata of the penis. (Reproduced with permission from Morse SA, Holmes KK, Ballard RC, Moreland AA, eds. Atlas of Sexually Transmitted Diseases and AIDS. 4th ed. Saunders Elsevier; 2010. Copyright © 2010 Elsevier, Ltd.)

FIGURE 9.33

Genital Warts—Male. Cauliflower-like appearance of condyloma acuminata of the foreskin of this uncircumcised male. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 9.34

Perianal Condyloma Acuminata. Multiple perianal pedunculated warts are seen in this patient. (Photo contributor: Larry B. Mellick, MD.)

FIGURE 9.35

Giant Warts—Female. Extensive condyloma acuminata in a female. (Photo contributor: Hope Haefner, MD.)

FIGURE 9.36

Genital Warts—Child. Condyloma in female child should raise suspicion for sexual abuse. (Photo contributor: Hope Haefner, MD.)

FIGURE 9.37

Giant Warts—Male. Giant warts in a male patient with extensive condyloma acuminata. (Reproduced with permission from Wisdom A. A Colour Atlas of Sexually Transmitted Diseases. London, United Kindom: Mosby-Wolfe Ltd; 1992. Copyright © Elsevier)

FIGURE 9.38

Genital Wart. Single verrucous eruption of condyloma acuminata in the perianal area. (Photo contributor: Lawrence B. Stack.)

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