Human papillomavirus (HPV) types 6 and 11 are historically associated with mucosal condylomata acuminata and account for approximately 90% of warts affecting the anogenital region according to cited references. Reports of these genital-associated types at extragenital cutaneous sites are uncommon and have most often been described in children, persons with immunosuppression (including HIV), or men who have sex with men. This case report describes extragenital condylomas caused by HPV types 6 and 11 occurring on the lateral neck of an otherwise immunocompetent heterosexual adult, a presentation that is rarely documented.
In 2025, a heterosexual man in his 40s with an unremarkable medical history sought care for a growth on the right side of his neck that had been present for approximately one year and had increased in size. On examination, clinicians observed six clustered, brown, verrucous-to-mamillated papules distributed along the right lateral neck. The initial differential diagnosis included inflamed seborrheic keratoses and verruca vulgaris.
The lesions were initially treated with cryotherapy, which produced temporary resolution. Eleven months after that treatment the patient returned with recurrent lesions and underwent a shave biopsy of an affected papule.
Histopathology of the shave biopsy demonstrated papillated epidermal hyperplasia with hypergranulosis, compact orthokeratosis, and dilated blood vessels in the papillary dermis. In situ hybridization testing for HPV was positive for HPV types 6 and 11 (the laboratory method could not distinguish between types 6 and 11 individually).
Screening for sexually transmitted infections returned negative results for gonorrhea, chlamydia, syphilis, and HIV. Complete blood count and comprehensive metabolic panel results were within reference limits. Immunologic screening showed normal levels of IgA, IgG, and IgM; an antinuclear antibody (ANA) titer was 1:80 (reference <1:40).
The biopsy findings were consistent with an HPV-related verrucous lesion. In situ hybridization for HPV types 6 and 11 detected viral presence in the lesion, supporting a diagnosis of condyloma at an extragenital cutaneous site. The laboratory method employed did not provide a type-specific distinction between HPV 6 and HPV 11.
This case challenges the traditional paradigm that HPV types 6 and 11 demonstrate strict mucosal tropism limited to anogenital sites. Although prior reports have described extragenital manifestations of condylomas, these have typically been associated with pediatric patients, persons with immunosuppression (including HIV infection), or patients with concurrent genital disease. Cases of HPV type 6 or 11 involvement at nongenital cutaneous sites in immunocompetent adults without anogenital disease are infrequently reported.
Potential mechanisms proposed for transmission to a cervical cutaneous site include:
The report notes that HPV types 6 and 11 can co-occur with higher-risk HPV types in genital skin, but this case did not identify concurrent high-risk types and there was no anogenital involvement documented.
A principal limitation reported by the authors was the inability of the laboratory in situ hybridization technique to distinguish between HPV type 6 and HPV type 11 individually. In addition, this report describes a single patient and therefore cannot determine incidence, prevalence, or causal pathways. No concurrent anogenital lesions were identified, and transmission route in this case remains speculative.
This case highlights that condylomas attributable to HPV types 6 and 11 can present on nonanogenital cutaneous sites in immunocompetent adults. Clinicians encountering atypical, verrucous lesions at cutaneous sites should consider biopsy with histopathology and HPV typing to establish diagnosis. Recognition of extragenital presentations may broaden diagnostic consideration beyond classic anogenital tropism and prompt appropriate diagnostic testing.
The case authors emphasize that, despite the rarity of extragenital condylomas in immunocompetent adults without genital disease, biopsy and HPV testing are useful when lesions are atypical or recurrent.
(Original case report published in Emerging Infectious Diseases: Fong S, Zampella JG. Human Papillomavirus condylomas of extragenital site in immunocompetent man, New York, USA, 2025. DOI: 10.3201/eid3210.260872.)