Condyloma acuminatum is the medical term for genital warts, a sexually transmitted infection caused by human papillomavirus (HPV). About 90% of cases are caused by two specific low-risk strains: HPV-6 and HPV-11. The warts appear as small, flesh-colored growths in the genital or anal area and are one of the most common STIs worldwide.
What Causes Genital Warts
HPV spreads primarily through vaginal or anal sex, and less commonly through close skin-to-skin contact during sexual activity. A person can transmit the virus even when they have no visible warts or symptoms, which makes it difficult to pinpoint exactly when or from whom someone was infected. You can develop warts years after exposure, so their appearance doesn’t necessarily reflect recent sexual contact.
Once the virus enters the skin through tiny breaks or abrasions, it infects cells in the outer layer and eventually triggers the abnormal cell growth that produces warts. Not everyone infected with HPV-6 or HPV-11 develops visible warts. Your immune system can sometimes suppress the virus before growths appear.
What They Look and Feel Like
Genital warts typically start as small, flesh-colored papules about 1 to 5 millimeters across. They can stay that small or grow over weeks to months into larger masses several centimeters wide. Their appearance varies: some are flat, some are raised on a stalk, and others cluster together into a bumpy, cauliflower-like shape. Color ranges from white or pink to purplish or reddish-brown, depending on the skin and the location.
In women, warts most commonly appear on the vulva, perineum, and around the anus. They can also develop inside the vagina or on the cervix, where they may not be visible without a medical exam. In men, lesions typically appear on the shaft or tip of the penis, around the anus, and occasionally inside the urethra, where they can cause pain during urination or bleeding. Scrotal warts are rare in people with healthy immune systems. Warts can also develop in the mouth or on the tongue and lips after oral sexual contact.
Most genital warts are painless, though some people report itching, tenderness, or discomfort, especially when warts grow large or cluster in areas subject to friction.
How Genital Warts Are Diagnosed
Doctors typically diagnose condyloma acuminatum through a visual exam. The characteristic appearance of raised, soft, skin-colored papules in the genital or anal region is usually enough. A biopsy is generally only needed when the diagnosis is uncertain, when warts don’t respond to treatment, or when a large tumor mass covers the entire anogenital area. In that case, a provider will want to rule out a rare condition called a Buschke-Löwenstein tumor, which is a giant form of condyloma acuminatum that behaves more aggressively.
Treatment Options
Treatment focuses on removing the visible warts, since there’s no cure for the underlying HPV infection. The good news is that initial clearance rates approach 100% with current methods. The challenge is recurrence: up to about 43% of people develop new warts within six months of treatment, usually at or near the original site.
Patient-Applied Treatments
For external warts, your doctor may prescribe a topical cream that stimulates your immune system to fight the virus at the skin’s surface. One common option is applied at bedtime three times per week for up to 16 weeks. Another formulation is used nightly for up to 8 weeks. These creams can cause redness, irritation, and flaking at the application site, which is actually a sign the immune response is working. Other topical options include plant-based solutions that break down wart tissue directly.
In-Office Procedures
Cryotherapy (freezing the warts with liquid nitrogen) is one of the most common in-office treatments. It produces complete clearance in roughly 83% of cases, though it tends to cause more side effects like blistering and discomfort compared to chemical treatments. Chemical peels using strong acids are another option. They clear warts in a smaller percentage of people but cause fewer complications. For larger or stubborn warts, doctors may use surgical removal, laser therapy, or electrocautery (burning the tissue with an electric current).
Because recurrence is common regardless of which method is used, follow-up visits in the months after treatment help catch new warts early when they’re easier to manage.
When Warts Become a Bigger Problem
Standard genital warts caused by HPV-6 and HPV-11 are considered low-risk, meaning they very rarely lead to cancer. However, in rare cases, warts can grow into a giant condyloma acuminatum, also called a Buschke-Löwenstein tumor. This is a slow-growing mass that invades and destroys surrounding tissue locally, even though it’s technically classified as benign. It most often appears between ages 30 and 50.
Despite the benign label, giant condyloma carries a 40 to 60% chance of transforming into a malignant tumor over time, and it recurs in about 67% of cases after removal. The growth can be especially aggressive in people with weakened immune systems. Fortunately, distant spread to other parts of the body has not been reported. Long-term monitoring is essential for anyone diagnosed with this form.
HPV Vaccination and Prevention
The most effective prevention is the HPV vaccine (Gardasil 9), which protects against HPV-6 and HPV-11 along with seven other strains linked to cancer. It has been the only HPV vaccine available in the United States since late 2016. The results have been dramatic: within 12 years of the vaccine’s introduction, infections with the four originally targeted HPV types dropped 88% among females aged 14 to 19 and 81% among those aged 20 to 24. Genital wart prevalence fell 61% among 15- to 19-year-old females and 44% among 20- to 24-year-old females between 2006 and 2014. Similar declines have been documented in more than 14 countries with vaccination programs.
Condoms reduce the risk of transmission but don’t eliminate it, since HPV can infect skin that a condom doesn’t cover. Vaccination before sexual debut offers the strongest protection, but it’s approved for people up to age 45 and still provides benefit even after someone has become sexually active, since most people haven’t been exposed to all the strains the vaccine covers.