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Urethral Warts

Overview

Genital and urethral warts are caused by human papillomavirus (HPV) and are easily spread by sexual contact, with more than 30 strains of HPV infecting the genital tract (subtype HPV 6 is most frequently detected in genital warts).
However, urethral warts are uncommon, and most genital warts are benign and probably self-limiting.

The majority of newly acquired genital HPV infections are subclinical and asymptomatic. Occasionally, the detection of HPV DNA in genital specimens may be the only evidence of current infection. Furthermore, serum antibodies to specific HPV types may be the only indication of past exposure.

After a long period of latency, individuals infected with certain HPV subtypes are at risk of developing squamous cell carcinomas.
Epidemiologic and molecular studies have conclusively shown the association of HPV with the development of genital tract and anal cancers.
Immunosuppression is associated with reactivation of HPV, increasing the risk of malignant transformation.

Patients at risk of developing malignancies may benefit from therapy aimed at eradicating genital warts.
However, medical treatments aimed at treating urethral warts should generally be used with caution, and they should be used only when the warts are easily accessible, as in the fossa navicularis. Podophyllin is contraindicated during pregnancy.

HPV subtypes

HPV is a DNA virus with several characterized subtypes.
Viral types 6, 11, 42-44, and 54 are associated with condylomata acuminata and low-grade dysplasia, while types 16, 18, 31, 33, 35, 39, 45, 51, 52, 54, 56, 66, and 68 have a higher association with genital malignancy (especially cervical malignancy).

Types of HPV-associated warts

Warts arising from HPV infection include the following morphologic types (regional lymph nodes are not enlarged in the presence of these lesions):

Larger cauliflowerlike condylomata

Flesh-colored, dome-shaped papular warts that are 1-4mm in diameter

Keratotic warts with a thick, crustlike layer resembling skin warts

Flat-topped macular warts

Complications of urethral warts

Complications of urethral warts include the following:

Recurrent disease

Urethral strictures and related problems – Reduced urinary flow/urinary obstruction, infertility due to urethral and ejaculatory duct obstruction

Associated malignancies – Penile and cervical intraepithelial neoplasia, predisposition to bowenoid papulosis (carcinoma in situ of the penis)

Patient education

For patient education information, see the Sexual Health Center, as well as Genital Warts (HPV Infection).

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