Genital wartsBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1171 (Published 17 October 2008) Cite this as: BMJ 2008;337:a1171
- Elizabeth K Delaney, clinical lecturer1,
- Steve Baguley, consultant2
- 1Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY
- 2Department of Genitourinary Medicine, Woolmanhill Hospital, Aberdeen AB25 1LD
- Correspondence to: E Delaney
- Accepted 3 May 2007
A 19 year old heterosexual man attends the surgery complaining of “some spots down below.” They are not painful and he says he has no urethral discharge or scrotal pain. He has had a regular female partner for the past two years. On examination he has several warts on the shaft of his penis and no other abnormal findings.
What issues you should cover
History—should be relevant for each individual patient. Does he have other symptoms? Ask about sexual activity in the past three months: timing and duration of relationships, sex and nationality of partners, condom use. Ask about any previous activity that would put him at increased risk of HIV—the main activities are sex with men and sex with someone from a country where HIV is relatively common. Is immunosuppression a factor (associated with poorer treatment responses, more relapses, and dysplasia)?
Implications—Anogenital warts, one of the commonest sexually transmitted infections in the UK, are disfiguring and can be psychologically distressing, so treat the patient sensitively. Over 90% of anogenital warts are caused by the human papillomavirus type 6 or 11 (rather than types 16 or 18, which are associated with cervical intraepithelial neoplasia), and for most people the infection is transient. Partner notification is not necessary. 20-30% of patients will have another sexually transmitted infection so …