Table of contents
Anogenital warts
What's new
Updated 2024 EAU guidelines for the management of anogenital warts.
Background
Overview
Definition
Anogenital warts, also known as condylomata acuminata, are a STI caused by certain strains of the HPV, primarily HPV genotypes 6 and 11.
1
Pathophysiology
The pathophysiology of anogenital warts involves the transmission of HPV through sexual contact, leading to the infection of squamous epithelial cells in the anogenital region. The virus causes these cells to proliferate excessively, resulting in the formation of warts.
1
Epidemiology
The incidence of anogenital warts is estimated at 160-289 per 100,000 person-years worldwide.
2
Disease course
Clinically, anogenital warts present as growths on the skin or mucous membranes of the anogenital area. They can vary in size and shape, ranging from flat to raised, small to large, and singular to multiple. Some warts may be asymptomatic, while others can cause symptoms such as itching, discomfort, or bleeding.
1
3
Prognosis and risk of recurrence
The prognosis of anogenital warts is generally good as they are usually benign. However, they can recur after treatment, and certain high-risk HPV strains can lead to malignancies, such as SCC.
1
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of anogenital warts are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2024), the Center for Disease Control (CDC 2021,2019), the International Union Against Sexually Transmitted Infections (IUSTI 2020), the American College of Obstetricians and Gynecologists (ACOG 2017), and the American Society of Colon...
Show more
Diagnostic investigations
Physical examination: as per CDC 2021 guidelines, Consider performing inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy in patients with external anal warts, as they might also have intra-anal warts.
E
More topics in this section
Screening for STIs
Screening for cervical cancer
Assessment of sexual partners
Diagnostic procedures
Medical management
Imiquimod: as per EAU 2024 guidelines, Offer self-administered imiquimod 5% cream, applied to all external warts overnight thrice weekly for 16 weeks, for the treatment of anogenital warts.
A
More topics in this section
Podophyllotoxin
Sinecatechins
Trichloracetic acid
5-FU
Management of internal involvement (intra-anal)
Management of internal involvement (urethral)
Management of internal involvement (vaginal)
Management of internal involvement (cervical)
Nonpharmacologic interventions
Therapeutic procedures
Intralesional interferon injection: as per IUSTI 2020 guidelines, Consider offering intralesional interferon injections in patients with refractory anogenital warts.
B
More topics in this section
Cryotherapy
Photodynamic therapy
Perioperative care
Surgical interventions
Surgical excision: as per EAU 2024 guidelines, Offer surgical management (excision, electrosurgery, electrocautery, or laser therapy) of anogenital warts based on an informed discussion with the patient.
A
More topics in this section
Male circumcision
Specific circumstances
Patient education
Patient education
As per IUSTI 2020 guidelines:
Provide patients with a detailed explanation of their condition, including advice about onward transmission,
B
and offer them clear and accurate written information. B
Advise on condom use when either partner has genital warts until resolution of lesions,
A
while informing them that condoms offer only partial protection against onward transmission. B