Genital Warts (Condylomata Acuminata) in Sexually Active Young Men

Etiology and Epidemiology

Human papillomavirus (HPV) types 6 and 11 are responsible for approximately 90 % of genital warts and are classified as low‑risk (non‑oncogenic) HPV types【1】.
The lesions typically appear on the penile shaft, which is a common anatomic site for HPV‑induced warts【1】.
The natural history of HPV infection includes a progressive increase in the number of lesions over months, reflecting the virus’s replication cycle【1】.

Genital warts are diagnosed clinically on the basis of their characteristic exophytic, flesh‑colored, hyperkeratotic, cauliflower‑like appearance; no serologic testing or viral culture is required for typical presentations【1】.

Bowenoid papulosis (a form of penile intraepithelial neoplasia) presents as pigmented papules in young sexually active men, not as flesh‑colored cauliflower lesions【2】.
Erythroplasia of Queyrat appears as red, moist plaques on the glans or inner foreskin, distinct from the described shaft lesions【2】.
Penile intraepithelial neoplasia (PIN) carries a higher risk of malignant transformation and therefore requires different management【2】.
Lichen sclerosus manifests as porcelain‑white atrophic patches, usually affecting the glans and prepuce and leading to phimosis and scarring, not as exophytic growths【4】.
Biopsy is mandatory when lesions are pigmented, indurated, fixed, ulcerated, show persistent hyperkeratosis or erosion, or when neoplastic change is suspected【4】.

Approximately 20–30 % of genital warts resolve spontaneously within 3 months; however, active treatment is recommended to reduce transmission, autoinoculation, and psychological distress【1】.
Screening for other sexually transmitted infections, including HIV, is advised in patients with multiple partners and inconsistent condom use, as immunosuppression can exacerbate HPV disease【1】.

Low‑risk HPV warts may coexist with high‑risk (oncogenic) HPV types that can cause subclinical infection; clinicians should remain vigilant for co‑infection【1】.
Sexual partners should be examined and counseled about HPV transmission, emphasizing that condom use reduces but does not eliminate risk and that vaccination is available【7】.
Patients should be educated that HPV can persist in a dormant state and that ongoing condom use and vaccination are key strategies to prevent future infection and transmission【7】.