There are at least 80 different types of HPV; 20 can infect the genital area.
Genital warts (or condylomata acuminata, venereal warts, anal warts and anogenital warts) are symptoms of a highly contagious sexually transmitted disease caused by some types of human papillomavirus (HPV)
At least 75% of sexually active adults have been infected with at least one type of genital HPV at some time in their life.
What are genital warts? Genital or more accurately anogenital warts are skin lesions of the genital, perineal and anal areas; the medical term is condylomata acuminata.
What causes genital warts?
Genital warts are an infectious disease caused by sexually transmitted viruses, the Human Papilloma Virus (HPV), types 6 and 11.
The incubation period (time between infectious contact and showing clinical signs) can be as long as eight months.
Most infections by HPV cause no symptoms and clear within 2 years. This means that you might not realize that you carry the virus, (and there is a chance that you may infect another person without knowing it).
The virus can persist for months or years in the skin, with or without symptoms. If the warts reappear after clearing it is usually due to the original not a new infection. Infection can occur in up to 30% of women between 20 and 30 years of age; elderly women are less frequently affected.
Are genital warts hereditary? No.
What are the signs and symptoms of genital warts? The presence of external genital warts (at the outside of the ano-genital skin) is nearly always detected by the woman herself. You do not usually feel them but there may be some degree of itching.
Internal warts/condylomata may occur inside the genitals for example the cervix or vagina or the back passage (anus). They usually cause no symptoms may cause vaginal discharge, anal itch or discomfort on passing urine and very rarely bleeding.
What do genital warts look like? The warts are small, warty lumps with fronds although some have a smooth surface. They may be browner than the surrounding skin.
How is the diagnosis made? The diagnosis is usually easily made on their appearance.
A biopsy is necessary if the diagnosis is uncertain, if treatments have not worked or if the warts are darker than the rest of the skin, ulcerated or very hard.
Vaginal examination may show vaginal or cervical warts.
Natural course of genital warts The natural clinical course is variable; it depends on the individual’s immune system. In pregnancy the mother’s immune system is altered, so warts can be more of a problem. They may resolve spontaneously; however, they may also re-appear after clearing.
Can genital warts be cured? Yes, but it is very difficult to know if the virus has been eradicated. Persistent or recurrent lesions often require repetitive treatments; recurrences may occur even months or years later.
Warts/Condylomata are very contagious. The use of condoms is the only way to prevent sexual transmission, but this does not offer complete protection. The risk of transmission is increased by a high number of sexual partners.
Complications Large warty lesions may be seen in pregnant women . They can cause pain, may become infected, may bleed and may interfere with passing urine, intercourse and having your bowels open. Cervical screening should also be done as sometimes there may be an infection with wart types that can cause cancer
How can genital warts be treated during pregnancy? The choice of the therapy is dependent on the type, the extent and the location of the warts. Treatment should be started as soon as possible. However, in the last eight weeks of pregnancy methods that destroy the warts and harm the skin should be avoided over large areas so there is no damage to the skin before delivery.
Localized lesions can be treated with freezing (cryotherapy), electro surgery or with trichloracetic acid TCA (Trichloroacetic acid, 33% to 50%) which is a liquid that “burns” or “peels” the warts away. TCA can be applied to the lesions with a cotton tip by a physician once every 2 to 3 weeks or once a week respectively.
Some treatments must not be used in pregnancy, these are Podophylotoxin which is harmful to the baby Imiquimod has been used in pregnancy without observed adverse effects but is not licensed for use in pregnancy.
After delivery, the woman’s immunity increases and warts often clear themselves..
What can I do? Condylomata acuminate are highly contagious and clearing is uncertain. Disease progression can lead to extensive lesions, therefore, treatment is recommended!
How will condylomata acuminata affect the baby? The baby is not affected by the condylomata. Maternal antibodies against the HPV are transmitted to the baby and may protection it so the chance of the baby to catching HPV from the mother during delivery is very low. The only rare serious complication is “juvenile laryngeal papillomatosis” (numerous warty papules on the vocal cords). The period of delivery should be as short as possible with the use of vaginal antiseptics; caesarean section is not justified because it does not prevent the risk of viral transmission completely.
Investigation of the male partner and his treatment Similar diagnostic and treatment options are available for men and women. Male partners with genital warts are referred to a dermatologist, a urologist or a GU physician.
Most do not develop visible warts; the infection may show up on a cervical smear. This is known as subclinical infection.
Visible genital warts are often easy to diagnose by their typical appearance. They are usually due to HPV Types 6 and 11.
Some genital warts are often called squamos pappilloma
Genital warts may occur in the following sites:
Genital warts are soft, wart-like growths on the genitals caused by a virus. Genital warts are a type of sexually transmitted infection (STI).
The virus responsible for genital warts is called human papilloma virus (HPV). More than 70 different types of HPV exist. Several types cause genital warts.
Genital warts may be found on the penis, vulva, urethra, vagina, cervix, larynx, and around and in the anus.
Other types of HPV are associated with common or flat warts found on other parts of the skin, such as the hands. However, people will not get genital warts from contact with warts on the hands or other parts of the body.
HPV infection around the genitals is common, although most people have no symptoms. Even if you do NOT have symptoms, however, you must be treated to prevent complications and spreading the condition to others.
In women, HPV can invade the walls of the vagina and cervix. These warts are flat and not easy to see without special procedures.
Certain types of HPV can lead to precancerous changes in the cervix, cervical cancer, or anal cancer. These are called high-risk types of HPV.
The following are important facts about how HPV and genital warts can be spread:
HPV infection is passed from one person to another through sexual contact involving the anal, oral, or vaginal skin or mucus membrane. It is possible for genital warts and HPV to be spread, even when no warts are visible.
You may not see warts for at least 6 weeks to 6 months after becoming infected with HPV. It may also take longer, even years. Because of this, when you first notice genital warts, it does not mean that you or your partner has had sexual contact with someone outside of your relationship.
Not everyone who has been exposed to the HPV virus and genital warts wil develop them.
The following factors put you at higher risk for getting genital warts, having them spread more quickly, having them return, or having other complications of HPV:
Having multiple sexual partners
Not knowing whether someone you had sex with had STIs
Becoming sexually active at an early age
Using tobacco and alcohol
Having stress and other viral infections (such as herpes) at the same time
Having an immune system that does not work well, such as during cancer treatment or AIDS
If a child has genital warts, you should suspect sexual abuse as a possible cause.
Genital warts can be raised or flat, and are usually flesh-colored. They may appear as cauliflower-like growths. Sometimes they are so small and flat that they cannot be seen with the naked eye.
Common places to find genital warts:
Females most often have warts inside or around the vagina or anus, on the skin around these areas, or on the cervix.
Males most often have warts on the penis, scrotum, groin area, or thighs, as well as inside or around the anus in those who have anal intercourse.
Both males and females may have warts on the lips, mouth, tongue, palate, or throat (larynx)
Other symptoms are rare, but may include:
Increased dampness or moisture in the area of the growths
Increased vaginal discharge
Itching of the penis, scrotum, anal area, or vulva
Vaginal bleeding, with or after sexual intercourse
However, many people with HPV infection often have no symptoms.
Exams and Tests
A genital examination reveals flesh-colored to white, flat or raised, single or clustered lesions anywhere on the genitalia.
In women, a pelvic examination may reveal growths on the vaginal walls or cervix. Magnification (colposcopy) may be used to see lesions that are invisible to the naked eye. The tissue of the vagina and cervix may be treated with acetic acid (dilute vinegar) to make the warts visible.
A Pap smear may note changes caused by HPV. Women with these types of changes often need more frequent Pap smears for a period of time.
An HPV DNA test can identify the high-risk types of HPV that are known to cause cervical cancer. It may be done as a screening test for women over age 30, or for women of any age who have a slightly abnormal Pap test result.
Genital warts must be treated by a doctor. Do NOT use over-the-counter remedies meant for other kinds of warts.
Your doctor may treat genital warts by applying a skin treatment in the office. Or, the doctor may prescribe a medication that you apply at home several times per week. These treatments include:
Podophyllin and podofilox (Condylox)
Trichloroacetic acid (TCA)
Surgical treatments include:
Surgical excision (cutting them out)
Dr. Rothfeld feels that cryosurgery (freezing) is the best method and at this point in time this is the only procedure he performs.
If you develop genital warts, all of your sexual partners must be examined by a healthcare provider and treated if genital warts are found.
After your first treatment, your doctor will schedule follow-up examinations to see if the warts have returned.
Women who have had genital warts, and women whose partners have ever had genital warts, should have Pap smears at least once a year. For warts on the cervix, women may be advised to have Pap smears every 3 to 6 months after initial treatment.
Women with precancerous changes caused by HPV infection may need further treatment.
Young women and girls ages 9 - 26 shoul be vaccinated against HPV.
Most sexually active young women become infected with HPV, but very few remain infected for more than 5 years. In many cases, HPV goes away on its own.
Most men who become infected with HPV never develop any symptoms or problems from the infection. However, they can pass it on to current and sometimes future sexual partners.
Even after you have been treated for genital warts, you may still infect others.
Certain types of genital warts increase a woman's risk for cancer of the cervix and vulva.
Some types of HPV have been found to cause cancer of the cervix and vulva. They are the main cause of cervical cancer.
The types of HPV that can cause genital warts are not the same as the types that can cause penile or anal cancer.
The warts may become numerous and quite large, requiring more extensive treatment and follow-up procedures.
When to Contact a Medical Professional
Call your doctor if a current or past sexual partner is found to have genital warts. Call if you have visible warts on your external genitals, itching, discharge, or abnormal vaginal bleeding. Keep in mind that genital warts may not appear for months to years after having sexual contact with an infected person.
Call your doctor if a young child is thought to possibly have genital warts.
Women should begin to have Pap smears at age 21.
Total abstinence is the only foolproof way of avoiding genital warts and other STIs. You can also avoid STIs by having a sexual relationship with only one partner who is known to be disease-free.
Skin near the warts and around the genitals, anus, and other areas can pass the virus from one person to the next. Therefore, male and female condoms cannot fully protect you. Nonetheless, condoms reduce risk and should still be used. They reduce your chances of getting or spreading STIs. These precautions must be taken at all times. HPV can be passed from person to person even when there are no visible warts or other symptoms.
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