Natural history of genital warts.

Genital warts were known to the ancients, and many Greek and Roman writers referred to them. The early history of the disease has recently been reviewed by Bafverstedt (1967), who pointed out that some of the early synonyms for the lesions, particularly the words 'fig' and 'condyloma', have survived into modern times. In the Middle Ages, descriptions of diseases were less precise than in the ancient world, but some of the genital lesions described (Lanfranc, 1306) may have been warts. The outbreak of syphilis in Europe at the end of the 15th century led to renewed interest in genital diseases, but at this time most genital lesions were attributed to the 'venereal poison', and no causal distinction was made between the diseases now known as gonorrhoea, syphilis, and genital warts. Even Hunter (1786), who gave a clear description of genital warts, regarded them as a manifestation of syphilis, and did not differentiate them from condylomata lata. The important recognition that genital warts comprised a disease entity unrelated to syphilis was first made by Bell (1793), and his work was later confirmed by Jourdan (1826) and Ricord (1838). But, as the belief that genital warts were due to syphilis was gradually abandoned, the erroneous view developed that they were connected with gonorrhoea (Pirrie, 1852); indeed, in the 19th century, they were sometimes referred to as 'gonorrhoeal warts'. But Aime Martin (1872) pointed out that many patients with genital warts gave no history of gonorrhoea, and after the isolation of the gonococcus in 1879 it was realised that over half of the patients with genital warts showed no sign of it (Jadassohn, 1905). Many 19th century writers thought that genital warts were caused by irritation of the epidermis by various agents such as dirt, decomposed smegma, and genital discharges (Astley Cooper, 1835; Bumstead, 1864). This 'non-specific irritant' theory was widely accepted for many years; Cronquist (1912) strongly supported it, and it was reaffirmed well into the 20th century (Kaplan, 1942).