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Genital Warts by Michelle Badash, MS

Definition

Genital warts are growths or bumps that appear:

On the vulva
In or around the vagina or anus
On the cervix
On the penis, scrotum, groin, or thigh
In the mouth or throat (rare)

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).

Most people will be exposed to a form of HPV at some point in their lives. Not everyone will become infected or develop symptoms.

Genital Warts

Causes

Genital warts are caused by the human papillomavirus (HPV). HPV is a family of more than 80 common viruses. Many types of HPV cause harmless skin warts . These warts 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.

Risk Factors

Risk factors for HPV and genital warts include:

Age 15-30 years old
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
Taking oral contraceptives

Symptoms

Genital warts often look like fleshy, raised growths. They have a cauliflower shape, and often appear in clusters. Sometimes warts may not be easy to see with the unaided eye.

In women, warts may be found in the following areas:

Vulva or vagina
Inside or around the vagina or anus
Cervix

In men, warts are less common. If present, they are usually found in these areas:

Tip or shaft of the penis
Scrotum
Around the anus

While warts do not usually cause symptoms, the following may occur:

Bleeding
Itching
Irritation
Burning
Secondary bacterial infection with redness, tenderness, or pus

Complications of HPV

Cancer

Most strains of HPV that produce genital warts do not cause cancer. But, certain strains may cause cervical cancer . Less commonly, cancers of the vulva, anus, or penis occur.

For women, it is important to have Pap tests , which can detect any HPV-related problems, including cervical cancer. The current recommendations for this screening test are:

If you are aged 21-29 years—You should have the Pap test every two years. (If you had sex before age 18, Pap test screening should begin before age 21.)
If you are aged 30 or older—You should have the Pap test every three years, if you had three normal Pap tests in a row.
If you are aged 65 or older—You may be able to stop having Pap tests if you have had three normal results in a row and no abnormal results in the past 10 years.
Note: You will need to have Pap tests done more often if you have abnormal results or certain conditions, like a suppressed immune system or a history of cervical dysplasia or cervical cancer. Talk to your doctor about the right screening schedule for you.

Pregnancy and Childbirth Complications

Genital warts may get larger during pregnancy. This may make it hard to urinate. Warts in or near the vaginal opening may also block the birth canal during delivery.

Diagnosis

Genital warts may be diagnosed by:

Visual Exam

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

Pap Test

If you get abnormal Pap test results, this may indicate HPV. But, your doctor will order more accurate tests, like a colposcopy , to diagnose HPV.

Colposcopy and Biopsy

During a colposcopy, the doctor uses a special device to see if warts are in the cervix and vagina. For a biopsy , the doctor takes a tissue sample and tests it.

HPV Testing

During an HPV test , a swab of cells from the affected area can be checked for certain types of HPV.

Treatment

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

Treatments may include:

Topical Treatments

Your doctor may recommend one of these medications to be applied to the affected areas:

Imiquimod cream
Podophyllum resin
Podofilox solution
5-Fluorouracil cream
Trichloroacetic acid

Combining one of these treatments with cryosurgery or laser treatment may increase their effect.

Cryosurgery, Electrocautery, or Laser Treatment

Methods that instantly destroy warts include:

Cryosurgery (freezing)
Electrocautery (burning)
Laser treatment

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

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% effective. They do not cover the entire genital area.

Other ways to prevent infection include:

Abstaining from sex
Having a monogamous relationship
Getting regular check-ups for STDs

Vaccine

The HPV vaccine , a series of three injections, is given to girls aged 11-12 years old to prevent cervical cancer and genital warts. If you are aged 26 or younger and were not vaccinated, you can receive a "catch-up" vaccine.

The vaccine can also be given to males aged 9-18 to reduce the chance of developing genital warts.

Special Considerations

Genital warts are rare in children. This diagnosis may indicate sexual abuse. Abuse needs to be reported.

RESOURCES:

Centers for Disease Control and Prevention http://www.cdc.gov/
Planned Parenthood http://www.plannedparenthood.org/

CANADIAN RESOURCES:

Health Canada http://www.hc-sc.gc.ca/index_e.html/
Sex Information and Education Council of Canada http://www.sieccan.org/

References:

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Human papillomavirus and genital warts. National Institute of Allergy and Infectious Disease website. Available at: http://www3.niaid.nih.gov/healthscience/healthtopics/human_papillomavirus/ . Updated June 2007. Accessed June 24, 2008.
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10/23/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : FDA approves new indication for Gardasil to prevent genital warts in men and boys. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187003.htm . Published October 16, 2009. Accessed October 22, 2009.

Last reviewed September 2011 by Lawrence Frisch, MD, MPH

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