Condyloma acuminatum is a wart caused by infection with human papillomavirus (HPV). It is also called an anogenital wart or genital wart, and condylomas grow on the skin and moist lining of the genital area and in or around the anus. They often form soft, raised bumps that can join together into a cauliflower-shaped cluster.
Condyloma acuminatum is not cancer. About 9 in 10 condylomas are caused by HPV types 6 and 11, which are low-risk types that rarely cause cancer. Pathologists now consider a condyloma to be a form of low-grade squamous intraepithelial lesion (LSIL), the lowest-risk group of HPV-related changes.
This article explains what condyloma acuminatum is, how it is diagnosed, what the pathologist looks for, and what usually happens after this diagnosis.
Condyloma acuminatum is caused by HPV infecting the squamous cells that cover the skin and the lining of the genital and anal areas. HPV is passed by skin-to-skin contact during sexual activity, and it can spread even when no warts are visible. HPV is very common, and most sexually active people are infected at some point in their lives.
Not everyone infected with HPV types 6 or 11 develops warts, because the immune system often controls the virus. Warts usually appear a few months after infection, although the timing can vary widely. People with a weakened immune system, including people living with HIV and organ transplant recipients, are more likely to develop warts. They may need closer follow-up with a doctor experienced in treating warts.
Condyloma acuminatum usually appears as one or more small, raised growths on the skin or lining of the genital or anal area. Some warts are so small or flat that they go unnoticed, while others form larger clusters that are easy to see or feel. Symptoms can include:
Warts inside the anal canal, the vagina, or the urethra may cause bleeding or discharge, or no symptoms at all.
A doctor usually diagnoses condyloma acuminatum based on how the growth looks during a physical exam. A biopsy is done when the diagnosis is uncertain or when the growth looks unusual. A biopsy may also be done when warts do not respond to treatment, or when the person has a weakened immune system. Sometimes doctors remove the whole wart and send the tissue to a pathologist.
Under the microscope, condyloma acuminatum is made of long, finger-like folds of tissue covered by a thickened layer of squamous cells. Pathologists describe this finger-like shape as papillary. Many surface cells show changes caused by the virus. These infected cells, called koilocytes, have a large, dark, wrinkled nucleus surrounded by a clear halo.
The pathologist also checks the cells closely for more serious changes. In most condylomas, the abnormal cells are limited to the lower part of the lining, which fits a low-grade lesion. If larger, darker abnormal cells fill more of the lining, the report may also describe a high-grade squamous intraepithelial lesion (HSIL). The pathologist also confirms that no abnormal cells have grown into the tissue below.
For condyloma acuminatum, extra tests are usually not needed because the diagnosis is clear under the microscope. When the pathologist is concerned that a high-grade lesion may also be present, they may use one or both of the following tests:
Not every biopsy needs these tests, and laboratories use them differently.
Condyloma acuminatum caused by HPV types 6 and 11 rarely turns into cancer. Having warts does not mean a person will develop cancer of the cervix, anus, or genital area. However, some people with warts are also infected with high-risk HPV types such as 16 or 18. These types can cause high-grade changes within or near a wart, especially in people with a weakened immune system.
For this reason, a pathologist carefully examines every wart sent for biopsy. Very large, hard, fixed, darkly colored, bleeding, or ulcerated warts are usually biopsied to rule out other conditions, including squamous cell carcinoma.
Once your doctor confirms condyloma acuminatum, the next steps depend on the number, size, and location of the warts and your preferences. Without treatment, warts can go away on their own, stay the same, or grow larger. Treatment removes visible warts but does not clear HPV from the body. Options your doctor may discuss include:
Warts often return after treatment, and you may need more than one round. The HPV vaccine protects against HPV types 6 and 11, and warts have become less common in countries with high vaccination rates. Your doctor can tell you whether the vaccine is recommended for you. People with a weakened immune system or high-grade changes may be offered closer follow-up, such as anal cancer screening.