Genital warts (condylomata acuminatum) are growths or bumps that appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. The warts may be raised or flat, single or multiple, small or large, and some may cluster together forming a cauliflower-like shape.
Rarely, genital warts also can develop in the mouth or throat of a person who has had oral sex with an infected person. Genital warts are one of the most common forms of sexually transmitted diseases.
Genital warts are caused by the
human papillomavirus
(HPV). HPV is a family of more than 80 extremely common viruses. Many types of HPV cause harmless skin warts, such as those on the fingers or feet. Only a few specific types of HPV are thought to cause genital warts.
HPV is easily spread during oral, genital, or anal sex with an infected partner. About two-thirds of people who have sexual contact with a partner who has genital warts will develop them also, usually within three months of contact.
Most people will be exposed to a form of HPV at some point in their lives, although not all will become infected or develop symptoms. Warts can appear within several weeks after sexual contact with an infected person, or they can take months to appear.
Complications of HPV
Cancer
Most strains of HPV that produce genital warts do not cause cancer. But certain strains of HPV may cause
cervical cancer, or less commonly, cancers of the vulva, anus, or penis. For this reason, it is important for women to have annual Pap tests to detect any HPV-related abnormalities.
Pregnancy/Childbirth Complications
Genital warts may become larger during pregnancy, which may make it difficult to urinate. If the warts are in or near the vaginal opening, they may block the birth canal during delivery.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for contracting HPV and/or genital warts:
Age: 15-30 years old
Multiple sexual partners
Having sex without condoms
Skin-to-skin contact with an infected partner
Previous history of genital warts
Pregnancy
Smoking
Oral contraceptives
Having sex at an early age
Symptoms
Genital warts often look like fleshy, raised growths with a cauliflower shape. They often appear in clusters.
In women, warts may be found in the following areas:
Vulva or vagina
Inside or around the vagina or anus
Cervix
In men, genital warts are less common. If present, they are usually found in the following areas:
Tip or shaft of the penis
The scrotum
Around the anus
The following symptoms may also be present:
Bleeding
Itching
Irritation
Burning
Secondary bacterial infection with redness, tenderness, or pus
Diagnosis
Evidence of genital warts may be diagnosed by the following:
Visual Exam
A doctor can diagnose genital warts by visual examination. If external warts are found, the cervix is usually checked for warts as well. Application of acetic acid may assist in identifying lesions that do not have classic features.
Pap Smear
Abnormal
Pap smear
results may indicate the presence of HPV. However, the Pap test is not the most accurate test for HPV. Further tests, such as a
colposcopy, should be performed if Pap results are abnormal.
Colposcopy and Biopsy
Colposcopy is a test that enables the doctor to identify warts that might not be easily visible. A
biopsy
involves taking a sample of tissue to be tested.
HPV Testing
A swab of some cells from the affected area can be checked for specific types of HPV.
Treatment
Treatment for genital warts depends on the size and location of the warts. Treatment only alleviates the symptoms. It does not cure the virus. Since the virus remains, warts or other complications may recur later.
Treatments may include:
Topical Treatments
Your doctor may recommend one of the following treatments or solutions to be applied to the affected areas:
Imiquimod cream
Podophyllum resin
Podofilox solution
5-Fluorouracil cream
Trichloroacetic acid
Cryosurgery, Electrocautery, or Laser Treatment
Cryosurgery (freezing), electrocautery (burning), and laser are all methods that instantly destroy warts. These methods are used if the warts are small, or if the warts are large and have not responded to other treatment. Surgical removal is sometimes recommended for large warts. An antiviral drug, called alpha-interferon, can be injected directly into warts that keep recurring.
Prevention
The only way to completely prevent the spread of an HPV infection is to avoid physical contact with an infected sexual partner.
Latex condoms may help reduce the spread of HPV infection and genital warts. However, they are not 100% effective because they cannot cover the entire genital area.
Other preventive measures include:
Sexual abstinence
Monogamous sexual relationships
Regular check-ups for sexually transmitted diseases
Regular Pap smears for women starting at age 18 or at the onset of sexual activity, whichever comes earlier
Vaccine
A vaccine called Gradasil™ has been approved to prevent infection by some—but not all—of HPV strains that cause cervical cancer. Approved for use in females aged 9-26, the vaccine is given as a series of three injections over a 6-month period. There is a catch-up vaccination recommended for women between the ages of 13-26, regardless of their sexual history, who were never vaccinated or did not complete the recommended series.
Gradasil™ is the first vaccine ever developed to primarily prevent a cancer. The vaccine reduces the risk of infection from four strains of HPV, including the two strains—16 and 18—that account for over 70% of HPV infections leading to cancer. In a recent large trial involving women aged 15-26, the vaccine effectively reduced the incidence of precancerous cervical lesions over a three year period.*
Special Considerations
Anogenital warts are rare in children. Such a diagnosis should prompt consideration of sexual abuse and should be reported.
RESOURCES:
American Social Health Association http://www.ashastd.org
United States Centers for Disease Control and Prevention http://www.cdc.gov/std
References:
Behrman RE, Kliegman RM, Jenson HB.
Nelson Textbook of Pediatrics. 17th ed. Saunders: Philadelphia PA; 2004.
Chang TY, Brashear R. Genital warts. Emedicine website. Available at: www.emedicine.com/derm/topic454.htm.
Hanna E, Bachmann G. HPV vaccination with Gardasil: a breakthrough in women's health [review].
Expert Opin Biol Ther. 2006;6:1223-1227.
Kazzi AA, Ghadishah D. Genital warts. Emedicine website. Available at: www.emedicine.com/emerg/topic640.htm.
McLemore MR. Gardasil: introducing the new human papillomavirus vaccine.
Clin J Oncol Nurs. 2006;10:559-560.
National Center for HIV, STD, and TB Prevention. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nchstp/od/nchstp.html.
National Institute of Allergy and Infectious Disease website. Available at: http://www3.niaid.nih.gov/.
New vaccine prevents cervical cancer.
FDA Consum. 2006;40:37.
Updated Vaccine section on 5/18/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance: The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med.
2007;356:1915-1927.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
