Abstract
Jack is an 18-year-old student. He attends your surgery complaining of sore and itchy ‘lumps’ on the shaft of his penis. He has been reluctant to seek help as he feels embarrassed. Several of the lumps have started to bleed, and this has finally nudged him to make an appointment.
Dr P. Marazzi/Science Photo Library.
This is genital warts
Genital warts are a common sexually transmitted infection (STI). The highest incidence occurs in those aged between 16 and 25 years old. Genital warts are caused by human papillomavirus (HPV) infection, most commonly HPV types 6 and 11. The warts may occur anywhere on the genital or anal area, including the mucosal surfaces. They tend to look like superficial verrucous papules. Their colour can vary from white to flesh coloured.
Genital warts are highly contagious. In most cases, the mode of transmission is sexual contact. However, they may rarely be transmitted from hand warts or peri-natally.
They are seen far less commonly in people who have been vaccinated against the benign HPV types in childhood before beginning sexual activity. Patients who are immunocompromised are particularly vulnerable to acquiring HPV and therefore developing genital warts. In some, it may be the first indication of an underlying human immunodeficiency virus (HIV) infection.
Diagnosis can usually be made clinically. Lesions are painful and itchy, and sometimes bleed. An assessment should include taking a brief sexual history, and an examination of the anogenital skin. In women, a vaginal examination should also be completed. A biopsy is only needed in a minority of cases if the lesion looks atypical.
For anyone presenting with genital warts, a referral to a sexual health clinic is advisable to ensure a full sexual health screen is completed. This is particularly important for people who are immunocompromised, woman who are pregnant and for children (where the potential of sexual abuse should be considered).
Generally, treatment of genital warts is initiated by a sexual health specialist. Usually, several options are available depending on patient preference, and the site, location and size of the lesions. Treatment choices include self-applied topical therapy (for example, podophyllotoxin 0.5% solution) and ablative methods (for example, cryotherapy). Given that around one-third of warts resolve spontaneously within 6 months, a reasonable plan may also be to opt for no treatment at all. Recurrence of genital warts is common, and there is no cure. The aim of treatment is primarily to eliminate the visible lesions.
ORCID iD
Dr Charlotte Sidebotham https://orcid.org/0000-0002-7269-2734