Warts - Anogenital

Anogenital warts, also known as condyloma acuminata, are benign epithelial proliferations caused by infection with the human papillomavirus (HPV), primarily transmitted through sexual contact. They commonly affect the vulva, vagina, cervix, penis, scrotum, perineum, and perianal regions.

Definition

Epidemiology

One of the most common sexually transmitted infections worldwide
Caused mainly by HPV types 6 and 11 (low-risk, non-oncogenic types)
Peak incidence in sexually active adults aged 18–35 years
Increased risk with multiple sexual partners and unprotected intercourse
HPV vaccination has reduced incidence in countries with widespread immunization

Etiology

Human papillomavirus (HPV), primarily types 6 and 11 (low-risk types)
High-risk HPV types (16, 18, 31, 33) associated with intraepithelial neoplasia and malignancy but may coexist
Transmission via direct skin-to-skin or mucosal contact during vaginal, anal, or oral sex
Autoinoculation possible through scratching or shaving infected areas
Risk factors: early sexual activity, multiple partners, immunosuppression (HIV, corticosteroid therapy), lack of vaccination

Pathophysiology

HPV infects basal epithelial cells through microabrasions in the skin or mucosa
Viral DNA integrates into host cells, leading to hyperproliferation of keratinocytes
Low-risk HPV types remain episomal and cause benign lesions; high-risk types may integrate and induce dysplasia
Lesions appear weeks to months after infection
Immunosuppression increases persistence and recurrence rates