Genital warts

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Certain types of human papillomavirus (HPV) cause genital warts. The types of HPV that cause genital warts are usually spread by direct skin-to-skin contact during vaginal, anal, or possibly oral sex with someone who has this infection.

In females, warts may appear around the vulva (entire outer female genital area), in or around the vagina, in or around the anus, the groin (where the genital area meets the inner thigh),or the cervix (although this is less common than external warts). In males, warts may appear on the penis, scrotum (balls), in or around the anus, or the groin area.

Genital warts appear as growths or bumps. Warts may be raised or flat, single or multiple, small or large. They tend to be flesh-colored or whitish in appearance. Warts usually do not cause itching, burning, or pain. However, most HPV infections will not lead to visible warts and most people will not know they have the virus.

FAQs

When do warts appear?

Warts may appear within several weeks after sex with someone who has the wart-types of HPV, or it may take several months or years to appear. Or, warts may never appear. This makes it hard to know exactly when or from whom someone got the virus.

Genital warts may or may not return after the first episode. Some people only have one episode of warts, while others have recurrences (when warts reappear). When warts are present, the virus is considered active. When warts are gone, the virus is latent (sleeping) in the skin cells - it may or may not be contagious at this time.

A healthy immune system is usually able to clear the virus, or suppress it, over time.


How are warts transmitted?

The types of HPV that cause genital warts are usually spread by direct skin-to-skin contact during vaginal, anal, or possibly oral sex with someone who has this infection. Any person who is sexually active can get genital warts.

HPV may be more likely transmitted when warts are present, but the virus can be transmitted even when there are no visible symptoms.

The types of HPV that cause genital warts are usually different from those causing warts on other body parts, such as the hands. People do not get genital warts by touching warts on their hands or feet.

Warts are not commonly found in the mouth, so some experts believe that transmission through oral sex is not as likely as with genital-to-genital or genital-to-anal contact.


How are warts diagnosed?

If someone thinks he or she has warts or have been exposed to HPV, they should go to a healthcare provider or clinic. A provider will check more closely and may use a magnifying lens to find smaller warts. Sometimes, warts can be very hard to see. Also, it can be hard to tell the difference between a wart and normal bumps on the genital area.

To look for warts or other abnormal tissue, a healthcare provider may put acetic acid (vinegar) on the genitals. This causes warts to turn white and makes them easier to see, especially if they are viewed through a magnifying lens such as a colposcope. However, the vinegar can sometimes cause other normal bumps to be highlighted, so this method of diagnosis can be misleading.

A biopsy is not necessary for diagnosing genital warts. This is only done if the bump is unusual looking or discolored.

HPV DNA tests are only approved for use with women as part of cervical cancer screening and, and are not used to diagnosed warts. These are no blood tests clinically available to diagnose a person for HPV.


How are warts treated?

While there is no medical cure for HPV, there are several treatment options available for genital warts. The goal of any treatment should be to remove visible warts to get rid of annoying symptoms. Treating the warts may possibly help reduce the risk of transmission to a partner who may have never been exposed to the wart-types of HPV.

When choosing what treatment to use, the healthcare provider will consider the size, location and number of warts, changes in the warts, patient preference, cost of treatment, convenience, adverse effects, and their own experience with the treatments. No one treatment is best for all cases. Some treatments are done in a clinic or doctor's office; others are prescription creams that can be used at home for many weeks.

Treatments done in the doctor's office include:

  • Cryotherapy (freezing off the wart with liquid nitrogen). This can be relatively inexpensive, but must be done by a trained healthcare provider.
  • Podophyllin (a chemical compound that must be applied by a healthcare provider). This is an older treatment and is not as widely used today.
  • TCA (trichloracetic acid) is another chemical applied to the surface of the wart by a healthcare provider.
  • Cutting off warts. This has the advantage of getting rid of warts in a single office visit.
  • Electrocautery (burning off warts with an electrical current)
  • Laser therapy (using an intense light to destroy warts).This is used for larger or extensive warts, especially those that have not responded well to other treatments. Laser can also cost a lot of money. Most healthcare provider do not have lasers in their office and the provider must be well-trained with this method.
  • Interferon (a substance injected in to the wart). This is rarely used anymore due to extensive side effects and high cost. Less expensive therapies work just as well with fewer side effects.

At-home prescription creams (these are only available by a prescription):

  • Podofilox cream or gel (Condylox®). This is a self-applied treatment for external genital warts. It may be less expensive than treatment done in a healthcare provider's office, is easy to use and is safe, but it must be used for about 4 weeks.
  • Imiquimod cream (Aldara®). This is also a self-applied treatment for external genital warts. It is safe, effective and easy to use. This cream is different than other commonly-used treatments, which work by destroying the wart tissue. Aldara® actually boosts the immune system to fight HPV, and may make recurrences less likely.

IMPORTANT: Over-the-counter wart treatments should not be used in the genital area.


How can I reduce my risk?

Any person who is sexually active can come across this common virus. Ways to reduce the risk are:


  • Abstinence (not having sex with anyone).
  • Having sex only with one partner who has sex only with you. People who have many sex partners are at higher risk of getting other sexually transmitted infections (STIs).
  • If someone has visible symptoms of genital warts, he or she should not have sexual activity until the warts are removed. This may help to lower the risk of giving the virus.
  • Condoms used the right way from start to finish every time you have sex may help provide protection - but only for the skin that is covered by the condom. Condoms do not cover all genital skin, so they don't protect 100%.
  • Spermicidal foams, creams, jellies (and condoms coated with spermicide) are not proven to be effective in preventing HPV and may cause microscopic abrasions that make it easier to contract STIs. Spermicides are not recommended for routine use.

When someone has HPV, they are not likely to be reinfected if exposed again to the same type. This is probably due to the immune system's response to the virus. However, it is possible to be infected with a different type of HPV from a new partner. It is important for partners to understand the "entire picture" about HPV so that both people can make informed decisions based on facts, not fear or misconceptions.


What about pregnancy and genital warts?

Most pregnant women who have had genital warts previously but no longer do would be unlikely to have any complications or problems during pregnancy or birth. Most children are born healthy to women with a history of genital warts.

Because of hormone changes in the body during pregnancy, warts can grow in size and number, bleed, or, in extremely rare cases, make delivery harder. Very rarely, babies exposed to the wart-types of HPV during birth may develop growths in the throat. This so seldom happens, though, that women with genital warts do not typically need to have a cesarean-section delivery unless warts are blocking the birth canal. It is important that a pregnant woman notify her healthcare provider or clinic if she or her partner(s) has had genital warts. This way they can determine if they need to treat the warts, or not, during the pregnancy.

Counseling

Counseling Patients about HPV is a video primer for clinicians on effective patient counseling for HPV and genital warts. The brief video includes talking points on relationships, incidence and prevalence, vaccines, and HPV's natural history. This video was made possible by an unrestricted educational grant from Merck & Co., Inc.