Definition & Overview

Genital warts are soft growths that appear on the genitals and/or anal area. The warts are usually gray or flesh-coloured and vary in size. Genital warts are sometimes referred to as venereal warts or condyloma acuminata.

Men and women of any age can have genital warts. However, the condition occurs mainly in individuals between the ages 17-33. The warts are highly contagious, and although these are mostly transmitted through sexual contact, they can also be passed on to other individuals through non-sexual means. If genital warts appear in children, it does not necessarily mean that it was transmitted sexually. However, parents, guardians, or medical professionals should become suspicious.

When genital warts appear in men, they are usually on the penis, scrotum, groin, thighs, or in and around the anus. On women, genital warts appear outside or inside the vagina, or in the cervix. If genital warts are transmitted through oral sexual contact, they’ll be visible on the lips, mouth, tongue, or throat.

It is important to note that genital warts in women can lead to cancer. Women who have genital warts should not only be treated for the condition, but should also be screened for a variety of cancers.

Causes

Genital warts develop from certain strains of the Human Papillomavirus (HPV). There are over 100 types of HPV. However, according to the Center for Disease Control (CDC), more than 90% of genital warts come from HPV 6 or HPV 11.

Although HPV 6 and HPV 11 are the most common causes of genital warts, they do not usually cause cancer. Meanwhile, HPV 16 causes most cervical cancers. HPV 18, 31, and 45 are also “high-risk” types, meaning they usually lead to cancer.

HPV is a highly contagious virus. It can be transmitted through skin contact alone. Most cases of HPV are caused by sexual contact with a person who has it. In fact, a report from the American Academy of Dermatology revealed that more than half of individuals who have had sex, also have some of type of HPV infection.

There have been reports that birth control pills may also cause genital warts. However, studies revealed that the use of birth control pills minimizes the use of barrier types of birth control methods, such as condoms. Having unprotected sex increases the risk of transferring or receiving HPV from an infected person. It is important to understand that condoms do not provide 100% protection against HPV, because HPV can also be transmitted through bodily fluids.

Key Symptoms

Not all warts are genital warts. Some warts may be the common wart, which only affects the skin. Genital warts, like common warts, may also not cause any symptoms. If they do, the symptoms will usually be pain, itching, or a burning sensation. If genital warts appear inside a woman’s vagina, they can cause bleeding or abnormal vaginal discharge. Although the sizes of genital warts vary, they are usually between less than 1mm to several centimeters across. If warts join together, they can be quite large, usually several square centimeters. It is also common to see genital warts in more than one area. For instance, if the warts were transmitted through oral and sexual intercourse, it is highly likely warts will appear in both the mouth and genitals.

Who to See & Types of Treatment Available

If you notice an abnormal tissue growth on your genitals, lips, mouth, tongue, or throat, you need to consult your physician. If warts prevent you from urinating because they are blocking the urethral opening, the condition will be considered an emergency. If genital warts bleed and the bleeding cannot be stopped by pressure, this too will be considered an emergency.

Your doctor will need to perform several tests to diagnose the condition accurately. These tests can include a biopsy to confirm the presence of HPV, a pap smear, colposcopy (magnification), or different laboratory tests. The doctor may also want to apply an acetic acid solution to the suspicious area. If HPV is present, the area will turn white.

There is a variety of methods to treat genital warts. Unfortunately, none of them is 100% effective in either removing warts or preventing them from reoccurring. HPV infections cannot be totally cured. In some cases, genital warts may disappear without treatment, but there is no assurance that these will not grow back again.

The most common treatments available for genital warts are:

  • Laser Treatment – Lasers are mostly used when there is a large number of genital warts or when they keep coming back. Before undergoing laser treatment, your doctor will administer an anesthetic cream to minimize discomfort.

  • Cryotherapy – This type of treatment involves freezing genital warts using liquid nitrogen or cryoprobe. The response rates for cryotherapy are high, and the procedure has minimal side effects.

  • Electrodesiccation – In this method, the genital warts are destroyed using an electrical current. However, the smoke plume from the treatment can also be infectious. Prior to the treatment, the doctor will administer a local anesthetic.

  • Medications – Genital warts can also be treated using a variety of medications. These include Podofilox, Trichloroacetic Acid, Bichloroacetic Acid, Interferon Alpha-N3, Imiquimod, and 5-Flourouracil.

  • Surgery – You can also opt to undergo surgery to remove your genital warts. Surgical procedures will involve excising them. This type of treatment is usually recommended only when the genital warts are small, and there are only a few of them. The treatment is highly effective, but like all other treatments, there is no assurance that genital warts won’t reappear in the future.

If you have never been infected with genital warts, it is recommended that you receive an HPV vaccine. The vaccine is highly effective in preventing genital warts, but only when the person has never had them before. The effect diminishes significantly for people who have already been treated for HPV. An HPV vaccine called Gardasil is effective against HPV 6, HPV 11, HPV 16, and HPV 18. Another HPV vaccine called Cervarix is effective against HPV 16 and HPV 18.

References:

  • Advisory Committee on Immunization Practices (ACIP). Recommendations on the use of quadrivalent human papillomavirus vaccine in males. MMWR. 2011;60:1705-1708.
  • American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement: HPV vaccine recommendations. Pediatrics. 2012. DOI: 10.1542/peds.2011-3865.
  • Berman Bm Amini S. Condyloma acuminata. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, Pa: Elsevier Saunders; 2013:chap 46.
  • Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules for Persons Aged 0 Through 18 Years and Adults Aged 19 Years and Older - United States, 2013. MMWR. 2013;62(Suppl1):1-19.
  • Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Philadelphia, Pa: Elsevier Mosby; 2009:chap 11.
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