What are genital warts?

Definition

Genital warts are growths or bumps that appear on the vulva; in or around the
vagina or anus; on the cervix, penis, scrotum, groin, or thigh; or, rarely, in the
mouth or throat. The warts may be raised or flat, single or multiple, small or
large. Some may cluster to form a cauliflower-like shape. This condition is one of
the most common sexually transmitted diseases (STDs).

Causes

Genital warts are caused by the human papillomavirus (HPV). HPV is a family of more than
eighty common viruses. Many types of HPV cause harmless skin warts that are often
found on the fingers or feet. Only a few types 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 sex with a partner who has genital warts will also develop them. Warts can take several weeks or months to appear. Most people will be exposed to a form of HPV at some point in their lives, but not everyone will become infected or develop symptoms.

Risk Factors

Risk factors for HPV and genital warts include multiple sexual partners, women
whose first male sexual partner has had two or more previous sexual partners, sex
without condoms, sex at an early age, skin-to-skin contact with an infected
partner, previous history of genital warts, pregnancy, smoking, and taking
oral
contraceptives. Persons age fifteen to thirty years are at
higher risk.

Symptoms

Genital warts often look like fleshy, raised growths. They have a cauliflower
shape and often appear in clusters. In women, warts may be found in the area of
the vulva, inside or around the vagina or anus, and on the cervix. In men, warts
are less common. If present, they are usually found on the tip or shaft of the
penis, on the scrotum, or around the anus. The following symptoms may also occur
for women and for men: bleeding, itching, irritation, burning, and a secondary
bacterial
infection with redness, tenderness, or pus.

Complications of HPV include cancer. Most strains of HPV that
produce genital warts do not cause cancer, but certain strains may cause
cervical
cancer. Less common are cancers of the vulva, anus, or penis.
It is important for women to have yearly Pap
tests, which can detect any HPV-related problems.

Genital warts may get larger during pregnancy and could make urination difficult. Warts in or near the vaginal opening may also block the birth canal during delivery.

Screening and Diagnosis

A doctor can diagnose genital warts by looking at them. If external warts are found on a woman, her cervix is usually also checked. In all patients, the doctor may use a special solution to help find lesions that do not have classic features.

An abnormal Pap test may indicate HPV, but the doctor will order more accurate
tests, such as a colposcopy, to diagnose HPV. A colposcopy is a special
device that allows the doctor to see if warts are in the cervix and vagina. The
doctor may take a tissue sample (biopsy) and test it. During an HPV
test, a swab of cells from the affected area can be checked for certain types of
HPV.

Treatment and Therapy

Treatment, which depends on the size and location of the warts, helps the symptoms but does not cure the virus. The virus stays in the body, and warts or other problems may recur.

Treatments may include topical treatments. The doctor may recommend topical medications to be applied to the affected areas. They include imiquimod cream, podophyllum resin, podofilox solution, 5-fluorouracil cream, and trichloroacetic acid.

Other treatment options include cryosurgery (freezing the wart),
electrocautery (burning the wart), and laser treatment, all of which destroy the
warts. These methods are used on small warts and on large warts that have not
responded to other treatment. A large wart can also be removed surgically. For
warts that keep coming back, an antiviral drug, called alpha-interferon, can be
injected into the wart.

Prevention and Outcomes

The only way to completely prevent HPV from spreading is to avoid physical contact with an infected partner. Latex condoms may help reduce the spread of HPV infection and genital warts. Condoms are not 100 percent effective, however, because they do not cover the entire genital area. Other ways to prevent infection include abstaining from sex, having a monogamous relationship, and getting regular checkups for STDs. Women should get regular Pap tests, starting at age eighteen years or at the start of sexual activity.

The vaccine Gardasil protects against four types of HPV. Studies have
shown that the vaccine reduced the number of precancerous cervical cell changes
for up to three years after the shot. The vaccine is routinely given to girls ages
eleven to twelve years, and a “catchup” vaccine is given to young women who have
not been vaccinated. The U.S. Food and Drug Administration has also
approved the use of Gardasil in males ages nine to twenty-six years.

Genital warts are rare in children. This diagnosis may indicate sexual abuse, which persons should report to authorities.

Bibliography

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