Warts are caused by infection with the human papillomavirus (HPV). HPV infection is one of the most common STDs in the United States, with more than 14 million new cases and more than 79 million total cases each year. Globally, HPV affects millions of people. Some infected male/female children and adults can progress to benign and malignant neoplasms, including condyloma acuminata, Bowen-like papulosis, cervical cancer and anal cancer. The most common oncogenic types of the virus are type 16 and type 18, respectively. Although subclinical infections are common, infections are more common in the external genitalia, perineum, perianal area, and adjacent skin areas with verrucous growths. Lesions vary in size from a few millimeters to several centimeters of cauliflower-like growths. The lesions may be flesh-colored, pink, brown, or white in color. Impregnated lesions may be seen in the moist mucosal areas of the genitalia as opposed to the keratotic lesions seen in other areas. Figure: Condyloma acuminatum. (Image credit: CDC and Medscape) Although the spread of external genital condyloma is uncommon, it does occur in specific populations, such as renal dialysis patients, HIV-infected patients, and solid organ transplant recipients. Infections in the oral cavity may appear as cauliflower-like growths resembling genital warts, especially in the non-keratinized mucosal areas of the oral cavity. Most of these infections are acquired sexually through oral sex from an HPV-infected partner. Figure: Condyloma acuminatum of the tongue in a woman. (Image credit: CDC and Medscape) Figure showing intraoral condyloma acuminatum. (Image credit: US CDC/Sol Silverman) As of December 2014, three HPV vaccines (all three doses) were approved in the United States: a bivalent vaccine (HPV2; Cervarix) to prevent HPV 16 and 18 infections (associated with 70% of cervical cancer incidence); a quadrivalent vaccine to prevent HPV 6 and 11 (associated with 90% of genital warts incidence) and 16 and 18 infections (HPV4; Gardasil); and a quadrivalent vaccine to prevent HPV 6 and 11 (associated with 90% of genital warts incidence) and 16 and 18 infections. Gardasil); and a nine-valent vaccine against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 (Gardasil 9). Of these, the nine-valent vaccine may prevent 90% of cervical, vulvar, vaginal, and anal cancers; the other five HPV types not covered by the other two vaccines are associated with approximately 20% of cervical cancer cases. If you have any questions about this vaccine, please visit my homepage ( ) or contact me via WeChat at