Genital Warts: Rapid Evidence Review

Genital warts (also referred to as anogenital warts and condyloma acuminatum) are caused by human papillomavirus types 6 and 11 in 90% of cases. They are transmitted primarily through anogenital contact and penetrative and non-penetrative sex. Transmission can be effectively prevented with vaccination. Current evidence regarding the effects of condom use on the prevalence of genital warts is conflicting. In the United States from 2013-2016, the prevalence of genital warts among individuals ages 18 to 59 years was 1.3% in men and 3.1% in women. The diagnosis is made clinically by the appearance of single or multiple lesions that may coalesce or be the same color as surrounding skin, cauliflower-like, flat, papular, or keratotic. Biopsy is indicated in some cases, such as for atypical lesions. Treatment may be patient- or physician-administered, with choice of treatment informed by shared decision-making. Treatment options may be limited by physician skills and clinic availability. Podofilox 0.5% solution is the most effective patient-administered therapy and carbon dioxide laser therapy, surgery, and electrosurgery are the most effective for wart removal at the end of treatment. All treatment strategies are associated with some recurrence, but most successfully treated warts do not recur. Use of podofilox, imiquimod, and sinecatechins should be avoided in pregnancy.