Tests
1st tests to order
no initial test
Test
Diagnosis of genital warts is made based on the clinical presentation of lesions located on the genital area, perianal region, or adjacent areas such as the mons pubis, with a tendency for genital wart formation to occur on areas of high friction.[3][17][38][39]
External genital warts may be diagnosed using direct visual inspection aided by bright light and magnification.[3]
Biopsy is generally not performed for the diagnosis of genital warts.
Result
clinical diagnosis
Investigations to avoid
low-risk HPV testing
Tests to consider
biopsy
Test
Biopsy is not routinely used to diagnose genital warts, as the diagnosis is typically clinical.[3]
However, a biopsy may be of use if warts are indurated, fixed to underlying structures, bleeding, ulcerated, or pigmented, or if they worsen despite treatment.[6][40][44] In addition, mitotic figures can be detected in genital wart biopsy specimens.[5]
Should the biopsy be consistent with dysplasia or carcinoma, referral to a specialist is indicated for treatment.[40]
Should the biopsy be definitive for condyloma, do not perform immunohistochemistry (IHC) or in situ hybridization (ISH) for HPV.[41][42]
Result
epidermal hyperplasia, parakeratosis, koilocytosis, and papillomatosis
anoscopy
Test
Recommended in patients with recurrent perianal warts.[6]
Result
intra-anal warts
urethroscopy
Test
Recommended in patients with urinary symptoms such as terminal hematuria or abnormal stream of urine.
Result
warts in distal urethra, meatus
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