Although it is generally thought that cell-mediated immunity is the most important factor in the defence against HPV infections, the exact immune mechanism behind spontaneous warts regression is not known. The incubation period of genital wart is long and variable. It is estimated to be around 3 months with a range from 3 weeks to 8 months. Perinatal acquired HPV infection may not manifest for up to two years. On moist area exuberant rapid growth may occur, forming cauliflower-like mass .
Growth is enhanced during pregnancy, or in the presence of other local infections.
Over drier areas, genital warts tend to be more keratotic and may look like common wart. At times it may be sufficiently pigmented to resemble seborrhoeic keratoses. Flat lesions and smooth papular lesions can also be present and cause diagnostic difficulty. The sites of infection correspond with greatest coital friction. In males warts are most common on the fraenulum and coronal sulcus but may be seen anywhere on the genitalia, perianal region, anus and anal canal.