Genital warts
Genital warts, also known as anogenital warts or condyloma acuminatum, are benign growths that can appear in various areas, including the vulva, vagina, cervix, penis, scrotum, and occasionally the mouth or throat. They are primarily caused by the human papillomavirus (HPV), particularly types 6 and 11, which account for over 90% of cases. The transmission of HPV occurs through direct skin-to-skin contact during sexual activities, making it one of the most common sexually transmitted infections.
While many people may be exposed to HPV, not everyone develops genital warts or symptoms, and the appearance of warts can vary widely. Risk factors include having multiple sexual partners, early sexual activity, lack of condom use, and certain health conditions or lifestyle factors. Although genital warts themselves are usually harmless, they can cause discomfort and lead to complications, especially in women where they may be associated with cervical cancer.
Diagnosis is typically made through visual examination, with further tests like Pap smears or biopsies as needed. Although treatment options exist to manage symptoms, including topical medications and surgical removal, they do not eradicate the virus, which can lead to recurrences. Preventive measures such as HPV vaccination and regular health screenings are recommended to reduce the risk of infection and associated complications.
Genital warts
- ANATOMY OR SYSTEM AFFECTED: Genitalia, mouth, skin, throat
- ALSO KNOWN AS: Anogenital warts, condyloma acuminatum, penile warts, venereal 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 two hundred common viruses, but HPV 6 and HPV 11 cause more than 90 percent of genital warts. Many other types of HPV cause harmless skin warts that are often found on the fingers or feet.
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, but most appear within three months. 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 aged fifteen to thirty years are at higher risk. Individuals with compromised immune systems, those who have not received the HPV vaccine, and those who have breaks in the skin are also at an increased 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 in women and 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 are low-risk strains that do not cause cancer, but some strains cause cervical cancer. Less common are cancers of the vulva, anus, or penis. It is important for women to have Pap tests according to their physician’s recommended time intervals, usually every three years, which can detect 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 to confirm the presence of the virus or other tests such as a colposcopy, to diagnose complications from HPV. A colposcope 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 treatments. 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 according to intervals set by the American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society (ACS).
The vaccine Gardasil-9 protects against the types of HPV that most commonly cause cancer. 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 and boys ages eleven to twelve years but may be given beginning at age nine. A “catchup” vaccine can be given to those who have not been vaccinated up to age forty-five.
Genital warts are rare in children. This diagnosis may indicate sexual abuse, which persons should report to authorities.
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