|Terminology: Genital warts are also called venereal warts and condyloma acuminata.
What Are Genital Warts?
Genital warts are benign growths that form in the genital and anal area. They are a common type of sexually transmitted disease (STD) caused by one of the many types of the human papilloma virus (HPV). At least 50 percent of all sexually active people become infected with the virus at some point in their life - but not all develop warts. Genital warts is believed to be transmitted by sexual intercourse through direct skin to skin contact. Poor hygiene is also a factor. The virus has a long incubation period so the warts may not appear for 6 months after infection. In about 10 percent of cases, no warts ever develop and the person remains symptom-free. Although they spread easily and can be difficult to get rid of, they generally cause no more than an annoyance. Warts caused by certain types of HPV infection however are associated with cervical cancer.
Is It Possible To Have Genital Warts Without The HPV Virus?
No, if you 'catch' genital warts from a sexual partner it means you have become infected with the strain of HPV virus that causes warts.
How Do I Catch Them?
Genital warts can develop in any person whose genital area has touched a wart on an infected person. As these warts thrive in warm moist areas they tend to spread quicker in pregnant women or if you have a vaginitis infection (because at both times vaginal secretions increase). People who have the HIV virus (nothing to do with the HPV virus) are particularly prone to warts, as well as many other STDs like syphilis and gonorrhea because their immune system is compromised.
What Are The Symptoms?
In women warts can grow on the vulva, inside the vagina, on the cervix and on the external skin around the vagina and anus. In men they tend to grow on the penis, sometimes on the scrotum and around the anus. Genital warts can also grow around the mouth of a person who has had oral sex with an infected partner. The symptoms and signs include:
• Small, pink, tan or red swellings about the size of a grain of rice which often merge to form a cauliflower shape.
• Some warts are so small they are not noticeable.
• Itching, irritation or burning in the genital area.
• Warts inside the vagina may bleed after sexual intercourse.
• Warts over 3 inches may make walking difficult.
Symptoms can take anywhere between 1 and 6 months to appear after infection.
When to see a doctor
Immediately if you or your partner develops suspicious bumps in the genital area.
Cancer: Warts caused by certain types of HPV have been linked to cervical cancer as well as vulva cancer and cancer of the anus. If you are infected with a higher risk HPV virus you will need be extra vigilant about having a regular Pap smear test.
Pregnancy: In rare incidences genital warts are passed to a baby during delivery (the baby develops warts on his/her throat and they need to be surgically removed). Additionally a large mass of warts on the wall of the vagina could physically obstruct labor. To avoid these possible complications, treatment of pregnant women is recommended.
How Are Genital Warts Diagnosed?
Often genital warts are so small, or hidden deep within the vagina that they are not noticed. They may only be discovered during a routine Pap smear test. Other women will notice suspicious lumps on their vulva and consult a doctor. As the naked eye may miss most warts your doctor is likely to use a special magnifying glass called a colposcope for a detailed examination. Often a vinegar type solution (acetic acid) is applied to turn wart cells white which makes them more visible. As warts resemble cancer growths and because they are frequently found in women with cervical cancer, a biopsy (small sample of wart tissue) is taken to firmly establish a diagnosis. A blood test to check for the presence of the HPV virus may also be recommended.
Genital Warts Treatment. Do They Go Away?
If left untreated genital warts can disappear on their own - but they may also remain the same or worsen and multiply. If your warts are not causing discomfort or emotional distress it is acceptable to hold off having treatment to see if they resolve on their own. However, as there is no cure for the HPV virus (the cause) - even if warts do disappear (treated or not) they can recur at any time in the future. In effect, there is no permanent cure. A recurrence within 3 months of treatment, even if warts are surgically removed, is common. When it comes to management of the condition, there is no one treatment that suits all.
Treatment For Small Warts
Small warts can be treated with a topical cream or gel such as Podofilox or Imiquimod (Aldara, Zyclara). These are applied directly to the warts once or twice a day for up to 16 weeks until the warts dissolve. Be aware that these medications can interfere with the effectiveness of contraceptive diaphragms and condoms. Sinecatechin ointment, a green-tea extract can also be used and is applied 3 times a day for up to 16 weeks.
Note: Don't try to treat genital warts with over-the-counter wart removers. These medicines are not meant for use in the genital area and can cause irritation and pain.
Larger Or Persistent Warts
Topical agents such as podophyllin resin or trichloroacetic acid (TCA) can be applied to dissolve large or persistent warts. Both are strong medications that can cause chemical burns if not used correctly. Your doctor should apply the product to each wart and allow it to air dry before telling you to put your underwear back on. The treatment can be repeated weekly if necessary. It should not be used by pregnant women because it can cause birth defects. Another topical cream which you can apply yourself called podofilox (Condylox) is used 3 times a day for up to 3 weeks. It is available on prescription.
When Warts Return
If genital warts do not respond to topical treatment, or they persistently return or you are pregnant, you may be recommended surgery. Surgical options include:
Freezing Warts: with liquid nitrogen (cryotherapy). This works by freezing the wart so that a blister forms around it. As the skin heals the lesion drops off and new skin appears underneath. It might be necessary to repeat the surgery. This treatment may be recommended instead of topical therapy if there are excessive warts or if the warts are in a very sensitive area.
Burning Warts: with electrocautery. An electrical current burns the wart off.
Surgical Excision: performed under local anesthesia, the doctor cuts the warts out.
Laser Therapy: As a last resort, laser surgery may be used to treat persistent tough warts. Although effective, it does require local or general anesthesia and many women are left with a constant pain between the vulva and anus and/or vulvodynia (vulva pain).
Hypnosis: Some psychological research shows that people who fail to respond to wart treatments show some success under hypnotherapy.
Photodynamic Therapy: Photodynamic therapy (PDT) is a treatment that uses a special drug called a photosensitizer and a specific type of light. The photosensitizers are injected into the bloodstream and when the skin is exposed to a specific wavelength of light, they produce a form of oxygen that kills wart cells. It is primarily used an alternative treatment for cancer.
Intralesional Interferon Injections: Alpha interferon is injected into the warts several times a week for 3 weeks. This therapy is less likely to cause pain and scarring than other treatments but it can induce flu-like symptoms and is not safe for pregnant women. Interferon B injections are meant to be even more effective, they are injected into the arm or buttocks but they are not yet available in the United States.
Topical Cidofovir: Primarily used for treating DNA viruses such as genital herpes and syphilis studies show that applied topically it is an effective therapeutic alternative for warts that are unresponsive to conventional treatments.
It is not possible to cure the HPV virus, and consequently there is no permanent cure for genital warts. You may have recurrences for the rest of your life. Ideally you should refrain from sexual activity with an uninfected partner until the warts or gone or removed (when they are most contagious). As this is not always practical, using a condom will help prevent transmission (although it is not fail-proof). A female condom may be an even better option because it covers more of the skin.
• Genital warts are not life threatening. If they are not treated they might disappear naturally, stay the same, or grow in size and number.
• Only in rare cases will they turn cancerous.
• Warts regularly recur after treatment - particularly in the first 3 months.
• Women should have a regular Pap test according to regular guidelines (see recommended health screenings for women), regardless of vaccination or genital wart history. If you have genital warts you do not need to get a Pap test more often than women without warts.
• If one partner has genital warts, both partners benefit from STD testing - it may also highlight other silent STDs.
Can They Be Prevented?
Preventing the spread of genital warts involves the same STD prevention advice as for other STDs. Also, it is worth becoming familiar with the most common symptoms of STDs. Additionally:
• The Gardasil vaccine, approved for females and males aged 9 to 26, protects against the HPV types that cause 90 percent of genital warts.
• Correct and consistent male or female condom use can lower the chances of giving or getting genital warts, but such use is not fully protective because HPV can infect areas that are not covered by a condom.
• Genital warts can be spread to sexual partners even if there are no visible signs of warts or if warts are treated.