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Genital Warts

Genital Warts

Genital warts are flesh-colored or gray growths found in the genital area and anal region in both men and women. Genital warts are sometimes referred to as condyloma acuminata or venereal warts. They represent the most common sexually-transmitted disease caused by a virus. The warts are caused by the human papillomavirus (HPV). Infection with genital warts may not be obvious.

 

Genital warts affect both men and women and can occur at any age.

 

  • Most patients with genital warts are between the ages of 17-33 years. Genital warts are highly contagious. There is around a 60% risk of getting the infection from a single sexual contact with someone who has genital warts.

 

  • In children younger than three years of age, genital warts are thought to be transmitted by nonsexual methods such as direct manual contact. Nevertheless, the presence of genital warts in children should raise the suspicion for sexual abuse.

 

Up to 20% of people with genital warts will have other sexually transmitted diseases (STDs).

Symptoms

Although genital warts are painless, they may be bothersome because of their location, size, or due to itching.

 

  • The size may range from less than one millimeter (1 mm = 0.039 inches) across to several square centimeters (1 cm = 0.39 inches) when many warts join together. 

 

  • Men and women with genital warts will often complain of painless bumps, itching, and discharge. 

 

  • Rarely, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral opening (the opening where urine exits the body.) 

 

  • Warts in more than one area are common.

 

  • There may be a history of previous or concurrent sexually transmitted diseases (STDs).

 

Specific descriptions

 

Men

 

  • In men, genital warts can infect the urethra,penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many fingerlike projections (anal warts). Others may appear pearly, cauliflower-like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Sometimes lesions may be hidden by hair or in the inner aspect of the uncircumcised foreskin in males.

 

Women

 

  • In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals warrant a thorough examination of the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. Rarely, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.

Causes

Genital warts are caused by the human papillomavirus (HPV). Over 100 types of HPVs have been identified; about 40 of these types have the potential to infect the genital area.

 

  • About 90% of genital warts are caused by two specific types of the virus (HPV-6 and -11) and these HPV types are considered "low risk", meaning they have a low cancer-causing potential. Other HPV types are known causes of premalignant changes and cervical cancers in women. HPV-16, one of the "high-risk" types, is responsible for about 50% of cervical cancers. HPV types 16, 18, 31, and 45 are other known "high risk" virus types. High-risk HPV types are also referred to as oncogenic HPV types. HPV is believed to cause 100% of cases of cervical cancer.

 

  • Common warts are not the same as genital warts and are caused by different HPV types that infect the skin. The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years may occur, during which there is no evidence of infection.

 

  • Generally, about two-thirds of people who have sexual contact with a partner who has genital warts develop them within three months.

 

  • Genital warts are indirectly associated with use of birth control pills due to increased sexual contact without the use of barrier protection, multiple sex partners and having sex at an early age.

Treatment

Self-Care at Home

 

Because genital warts essentially have no symptoms other than their appearance, there is little need for home treatment. It is important, however, to recognize that the warts exist.

 

  • Take the necessary precautions to prevent trauma to the area, which can result in bleeding.
  • Be careful to prevent transmission to a sexual partner.
  • Because the warts themselves are infectious, avoid touching them. Do not pick or squeeze the warts.

 

Medical Treatment

 

There is no single effective cure for removal of genital warts. A number of treatment options exist; however, no treatment is 100% effective in eliminating warts and preventing them from coming back in all patients.

It also is not possible to eliminate infection with human papillomavirus once it has occurred. Genital warts may go away on their own in about 10%-20% of people over a period of three to four months.

 

  • Cryotherapy: This technique freezes the wart using liquid nitrogen or a "cryoprobe". It is an excellent first-line treatment because response rates are high with few side effects.
  • Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. The laser physically destroys the HPV-induced lesion. Disadvantages include high cost, increased healing time, scarring, and potentially infectious viral particles in the air caused by the laser plume.
  • Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia. Of note, the resulting smoke plume may be infectious.
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