Anogenital warts guide: Etiology and epidemiology

This guide focuses on the assessment and management of external anogenital warts (AGW) caused by human papillomaviruses (HPV). HPV vaccination and HPV-related cancer screening recommendations are beyond the scope of this guide.

On this page

Etiology

Anogenital warts (AGW) are caused by human papillomaviruses (HPV)Footnote 1Footnote 2Footnote 3Footnote 4Footnote 5Footnote 6Footnote 7Footnote 8Footnote 9Footnote 10. HPV are small, double-stranded DNA viruses that infect the epitheliumFootnote 6Footnote 11Footnote 12. Approximately 40 types of HPV are known to affect the human anogenital areaFootnote 3Footnote 6Footnote 7Footnote 8Footnote 9Footnote 14Footnote 15Footnote 10. More than 90% of AGW are caused by HPV types 6 and 11Footnote 3Footnote 4Footnote 5Footnote 6Footnote 7Footnote 8Footnote 10Footnote 11Footnote 12Footnote 13Footnote 14Footnote 16. HPV types 6 and 11 are categorized as low-risk of oncogenesis based on their infrequent association with anogenital cancersFootnote 6Footnote 7Footnote 8Footnote 9Footnote 10Footnote 11Footnote 15Footnote 16.

Epidemiology

AGW caused by HPV are commonFootnote 1Footnote 2Footnote 4Footnote 7Footnote 10Footnote 11Footnote 14Footnote 15. AGW are associated with significant healthcare utilization costs and adverse psychosexual effectsFootnote 1Footnote 4Footnote 7Footnote 8Footnote 9Footnote 11Footnote 14Footnote 17.

Co-infection with multiple types of HPV is commonFootnote 1Footnote 2Footnote 7Footnote 9Footnote 10Footnote 13Footnote 18Footnote 19Footnote 20.

Infection with one type of HPV does not appear to be protective against acquisition of other typesFootnote 18Footnote 19Footnote 20.

HPV vaccine trials and population studies documented the incidence and prevalence of AGW prior to the establishment of HPV vaccination programs.

Globally:

In Canada:

In recent years, AGW occurrence has decreased markedly in countries where HPV vaccination programs have been introducedFootnote 4Footnote 8Footnote 14Footnote 28Footnote 29:

Footnotes

Footnote a

Published research summarized above does not systematically define or distinguish between sex and gender, and frequently refers to sex and gender as binary concepts. Where sex was the apparent variable measured by investigators, the terms "male" and "female" have been used to summarize the results.

Return to footnote a referrer

Footnote b

The terminology used by the authors has been used to report the findings of the systematic review by Drolet et alFootnote 28.

Return to footnote b referrer

References

References:

Footnote 1

Aubin F, Prétet J-L, Jacquard A-C, Saunier M, Carcopino X, Jaroud F, et al. Human papillomavirus genotype distribution in external acuminata condylomata: A large French national study (EDiTH IV). Clin Infect Dis 2008;47(5):610-615.

Return to footnote 1 referrer

Footnote 2

Ball SL, Winder DM, Vaughan K, Hanna N, Levy J, Sterling JC, et al. Analyses of human papillomavirus genotypes and viral loads in anogenital warts. J Med Virol 2011;83(8):1345-1350.

Return to footnote 2 referrer

Footnote 3

Forcier M, Musacchio N. An overview of human papillomavirus infection for the dermatologist: Disease, diagnosis, management, and prevention. Dermatol Ther 2010;23(5):458-476.

Return to footnote 3 referrer

Footnote 4

Karnes JB, Usatine RP. Management of external genital warts. Am Fam Phys 2014;90(5):312-318.

Return to footnote 4 referrer

Footnote 5

O'Mahony C, Gomberg M, Skerlev M, Alraddadi A, de las Heras-Alonso ME, Majewski S, et al. Position statement for the diagnosis and management of anogenital warts. J Eur Acad Dermatol Venereol 2019;33(6):1006-1019.

Return to footnote 5 referrer

Footnote 6

Public Health Agency of Canada. Human papillomavirus (HPV) vaccines: Canadian Immunization Guide For health professionals. 2017. Available at: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html.

Return to footnote 6 referrer

Footnote 7

Steben M, Garland SM. Genital warts. Best Pract Res Clin Obstet Gynaecol 2014;28(7):1063-1073.

Return to footnote 7 referrer

Footnote 8

Steben M, Tan Thompson M, Rodier C, Mallette N, Racovitan V, DeAngelis F, et al. A Review of the Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: 10 Years of Clinical Experience in Canada. J Obstet Gynaecol Can 2018;40(12):1635-1645.

Return to footnote 8 referrer

Footnote 9

Trottier H, Franco EL. The epidemiology of genital human papillomavirus infection. Vaccine 2006;24(SUPPL. 1):S4.

Return to footnote 9 referrer

Footnote 10

Yanofsky VR, Patel RV, Goldenberg G. Genital warts: A comprehensive review. J Clin Aesthetic Dermatol 2012;5(6):25-36.

Return to footnote 10 referrer

Footnote 11

Chelimo C, Wouldes TA, Cameron LD, Elwood JM. Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. J Infect 2013;66(3):207-217.

Return to footnote 11 referrer

Footnote 12

International Agency for Research on Cancer Working Group. Human papillomaviruses (HPV). IARC Monographs 2007;90.

Return to footnote 12 referrer

Footnote 13

Chan PKS, Luk ACS, Luk TNM, Lee K-F, Cheung JLK, Ho K-M, et al. Distribution of human papillomavirus types in anogenital warts of men. J Clin Virol 2009;44(2):111-114.

Return to footnote 13 referrer

Footnote 14

Tyros G, Mastraftsi S, Gregoriou S, Nicolaidou E. Incidence of anogenital warts: epidemiological risk factors and real-life impact of human papillomavirus vaccination. Int J STD AIDS 2021;32(1):4-13.

Return to footnote 14 referrer

Footnote 15

Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021 07 23;70(4):1-187.

Return to footnote 15 referrer

Footnote 16

Brianti P, De Flammineis E, Mercuri SR. Review of HPV-related diseases and cancers. The new microbiologica 2017;40(2):80-85.

Return to footnote 16 referrer

Footnote 17

Dawar DM, Harris MT, McNeil DS. Update on Human Papillomavirus (HPV) Vaccines: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI). Can Commun Dis Rep 2012 Jan 02;38(ACS-1):1-62.

Return to footnote 17 referrer

Footnote 18

Liaw K-L, Hildesheim A, Burk RD, Gravitt P, Wacholder S, Manos MM, et al. A prospective study of human papillomavirus (HPV) type 16 DNA detection by polymerase chain reaction and its association with acquisition and persistence of other HPV types. J Infect Dis 2001;183(1):8-15.

Return to footnote 18 referrer

Footnote 19

Rousseau M-C, Pereira JS, Prado JCM, Villa LL, Rohan TE, Franco EL. Cervical coinfection with human papillomavirus (HPV) types as a predictor of acquisition and persistence of HPV infection. J Infect Dis 2001;184(12):1508-1517.

Return to footnote 19 referrer

Footnote 20

Thomas KK, Hughes JP, Kuypers JM, Kiviat NB, Lee S-, Adam DE, et al. Concurrent and sequential acquisition of different genital human papillomavirus types. J Infect Dis 2000;182(4):1097-1102.

Return to footnote 20 referrer

Footnote 21

Garland SM, Steben M, Sings HL, James M, Lu S, Railkar R, et al. Natural history of genital warts: Analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) Vaccine. J Infect Dis 2009;199(6):805-814.

Return to footnote 21 referrer

Footnote 22

Kjær SK, Tran TN, Sparen P, Tryggvadottir L, Munk C, Dasbach E, et al. The burden of genital warts: A study of nearly 70,000 women from the general female population in the 4 Nordic countries. J Infect Dis 2007;196(10):1447-1454.

Return to footnote 22 referrer

Footnote 23

Dinh T-H, Sternberg M, Dunne EF, Markowitz LE. Genital warts among 18- to 59-year-olds in the United States, National Health and Nutrition Examination Survey, 1999-2004. Sex Transm Dis 2008;35(4):357-360.

Return to footnote 23 referrer

Footnote 24

Koshiol JE, St. Laurent SA, Pimenta JM. Rate and predictors of new genital warts claims and genital warts-related healthcare utilization among privately insured patients in the United States. Sex Transm Dis 2004;31(12):748-752.

Return to footnote 24 referrer

Footnote 25

Kliewer EV, Demers AA, Elliott L, Lotocki R, Butler JR, Brisson M. Twenty-year trends in the incidence and prevalence of diagnosed anogenital warts in Canada. Sex Transm Dis 2009;36(6):380-386.

Return to footnote 25 referrer

Footnote 26

Marra F, Ogilvie G, Colley L, Kliewer E, Marra CA. Epidemiology and costs associated with genital warts in Canada. Sex Transm Infect 2009;85(2):111-115.

Return to footnote 26 referrer

Footnote 27

Kliewer EV, Demers AA, Elliott L, Lotocki R, Butler JRG, Brisson M. Twenty-year trends in the incidence and prevalence of diagnosed anogenital warts in canada. Sex Transm Dis 2009;36(6):380-386.

Return to footnote 27 referrer

Footnote 28

Drolet M, Bénard É, Pérez N, Brisson M, Ali H, Boily M-C, et al. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet 2019;394(10197):497-509.

Return to footnote 28 referrer

Footnote 29

Righolt CH, Willows K, Kliewer EV, Mahmud SM. Incidence of anogenital warts after the introduction of the quadrivalent HPV vaccine program in Manitoba, Canada. PLoS ONE 2022;17(4):e0267646.

Return to footnote 29 referrer

Page details

Date modified: