Medical Disorders Network

How do you get genital warts is always the first question that most ask. Skin-to-skin contact with productive lesions that are shedding HPV DNA is the main way genital HPV is transmitted. It enters a person’s tissue through inflamed and macerated skin or through microscopic abrasions during sexual intercourse.

It appears likely that transmission can occur even when there are no lesions because tests have detected HPV DNA during asymptomatic infection periods. HPV transmission, according to  2001 Update in STDs, occurs via sexual contact in the majority of adults; little is known about the mechanics
of inoculation; two-thirds of partners have disease after an average incubation period of two to three months; the role of fomites remains unknown for genital HPV; and autoinoculation from nongenital warts in adults is rare.

Although the EGW incubation period can be one month to two years, typically warts appear about two to four months after exposure to HPV, or the infection remains latent or subclinical. In some experts’ belief, latent HPV infection lasts throughout the lifetime of the infected person, remaining in the epithelial cells.

Genital warts that are untreated may regress, remain the same, or increase in size. About one- fifth of those with EGWs see the lesions resolve spontaneously—typically, within a year of their appearance. Although these are unsightly, most are benign.

The strains of HPV most likely to result in cancer usually produce only macular warts that are hard to detect unless viewed colposcopically. A controversial theory being advanced in some circles is that HPV can be transmitted nonsexually. This could mean that an individual can contract genital warts from fomites or from perinatal or digital transmission (via a person’s fingers or hand). If this does turn out to be true, nonsexual transmission would explain some of the infections seen in children that are currently being attributed to sexual abuse.

It seems clear that cell-mediated immunity has a major role in containment of this infection, especially considering the course the infection takes in HIV/AIDS patients and transplant patients, who have a high rate of wart recurrence.

EGWs usually can be seen with the naked eye.

Describing four kinds of lesions in a 1998 report, the American Medical Association Expert Panel on
EGWs lists:

1. Condyloma acuminata in cauliflower shapes, usually on moist surfaces
2. Papular warts that are dome-shaped, flesh-colored, smaller than 4 mm, and appear on keratinized skin
3. Keratotic warts with a thick, horny layer, which look like common nongenital warts and occur
on fully keratinized skin
4. Flat-topped papules that are macular or slightly raised and are seen on moist partially keratinized or fully keratinized skin

Those patients with EGWs who have symptoms report itching, burning, pain, bleeding, and painful
intercourse. Doctors usually diagnose external warts by direct visual examination, using a bright light and handheld magnifying glass. The colposcope is used for detecting cervical and vaginal warts.