Genital human papillomavirus infections in adolescents: implications for evaluation and management

Genital infections caused by human papillomaviruses (HPV) have become the most prevalent sexually transmitted disease in the United States. Rates of infection with these agents are particularly high among adolescents. The most common clinical expression of genital HPV infection is condyloma acuminata, a condition that dermatologists are frequently called on to treat. The identification of external genital warts in a teenager raises questions that impact directly on the patient's evaluation and management. Issues of importance include the likelihood that occult infection exists at other sites in the genital tract, the risks associated with HPV infection, and the need, if any, for further diagnostic assessment, including that necessary to detect the presence of coexisting sexually transmitted infections. This article examines these and associated issues and provides information that will be of value to the dermatologist caring for adolescent patients with genital warts.