Genital warts are a cutaneous manifestation of infection with the epidermotropic, sexually transmitted human papillomavirus (HPV). There are >one hundred of those double-stranded-DNA papovaviruses characterised, with most now totally DNA-sequenced.

HPV is transmitted sexually in most cases however will also be transmitted prenatally, by autoinoculation or heteroinoculation from non-genital warts and presumably by fomites.1
A private's lifetime risk of HPV infection exceeds fifty% but most are asymptomatically infected, with solely concerning one-two% developing genital warts.
About 90% of genital warts are caused by infection with HPV sorts six and 11. These types are not associated with a vital risk of neoplastic transformation.
Varieties sixteen and eighteen are related to a high risk of neoplastic transformation.

Epidemiology
Incidence

Genital warts are the most commonly diagnosed sexually transmitted infection (STI) within the UK. In 2003, there have been an estimated seventy six,457 initial and fifty five,657 recurrent or persistent cases of genital warts proscribed at a value of ?22.four million.
Risk factors

Smoking
Multiple sexual partners
Early age of onset of sexual intercourse
Illicit drug use
Anoreceptive intercourse
Manual sexual practices like fisting and fingering increase the chance of anal warts
Immunosuppression (together with iatrogenic selection in transplant recipients and HIV)

After an incubation period of several weeks to months (occasionally years), lesions appear which are sometimes painless and asymptomatic but that could itch, burn, bleed or discharge. Urethral lesions could cause distortion of the urinary stream.

A relevant sexual history should be obtained to assess the risk of different STIs and sexual health needs:

Alternative symptoms, e.g. urethral/vaginal discharge, pelvic or scrotal pain, intermenstrual or postcoital bleeding, dyspareunia
Sexuality within the last three months
Contraceptive and condom use
Possibility of pregnancy
HIV risk activities
Signs
Lesions are usually papular and pink, red or brown and might be single but often multiple. A variety of lesions could form a confluent mass. Over time the lesion might grow and become the classical florid warty appearance. They will become huge in immunocompromised patients.
Four varieties are seen:
Little papular
Cauliflower floret
Keratotic
Flat-topped papules or plaques (sometimes seen on the cervix)
In males, genital warts mainly appear on the frenulum, corona, glans, prepuce, shaft and scrotum.
In females, they have an inclination to be seen on the labia, clitoris, periurethral area and cervix.
Both sexes may be affected within the perineum, perianal area and anal canal.