Cockscombs: What are they? When and why do they manifest themselves? Symptoms and Treatment of G.Bertelli


The rooster crests (or condylomata acuminata) are warty lesions, which arise mainly on the skin and mucous surfaces of the ano-genital area .

The disease is caused by some types of human papilloma virus or HPV (Human Papilloma Virus). The infection that supports the pathological process is transmitted through direct contact, often during sexual intercourse .

The rooster crests appear on the genitals and / or around the anus, like fleshy and rosy growths, with an irregular surface (hence the name) and a variable diameter. These lesions can be isolated or confluent. Normally, rooster combs are not painful, but can cause intense itching, burning and bleeding .

Available treatments include the use of drugs (taking modulators of immune response and caustication with acids) or therapeutic destruction with outpatient or surgical interventions (cryotherapy, laser therapy, electrocautery and surgical removal).

What are

What are rooster crests?

" Cockscomb " is a term used in popular parlance to refer to condylomata acuminata . These lesions manifest themselves as warty skin growths, which are mainly located on the external genitals and around the anus .

The rooster crests are caused by some types of HPV (Human Papilloma Virus), the same pathogen involved in the formation of warts in the feet and in other anatomical sites.

Infection is transmitted mainly, but not exclusively, through sexual intercourse .

Rooster Crests: synonyms

  • Condylomata acuminata;
  • Genital warts.


At the genital level, the rooster crests are one of the most frequent infections with a viral etiology. The infection occurs mainly through sexual activity, but it is also possible by intimate skin-to-skin contact ("skin to sin").

The rooster crests are highly contagious injuries.

Rooster Crests: what are they caused by?

The rooster crests are caused by some genotypes of the human papilloma virus, including HPV 6 and 11, at low oncogenic risk. This means that, although the etiological agent is an HPV, the subtypes responsible for the rooster crests rarely demonstrate a potential evolution in the neoplastic sense.

HPV, rooster's crests and cervical cancer: is there a correlation?

The genital infection from human papilloma virus is notoriously related to some types of neoplasms, in particular it represents the main cause of cervical cancer (or cervix).

After infection, the probability of a carcinogenic evolution depends on the HPV subtype responsible for the disease. The viral agents that are normally involved in the onset of rooster's crests (HPV 6 and HPV 11) have a very low probability of malignant degeneration. A high risk of neoplastic evolution is associated, however, to genomes 16 and 18, considered "high-risk" oncogenes, that is strongly associated with cervical carcinomas.

How the infection occurs

The rooster crests are transmitted " skin to skin ", that is through direct contact with the skin and mucous membranes where the viral agent is present.

The spread of infection often occurs during vaginal, anal and oral sex . In this regard, it should be noted that even an appropriate use of the condom does not completely protect from the transmission of the cock crests.

The viral agent can also spread by prolonged hand-genital contact or self-inoculation . In the latter case, the person himself distributes the virus to other parts of the body, where condylomatous lesions develop (eg the infection is "transported" from the genitals to the anal region). In most cases, self-inoculation occurs during intimate hygiene practices.

In some cases, there is the possibility of transmission through the mixed use of objects, such as sex toys, underwear or bath towels and toothbrushes.

At the time of delivery, the infection can also be transmitted from the mother to the newborn .

Rooster's crests: how long after the infection does it occur?

The incubation period is normally between one and six months, at the end of which the rooster crests make their debut. In most cases, the infection runs out quickly; at other times, HPV remains in cells for a long time.

It should be noted that some individuals do not contract genital infection with human papilloma virus, probably due to a highly effective immune system. The chances of transmission of the cock crests from an infected partner to an uninfected one are not known with certainty, just as the duration of infectiousness is not known.

Risk factors

The factors that can favor the onset of the cock crests include:

  • Immune deficiency : although they do not prefer particular categories of people, immunodepression and the concomitant presence of other pathologies capable of weakening the immune system can increase the risk of contracting the rooster's crests;
  • Use of cortisone, especially local;
  • Pregnancies : these lesions can reach considerable dimensions during gestation .

Considering that the rooster crests are particularly contagious, special attention should be paid to hygienic prevention. The rooster crests spread more easily in conditions of high humidity and are more frequent in case of increased vaginal discharge, as in the case of vaginal candidiasis .

Being mainly sexual transmission, important risk factors are:

  • Number of sexual partners : promiscuity increases the risk of contracting rooster crests. It should be noted, then, that many subjects are contagious even without knowing it, as carriers of the virus or suffering from an asymptomatic form of the disease;
  • Failure to use a condom during intercourse (note: although the rules of safe sex are always valid, the effectiveness of the condom is not absolute, since the rooster crests can contract even through the contact of areas not covered by the device).

Symptoms and Complications

Rooster Crests: how do they manifest themselves?

The rooster crests are similar to the warts that can occur in other parts of the body. As the term suggests, these growths have an appearance that makes them similar to the crest of a rooster . Their diameter is variable and can range from a few millimeters to several centimeters .

The rooster crests appear as soft and fleshy lesions, with an irregular, dotted and fissured surface . When symptomatic and untreated, these can evolve into rough, more or less obvious eruptions .

If left untreated, rooster crests can persist for several months and even years. Condylomatous lesions can increase in number and appear even in areas distant from the initial site of appearance. In some cases, untreated rooster crests can also disappear spontaneously over time.

Disorders associated with rooster crests

The symptoms related to the presence of these genital lesions are not particularly serious. In some cases, the rooster crests are even asymptomatic and may even regress spontaneously .

In addition to the growth of warty growths in the genital area, there may be:

  • Irritations with swelling, redness and blood loss ;
  • Intimate itching ;
  • Localized burning .

Despite being rather unpleasant and annoying (when symptomatic), the rooster crests are generally harmless, that is they do not correlate to particular complications.

Locations involved

The rooster crests can occur in both men and women.

In both sexes, the typical locations of these condylomatous lesions are the mucous membranes and the skin surface of the genital area and the anal region .

In humans, rooster combs commonly strike:

  • Inguino-scrotal region;
  • Perineal raphe (between anus and scrotum);
  • Surface and crown of the glans;
  • Balano-preputial groove;
  • Urethral meatus;
  • Along the frenulum;
  • Penis rod.

As for the female sex, the locations affected by the rooster crests are predominantly:

  • Walls of the vagina (especially the lower third of the vaginal canal);
  • External genitals (vaginal orifice, large and small labia and perivulvary regions);
  • Neck of the uterus;
  • Perineum.

The cock's crests can also develop around or inside the mouth (lips and gums), while their occurrence at the level of the hands, conjunctiva and other areas of the face is rare.

Cockscombs: how they can evolve

The rooster crests have the appearance of a multiple verrucosity, often fleshy and pointed, of rosy, yellowish or brown color. Most often, these growths are so small that they are invisible to the naked eye. On other occasions, however, the rooster crests tend to flow together, joining and reaching even considerable dimensions.

If left untreated, the rooster crests can become brittle and can form masses similar to a cauliflower; from a symptomatological point of view, this variant is decidedly more annoying.

Cockscomb: possible complications

The main complication of the rooster crests is represented by recurrences . In fact, condylomatous lesions tend to appear again, even after treatment.

During pregnancy, the rooster's crests can increase their size, even creating important urinary disorders .


The diagnosis is mainly clinical and is based on the observation of the genitals during a medical examination, but, usually, histological confirmation is required.

The rooster's crests can be visible to the naked eye, but occasionally they run asymptomatically, so the feedback can be random. To make them more evident, the doctor can directly apply a solution of 3-5% acetic acid in situ.

Histological examination of rooster's crests

The analysis of a bioptic sample allows to ascertain or not the actual nature of the lesion.

On histological examination, the rooster crests are characterized by some typical alterations, such as:

  • Paracheratosis : keratinization disorder, in which a reversal of the normal epidermal maturation process occurs; in particular, there is an increase in the proliferation of keratinocytes;
  • Acanthosis : manifestation characterized by the hyperpigmentation of some areas of skin, not well delimited, which appear thickened and dark brown in color;
  • Papillomatosis : pathological condition characterized by the presence, in a site of the organism, of numerous papillomas derived from the excessive proliferation of the epithelium covering the skin or a mucous membrane.

The rooster crests can be transmitted with unprotected relationships, therefore, if their presence is verified, the partner will also have to be carefully controlled and possibly cared for.

Cockscomb: Pap test and colposcopy

Given the relationship between HPV infections and cervical cancer, for women with rooster crests who have not performed it in the previous two to three years, the Pap test (or Papanikolaou test ) is recommended. This examination allows us to highlight the early signs of a degeneration in the neoplastic sense and allows us to face the possible tumor in its initial stage.

A more modern exam, called HPV test can replace the Pap test starting from 30-35 years. This makes it possible to determine whether the woman has contracted a potentially oncogenic virus, even before any lesions develop, identifying the presence of HPV DNA in the cervical cells.

To learn more: HPV Test - Indications and Meaning of the Exam »

If one of these two tests has a positive outcome, a diagnostic procedure known as colposcopy is indicated to confirm or deny the possible presence of a tumor process affecting the cervix.

Treatment and Remedies

The treatment of rooster crests can be done according to different methods.

In general, smaller lesions can be treated with local applications of drugs, while larger ones require surgical excision or therapeutic destruction with other chemical-physical methods.

Cockscomb: drugs

The pharmacological treatment of rooster's crests is based on the local application of medicines with a destructive action (such as trichloroacetic acid and podophyllin ) or on the administration of modulators of the immune response (eg imiquimod, 5-fluorouracil, etc.). All these therapeutic protocols should be recommended, prescribed and monitored by the doctor.

To learn more: Drugs for rooster's crests (Condylomata Acuminati) »

Destructive methods and surgical therapy

Usually, at causticization with acids, the "destructive" methods of the rooster crests are preferred. These interventions can be ambulatory or surgical and include:

  • Cryosurgery : rooster crests can be frozen, using a swab soaked in liquid nitrogen. This treatment with the cold eliminates the lesions, avoiding bleeding;
  • Laser therapy : to be performed under local anesthesia or, in the most serious cases, general, causes cell lysis and death of the viruses contained in them. The laser beam can be directed with extreme precision on the rooster crests, minimizing the extension of post-treatment scars.

The same result can be achieved through cauterization of the rooster crests.

Read more: Therapeutic Destruction of Rooster Crests with Cauterization »

In other cases, it is preferable to opt for surgical excision, recommended for particularly annoying and resistant to medical treatment.

After treatment: follow up and precautions

After the removal of the rooster's crests, it is always recommended to perform the histological examination to define the characteristics and, considering the risk of relapses, establish a plan to monitor the patient.

Since the rooster crests are among the sexually transmitted diseases, it is recommended to adopt responsible sexual behavior and always use a condom, especially with people at risk. This device must be worn correctly before starting the relationship .

The control and eventual treatment of the rooster's crests must be extended also to the sexual parterns (even if they do not have condylomata evident to the naked eye), with which there have been relationships in the previous three months .

The risk of relapses should also be taken into consideration.

In order to avoid the reappearance of the cock crests, it is advisable to put into practice some simple precautions:

  • Refrain from sexual intercourse until the end of therapy;
  • Avoid exchange of underwear or towels, sex toys and toothbrushes;
  • Wash hands before and after using the toilet;
  • Use specific and delicate products for intimate hygiene, so as not to alter the balance of the mucous membranes;
  • Wear underwear in natural fibers, such as cotton, and avoid garments in nylon, microfiber and clothes that are too tight, which may hinder the natural transpiration of the skin.


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