Genital warts develop in about two-thirds of sexual contacts of persons who have genital warts,
so it's really highly contagious.
And what happens is the virus enters through the skin,
after some break in the skin,
and gets into the basal layers of the epidermis.
And there, the viral capsid modifies its conformation and enters the cell.
And so, I think you can see that problems develop in an upward direction
from the basal layer.
So basal layer infected initially,
and then the virus is moved to the surface
with the normal proliferation of squamous epithelium.
So the virus will replicate,
and then finally release the live and infectious virions
from the outermost portion of the skin, which is why it is so contagious.
So all epidermal layers proliferate leading to something called acanthosis,
which is simply hyperplasia of the squamous cell epithelium.
which is keratinization of the surface cells
with retention of nuclei in the stratum corneum.
Those nuclei are not supposed to be there.
Hyperkeratosis, which produces this thickened appearance.
And then some cells transform into koilocytes,
and what’s showing here is these vacuolated cells,
which are called koilocytes.
That’s the hallmark pathologically of a HPV infection.
So clinically, these warts are flesh-colored to gray.
They’re hyperkeratotic and exophytic.
Exophytic means that they are proliferating out to the surface.
They’re normally sessile on the skin,
which means they’re flat and attached,
or they can be attached by a short, broad peduncle or stalk.
In uncircumcised men, they involve, as this picture shows,
the preputial cavity 85 to 95 percent of the time.
In the circumcised men, the penile shaft is involved.
And among men who have sex with men, we get these warts in the anal mucosa.
Women get this in the posterior introitus, the labia, or clitoris.
Now, most of these warts are asymptomatic.
But occasionally, the patient will complain of itching, burning, pain, or even tenderness,
but that’s not frequent.