From the Guidelines
Genital warts are caused by human papillomavirus (HPV) infection, primarily types 6 and 11, which account for about 90% of cases, and the pathophysiology involves the virus infecting basal epithelial cells, manipulating the cell cycle, and leading to uncontrolled cell growth. The pathophysiology begins when HPV enters the body through microscopic breaks in the skin during sexual contact with an infected person [ 1 ]. Once inside, the virus infects basal epithelial cells of the epidermis, and viral genome amplification occurs in differentiating cells using the cellular replication machinery. This can result in a thickened, sometimes exophytic, epithelial lesion [ 1 ]. The virus manipulates the cell cycle by producing proteins that interfere with tumor suppressor genes, leading to uncontrolled cell growth. The incubation period typically ranges from 3 weeks to 8 months, with most warts appearing within 2-3 months after infection.
Some key points to consider in the pathophysiology of genital warts include:
- The role of HPV types 6 and 11 in causing visible genital warts [ 1 ]
- The importance of the immune system in controlling HPV infection, with immunocompromised individuals often experiencing more extensive and persistent warts
- The potential for other HPV types (16,18) to be associated with cervical and other anogenital cancers, though these types rarely cause visible warts [ 1 ]
- The process of viral genome amplification and the release of the virus as cells exfoliate from the epithelium [ 1 ]
The evidence suggests that the pathophysiology of genital warts is complex and involves the interplay of various factors, including the type of HPV, the immune system, and the cellular replication machinery [ 1 ]. The most effective approach to understanding the pathophysiology of genital warts is to consider the latest evidence and research, which highlights the importance of HPV infection and the immune system in the development and persistence of genital warts.
From the Research
Pathophysiology of Genital Warts
The pathophysiology of genital warts is primarily caused by human papillomavirus (HPV) types 6 and 11, which are responsible for approximately 90% of cases 2. The transmission of genital warts occurs mainly through anogenital contact and penetrative and non-penetrative sex.
Key Factors in the Development of Genital Warts
- Human papillomavirus (HPV) types 6 and 11 are the primary causes of genital warts 2, 3, 4
- Anogenital contact and penetrative and non-penetrative sex are the main modes of transmission 2
- The prevalence of genital warts varies among different populations, with a reported prevalence of 1.3% in men and 3.1% in women in the United States from 2013-2016 2
Diagnosis and Treatment of Genital Warts
- Diagnosis is typically made clinically based on the appearance of single or multiple lesions 2, 5
- Treatment options include patient-applied therapies such as imiquimod cream or podofilox, as well as physician-administered treatments like cryotherapy, laser therapy, and surgical excision 2, 3, 6, 5
- The choice of treatment depends on various factors, including the number, size, site, and morphology of lesions, as well as patient preferences and clinician experience 6