GPAtlas🧭 When to suspect
Anogenital warts (AGW) are benign epithelial growths caused by the human papillomavirus (HPV).
• Around 90% are caused by the low-risk types HPV 6 and 11.
• AGW remain one of the most commonly diagnosed STIs in the UK, although incidence has fallen sharply in vaccinated cohorts.
Suspect them in any patient reporting new lumps or growths on or around the genitals or anus:
• Single or multiple
• Soft or keratinised, flesh-coloured or pigmented
• Usually up to 5 mm
• Often asymptomatic but sometimes itchy, bleeding or uncomfortable
Transmission is usually by skin-to-skin sexual contact, and occurs even when no warts are visible.
The interval between infection and visible warts is highly variable – a median of roughly 3 months in women and 11 months in men, but sometimes over a year – so the appearance of warts is not evidence of recent infidelity.
Consider AGW more strongly with:
• Condomless sex
• New or multiple partners
• Immunosuppression (HIV, transplant, immunomodulators)
In practice:
• Recognise the lesion
• Exclude the few sinister mimics
• Offer a full STI screen
• In almost all cases, refer to a sexual health (GUM) service, while remembering that treatment clears the warts but does not eradicate the virus
| Morphological type | Typical appearance (and treatment relevance) |
|---|---|
| Condylomata acuminata | • Flesh-coloured, soft, exophytic “cauliflower” lesions – the classic genital wart • Respond well to topical agents |
| Keratotic warts | Thickened, horny papules on dry, keratinised skin – often better suited to ablative therapy. |
| Papular warts | Small, smooth, dome-shaped papules. |
| Flat (macular) warts | Flat or barely raised lesions – easily overlooked on inspection. |
Source: BASHH 2024
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