Genital Warts (Condyloma Acuminatum): Pathology, Signs & Symptoms

00:02 Genital warts develop in about two-thirds of sexual contacts of persons who have genital warts, so it's really highly contagious.

00:11 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.

00:24 And there, the viral capsid modifies its conformation and enters the cell.

00:31 And so, I think you can see that problems develop in an upward direction from the basal layer.

00:39 So basal layer infected initially, and then the virus is moved to the surface with the normal proliferation of squamous epithelium.

00:50 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.

01:04 So all epidermal layers proliferate leading to something called acanthosis, which is simply hyperplasia of the squamous cell epithelium.

01:17 Also, parakeratosis, which is keratinization of the surface cells with retention of nuclei in the stratum corneum.

01:28 Those nuclei are not supposed to be there.

01:31 Hyperkeratosis, which produces this thickened appearance.

01:37 And then some cells transform into koilocytes, and what’s showing here is these vacuolated cells, which are called koilocytes.

01:49 That’s the hallmark pathologically of a HPV infection.

01:54 So clinically, these warts are flesh-colored to gray.

02:00 They’re hyperkeratotic and exophytic.

02:04 Exophytic means that they are proliferating out to the surface.

02:10 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.

02:20 In uncircumcised men, they involve, as this picture shows, the preputial cavity 85 to 95 percent of the time.

02:31 In the circumcised men, the penile shaft is involved.

02:35 And among men who have sex with men, we get these warts in the anal mucosa.

02:42 Women get this in the posterior introitus, the labia, or clitoris.

02:48 Now, most of these warts are asymptomatic.

02:51 But occasionally, the patient will complain of itching, burning, pain, or even tenderness, but that’s not frequent.