Anogenital warts guide: Screening and diagnostic testing

On this page

• Screening and diagnostic testing
  • Screening
  • Cancer screening
  • Other sexually transmitted and blood-borne infections
  • Diagnosis of anogenital warts
• Differential diagnosis
• Physical examination
• References

Screening and diagnostic testing

Screening

Screening for anogenital warts is not recommended^{Footnote 1}.

A clinical encounter for anogenital warts (AGW) is an opportunity to discuss comprehensive screening for other sexually transmitted and blood-borne infections (STBBI) and cancer screening^{Footnote 1}.

Cancer screening

Routine cervical and other cancer screening should be conducted as indicated, regardless of AGW diagnosis or HPV vaccination status^{Footnote 1Footnote 2}. Consult provincial or territorial cervical cancer screening guidelines and recommendations.

Currently, there is no consensus about the use of screening methods, including digital anorectal exam, high resolution anoscopy, anal cytology and/or HPV testing for screening those at higher risk of anal cancer, including gay, bisexual and other men who have sex with men (gbMSM) and people living with HIV^{Footnote 3Footnote 4}. Some guidelines recommend digital anorectal exams for people living with HIV and gbMSM without HIV who have a history of receptive anal intercourse to detect early anal cancers^{Footnote 4}. Access to anal cytology and high resolution anoscopy may vary by jurisdiction. Consult local practice or consensus guidelines for recommendations about screening and follow-up of abnormal results.

Other sexually transmitted and blood-borne infections

STBBI screening varies by age, sex, gender, medical and sexual history. Screen anyone with STBBI risk factors and treat as appropriate to prevent transmission and reinfection.

People being evaluated or treated for AGW should be screened for:

• chlamydia
• gonorrhea
• syphilis
• HIV, as per the recommendations in the HIV Screening and Testing Guide.

If risk factors are present and if clinically indicated, consider screening for:

• hepatitis B
• hepatitis C

Offer vaccination for hepatitis B (HBV), hepatitis A (HAV), human papillomavirus (HPV) and mpox as per the Canadian Immunization Guide. Refer to provincial or territorial vaccination schedules for more information:

• Vaccination schedule for infants and children 
• Vaccination schedule for adults

Diagnosis of anogenital warts

Visual inspection is the usual means of diagnosing anogenital warts (AGW)^{Footnote 1Footnote 4Footnote 5Footnote 6Footnote 7}.

HPV testing is not recommended as results would not alter clinical diagnosis, management, or treatment of external AGW^{Footnote 4}.

Differential diagnosis

Consider the following differential diagnosis and confirm with biopsy if diagnosis is uncertain^{Footnote 1Footnote 5Footnote 6}:

• Non-pathological variations in sebaceous glands:
  • Fordyce spots and Tyson's glands
  • vestibular papillae or micropapillomatosis labialis
  • pearly penile papules on the coronal sulcus
  • sebaceous cysts
• Pathological entities caused by non-infectious diseases of the skin and mucosa:
  • intradermal nevi
  • lichen planus
  • lymphangioma
  • psoriasis
  • skin tags or acrochorda
  • seborrheic keratosis
  • squamous cell carcinoma
• Pathological entities caused by infectious agents:
  • Buschke–Löwenstein tumours (giant condylomata acuminata that may proceed to cancer)
  • molluscum contagiosum
  • condyloma lata of secondary syphilis
  • intraepithelial neoplasia (predominantly caused by HPV)
  • mpox (formerly Monkeypox)

Physical examination

Physical examination is strongly recommended when an STBBI is suspected. The physical examination for AGW should include a visual inspection of the external genitalia.

As applicable, offer a speculum examination of the vagina and cervix to identify any lesions and to obtain a sample for cervical cancer screening per provincial or territorial guidelines. Refer individuals with vaginal or cervical lesions for colposcopy in accordance with provincial or territorial guidelines^{Footnote 1}.

Consider anoscopy for individuals with perianal or intra-anal warts^{Footnote 1}.

Refer individuals with urinary flow problems that may be the result of AGW of the distal urethra or urethral meatus for urological assessment.

References