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Condyloma acuminatum (genital warts) is a sexually transmitted infection caused by human papillomavirus (HPV) types 6 and 11, producing cauliflower-like, cockscomb-like, or papillomatous warts on a man’s penis, coronal sulcus, foreskin, urethral meatus, and perianal area. It is caused by low-risk HPV types (6/11), which differ from the high-risk types (16/18) that cause HPV-related cancers; however, co-infection can occur, so caution is needed. In this article, a physician at Men’s Care Clinic provides a thorough explanation from a male perspective of the transmission routes, symptoms, diagnosis by visual examination and the acetic acid (acetowhitening) test, treatment with Beselna (imiquimod) cream and cryotherapy with liquid nitrogen, and prevention with the HPV vaccine (Gardasil 9 / Silgard 9).
Table of Contents
“Something like a wart has appeared on my penis,” “There are several small bumps under my foreskin,” “Cauliflower-like growths keep spreading” – many men troubled by these symptoms may have condyloma acuminatum (genital warts) caused by human papillomavirus (HPV) types 6 and 11. HPV is a huge virus family with more than 150 types: low-risk types (6/11) cause benign skin growths, while high-risk types (16/18) cause cancer.
To state the conclusion first, condyloma acuminatum is not a life-threatening disease, but if left untreated it can spread, autoinoculate, and infect partners, and in rare cases carries a co-occurring risk of HPV-related cancer – it is a chronic condition. With current standard treatment, HPV lesions can be removed, but there is no established treatment that completely eliminates the virus from the body, and the recurrence rate within 3 months of treatment is 25-30%, which is by no means low.
With appropriate treatment and the use of the HPV vaccine (Gardasil 9), symptom control and recurrence prevention are entirely possible. In this article, a physician at Men’s Care Clinic who treats many condyloma acuminatum patients at our STD clinic gives a practical explanation of how to identify condyloma acuminatum in men, as well as testing, treatment, and prevention.
Condyloma acuminatum (anogenital wart) is a sexually transmitted infection in which human papillomavirus (HPV) infection causes benign wart-like growths on the skin and mucous membranes of the anal and genital area. It is one of the most common viral STDs worldwide. In Japan, an estimated 10,000 men develop the condition newly each year, and it is most common among sexually active people in their 20s to 40s.
The causative virus is HPV, and of its more than 150 types, over 90% of condyloma acuminatum cases are caused by HPV types 6 and 11 (low-risk types). These viruses carry a low risk of becoming cancerous, and condyloma acuminatum almost never turns directly into cancer. On the other hand, high-risk types such as HPV 16 and 18 may be present as a co-infection and, in rare cases, become a risk factor for penile cancer, anal cancer, and oropharyngeal cancer.
The most notable features of condyloma acuminatum are that it develops after a long incubation period of 3 weeks to 8 months following sexual contact, and that 25-30% of cases recur within 3 months after treatment. This is because, even when the lesions are physically removed, HPV remains latent in the surrounding skin and reactivates when immunity declines.
| Category | Representative types | Main symptoms / diseases | Cancer risk |
|---|---|---|---|
| Low-risk types (6/11) | HPV 6, 11 | Condyloma acuminatum (over 90%) | Low |
| High-risk types (16/18) | HPV 16, 18 | Cervical cancer, penile cancer, anal cancer, oropharyngeal cancer | High |
| Other high-risk types | HPV 31, 33, 45, 52, 58 | Cervical cancer and related cancers | Moderate to high |
| Low-risk cutaneous types | HPV 1, 2, 4 | Common warts, plantar warts | Very low |
Because about 20% of condyloma acuminatum patients have a co-infection with high-risk HPV types, regular check-ups and additional testing as needed are recommended.
The typical symptom of condyloma acuminatum is “raised, benign tumors with a cauliflower-like, cockscomb-like, or papillomatous appearance on the skin of the anal and genital area.” It usually begins as a small, single wart and, if left untreated, increases in number and grows larger. There is almost no pain or itching, and in most cases it is noticed during visual inspection.
Common sites in men are the coronal sulcus, foreskin, glans, urethral meatus, scrotum, and perianal area of the penis, and in rare cases it can develop inside the urethra or anus. The number ranges from one to several dozen, and because it spreads if left untreated, early consultation is recommended.
The reasoning that “it does not hurt or itch, so I will just watch it for now” is a typical pattern that leads to neglect and spread. It is important to seek consultation promptly once you notice it.
| Site | Frequency | Characteristics |
|---|---|---|
| Coronal sulcus, inner foreskin | Most common | Easily proliferates in a moist environment |
| Glans surface | Common | Easily visible; discomfort during intercourse |
| Penile shaft, scrotum | Moderate | Prone to multiple lesions |
| Urethral meatus | Rare | Can cause urinary abnormalities |
| Inside the urethra | Very rare | Difficult to see; requires endoscopic examination |
| Perianal area | Moderate (common in MSM) | Grows large if left untreated |
| Inside the anus | Very rare (MSM) | Requires anoscopy |
Lesions inside the urethra or anus are easily missed on routine visual examination; if symptoms (discomfort on urination, bloody stool, pain) are present, specialized examination by a urologist or proctologist is necessary.
| Condition | Main features | Difference from condyloma |
|---|---|---|
| Condyloma acuminatum | Cauliflower-like growths, painless | Typical case; positive acetowhitening test |
| Pearly penile papules | Small bumps on the coronal sulcus; physiological | Symmetrical, regularly arranged, no treatment needed |
| Fordyce spots | Small yellow bumps on the penis; sebaceous glands | Physiological, no treatment needed |
| Squamous cell carcinoma | A growth that may be accompanied by ulceration | Differentiated by biopsy; high urgency |
| Genital herpes | Blisters that progress to ulcers; painful | Painful, recurring |
| Chancroid | Painful ulcers | Painful; caused by Haemophilus ducreyi |
Pearly penile papules and Fordyce spots are physiological structures that require no treatment; they are easily mistaken for condyloma, but can be distinguished by their arrangement, symmetry, and shape. If you are unsure, always see a physician.
The main route of HPV transmission is contact infection of the skin and mucous membranes through sexual contact. It is transmitted through all forms of sexual activity, including vaginal intercourse, anal intercourse, oral sex, and genital-to-genital rubbing. HPV enters through small breaks in the skin and remains latent in the basal cells of the epidermis. The probability of infection from a single sexual contact is very high, at 60-70%, which illustrates the strong infectivity of HPV.
An important point is that complete prevention is difficult even when using a condom. Because HPV can be present on the skin at the base of the penis, the scrotum, and around the pubic area, infection can occur from areas not covered by a condom. A condom lowers the risk but does not reduce it to zero.
The greatest feature of HPV is that many infected people are asymptomatic. An estimated 50-80% of people with sexual experience have a history of HPV carriage; in most of them the virus naturally clears through immunity, but during that period they spread the infection to others. The difficulty of HPV prevention is that “my partner has no symptoms, so it is fine” or “I used a condom” does not provide complete prevention.
Understanding that “you should not assume your partner is the source of infection” and that “tracing back to find the source of infection is pointless,” the realistic approach is to focus on measures for yourself and your partner.
The incubation period of condyloma acuminatum is long, at 3 weeks to 8 months, with an average of 2-3 months, making it a disease in which identifying the source of infection is difficult. After HPV becomes latent in basal cells, it takes time for proliferation and tissue changes to progress and for visible warts to appear.
There are large individual differences in the course after infection: in young men with strong immunity it may clear naturally, while chronic, persistent cases are also not uncommon. In people with HIV or in an immunosuppressed state, onset tends to be earlier and the condition tends to become more severe.
| After infection | State | Detectability |
|---|---|---|
| 0-3 weeks | HPV proliferating in basal cells, asymptomatic | Difficult to detect by visual exam |
| 3 weeks-2 months | Early lesions may appear | Detectable by visual exam |
| 2-3 months | Typical onset period; the period of most frequent onset | Definitive diagnosis by visual exam and acetic acid test |
| 3-8 months | Late-onset cases; period in which first onset is still possible | Detected as new lesions |
| 8 months onward | Source difficult to identify; transition to asymptomatic carriage | Detected at recurrence when immunity declines |
The approach of “getting tested because of a worrying act” is not well suited to condyloma acuminatum; the realistic approach is either to seek consultation after something wart-like appears or to combine this with regular screening.
It is known that 30-40% of condyloma acuminatum cases caused by HPV infection clear naturally within 1-2 years through the action of immunity. However, while waiting for spontaneous recovery, the risk increases that the lesions will spread, the infection will spread to a partner, and large lesions will become difficult to treat. Leaving it untreated in the hope that “it may heal someday” is not a wise choice; the standard is to begin treatment at the time of diagnosis.
The diagnosis of condyloma acuminatum centers on typical visual examination findings. In many cases the diagnosis is clinically confirmed from the characteristic cauliflower-like or cockscomb-like growths, but for early or flat-type lesions, differentiation from other conditions is needed, so an acetowhitening test and, when necessary, a tissue biopsy are performed.
| Test | Principle | Time required | Use |
|---|---|---|---|
| Visual exam (clinical diagnosis) | Confirming the typical morphology | A few minutes | Provisional to definitive diagnosis at first visit |
| Acetowhitening test | 3-5% acetic acid is applied and lesions turn white | 10 minutes | Detection of early / flat lesions |
| Tissue biopsy (pathology) | Part of the lesion is sampled and examined under a microscope | About 1 week | Suspected cancer, cases with uncertain diagnosis |
| HPV-DNA test | HPV type identification (the cervical version is standard) | About 1 week | Research purposes; not covered by insurance for men |
| Concurrent STD testing | Checking for co-occurring HIV, syphilis, and other STDs | 1 to several days | Screening for coexisting STDs |
| Anoscopy / urethroscopy | Checking for lesions not visible on visual exam | 10-20 minutes | When there are urinary / bowel abnormalities; MSM |
In many cases, the diagnosis is confirmed by visual examination and the acetowhitening test, and treatment can begin immediately. When cancer is suspected (accompanied by ulceration, accompanied by bleeding, or rapidly growing), a tissue biopsy is always performed.
Because about 20% of condyloma acuminatum patients have a co-occurring STD, concurrent screening at the first visit is recommended.
At Men’s Care Clinic, visual examination, the acetic acid test, and concurrent STD screening can all be carried out together at the first visit, and treatment can begin the same day.
The treatment of condyloma acuminatum is broadly divided into two systems: “self-treatment with topical drugs” and “physical removal by a physician.” The appropriate treatment is selected according to the number, size, and location of the lesions and the patient’s wishes. What is important is a long-term perspective that takes into account the reality that no treatment can completely eliminate the HPV virus from the body, and the recurrence rate within 3 months is 25-30%.
Beselna cream has the advantage of allowing self-treatment at home and is suitable for people who find frequent clinic visits difficult or who have multiple small lesions. However, because a strong inflammatory reaction can occur as a side effect, instruction on proper use is important.
Liquid nitrogen cryotherapy has the advantages of reliable physical removal and a rapid effect. The need for multiple clinic visits and the pain during the procedure are challenges, but the treatment effect is clear.
These physical treatments allow reliable removal in a single session, making them suitable for people who want a rapid effect or who want to minimize the number of treatments. However, there are trade-offs: they are highly invasive, require local anesthesia, and carry a risk of scarring.
| Situation | Recommended treatment | Reason |
|---|---|---|
| A few small lesions, difficulty visiting the clinic | Beselna cream | Home treatment possible, minimally invasive |
| Moderate number of lesions, wanting a rapid effect | Liquid nitrogen cryotherapy | Reliable physical removal, covered by insurance |
| Large or refractory lesions | CO2 laser, surgical excision | Reliable removal in one session |
| Lesions inside the urethra or anus | Surgical excision (referral to a specialist) | Outside the indication for topical drugs; endoscopic procedure |
| Recurrent or repeated cases | Combination of multiple treatments plus immune strengthening | Strategy for cases where standard treatment has failed |
| HIV / immunosuppressed state | Multidisciplinary treatment by a specialist | Risk of becoming refractory; careful management needed |
At Men’s Care Clinic, treatment centers on topical Beselna cream and liquid nitrogen cryotherapy. Severe and refractory cases are referred to affiliated medical institutions.
Because condyloma acuminatum consists of “benign growths that do not hurt or itch,” it tends to be left untreated; however, leaving it untreated causes various effects on the health and quality of life of both the patient and the partner.
The risk of HPV-related cancer is particularly important: because about 20% of condyloma acuminatum patients have a co-infection with high-risk HPV types, men too should not look away from the risk of penile cancer, anal cancer, and oropharyngeal cancer.
If left untreated, HPV is transmitted to sexual partners with high probability. Given the high infection probability of 60-70% per single sexual contact, it is also ethically problematic for a patient to continue sexual activity without treatment. For a female partner there is a risk of cervical HPV infection leading to cervical cancer; for a male partner (MSM) there is a risk of anal cancer; and for a fetus or newborn there is a risk of neonatal laryngeal papillomatosis.
HPV-related cancer is well known for cervical cancer in women, but men too have a risk of the following cancers.
| Cancer type | Proportion HPV-related | Main causative types |
|---|---|---|
| Penile cancer | 30-50% | HPV 16, 18 |
| Anal cancer (especially in MSM) | 80-90% | HPV 16, 18 |
| Oropharyngeal cancer | 50-70% | HPV 16 |
| Oral cancer (some cases) | Rare | HPV 16 |
These cancers can be largely prevented with the HPV vaccine (Gardasil 9), and it has become clear that vaccination is also highly meaningful for men.
The strongest preventive measure against condyloma acuminatum is prior vaccination with the HPV vaccine (Gardasil 9, the 9-valent vaccine). Vaccination before the start of sexual activity is most effective, but even for people with sexual experience, additional vaccination provides a reinfection-prevention effect. In Japan, voluntary vaccination for men is widely carried out, and Men’s Care Clinic also offers vaccination.
As of 2024, Gardasil 9 is the latest 9-valent HPV vaccine approved in Japan, and it covers both the causative types of condyloma acuminatum and the causative types of the major HPV-related cancers.
As a medical institution specializing in men, Men’s Care Clinic handles the diagnosis and treatment of condyloma acuminatum and HPV vaccination in one stop. We perform visual examination, the acetic acid test, prescription of topical Beselna cream, and liquid nitrogen cryotherapy in-house, and refer refractory cases to affiliated medical institutions.
All clinics provide condyloma treatment of the same quality, and through our partnership with Toyosu Hospital (Showa University affiliated), general hospital-level support is possible even for severe cases.
A physician answers, based on clinical experience, questions about condyloma acuminatum in men that are frequently raised at the STD clinic of Men’s Care Clinic.
A. It is known that 30-40% of cases clear naturally within 1-2 years through the action of immunity. However, during that time there is a risk of the lesions spreading, infecting a partner, and growing large, so the standard is to begin treatment at the time of diagnosis.
A. It is not a directly life-threatening disease, but in rare cases it can grow very large (Buschke-Lowenstein tumor) and become difficult to treat, and if there is a co-infection with high-risk HPV types, it can become a risk factor for penile cancer, anal cancer, and oropharyngeal cancer.
A. A general guide is up to 16 weeks for Beselna cream and 3-5 sessions (every 1-2 weeks) for liquid nitrogen cryotherapy. Including recurrence, follow-up observation over a period of several months to a year is necessary.
A. It depends on the number, size, and location of the lesions and whether you can visit the clinic. For a few small lesions, Beselna is common; for multiple lesions or when a rapid effect is wanted, liquid nitrogen is common. Make the optimal choice in consultation with your physician.
A. The recurrence rate within 3 months after treatment is 25-30%. Because the HPV virus cannot be completely eliminated, regular follow-up, the HPV vaccine, and maintaining immunity lower the recurrence risk.
A. Yes, it is meaningful. It provides a preventive effect against HPV types other than the type already infecting you (including high-risk types) and is also effective for recurrence prevention. Vaccination is recommended precisely for men with a history of condyloma.
A. Refrain from sexual activity during treatment and follow-up observation, and always use a condom when resuming. Encourage your partner to have a visual examination; if symptoms are present, both the patient and the partner need treatment and follow-up observation.
A. With insurance coverage, the first-visit fee plus testing plus one tube of Beselna cream is roughly 5,000-10,000 yen with a 30% co-payment. Liquid nitrogen cryotherapy is 1,500-3,000 yen per session. Laser treatment is self-pay, roughly several tens of thousands to 100,000 yen.
A. That is possible. Condyloma inside the urethra cannot be seen on visual examination, so a urethroscopy is necessary. If you have discomfort on urination or blood in the urine, consult a urology specialist.
A. In cases where phimosis leads to repeated recurrence, there is the option of combining condyloma treatment with phimosis surgery to lower the recurrence risk. Please consult Men’s Care Clinic.
A. Pearly penile papules are a physiological skin structure arranged symmetrically and regularly on the coronal sulcus and require no treatment. Condyloma is irregular and cauliflower-like and grows larger. If you are unsure, see a physician.
A. In principle, the first visit is in person because of the visual examination and acetic acid test. Follow-up visits and continued prescriptions can in some cases be handled by online consultation.
A. Condyloma in a man almost never directly affects pregnancy, but if it is transmitted to a female partner, there are concerns about a risk of cervical HPV infection leading to cervical cancer and, with infection during pregnancy, a risk of neonatal laryngeal papillomatosis.
A. Yes, it does. Smoking increases the risk of persistent HPV infection and the risk of cancer, lowers treatment efficacy, and raises the recurrence risk. Quitting smoking is strongly recommended alongside treatment.
A. The local use of Beselna cream and ED drugs can be used together without problems. Sexual activity itself should be refrained from during condyloma treatment.
Condyloma acuminatum (genital warts) is a benign viral STD caused by HPV types 6 and 11, and it is a condition in which the lesions can be removed with appropriate treatment (topical Beselna cream, liquid nitrogen cryotherapy). Although it is not directly life-threatening, if left untreated it carries a risk of spread, partner infection, and HPV-related cancer, so after diagnosis prompt treatment, long-term follow-up observation, and recurrence prevention are important.
At Men’s Care Clinic, we provide visual examination, the acetic acid test, Beselna prescription, liquid nitrogen cryotherapy, and HPV vaccination by physicians specializing in men all in one process. Please also refer to herpes in men and the list of STDs in men.
If you are troubled by thoughts such as “there is something wart-like on my genitals,” “it recurs even after I treat it,” or “I want to consider the HPV vaccine,” please first consult us at a counseling session at the STD clinic. With early consultation and early treatment, let us firmly control condyloma acuminatum and prevent recurrence.
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