An Overview of Genital Warts

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Genital warts on skin of the labia
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Genital warts, also known as condylomata acuminata, is one of the most common sexually transmitted infections. It's estimated that 340,00 to 360,000 people are affected by genital warts each year in the United States, though many infections do not cause symptoms.

Causes

Genital warts are caused by human papillomavirus (HPV). There are roughly 100 different types of HPV infections with around 30 of which are transmitted as sexually.

If you've been learning about genital warts you may be feeling confused and just a little nervous. That is because there is a lot of misunderstanding about the HPV virus and the complications of different strains of the virus. While HPV is the cause of genital warts, the strains which cause genital warts are not the strains which cause cancer.

Around 90 percent of genital warts are caused by HPV 6 and HPV 11. In contrast, roughly 70 percent of cervical cancers are caused by HPV 16 and HPV 18 and most oral cancers caused by HPV are due to HPV 16. Another 20 percent of cervical cancers are caused by HPV types 31, 33, 34, 45, 52, and 58.

In other words, the strains of HPV which cause genital warts are different than the strains which cause cervical cancer and vice versa. On the other hand, the risk factors for developing HPV—both the genital-wart-causing strains and the cervical-cancer-causing strains—are the same.

HPV Infections

Many people are infected with HPV infections, but most of the time, even with the cancer-causing strains, the virus is eliminated from the body before any symptoms occur. If you are infected with one of these viruses, you may not have any symptoms, may develop genital warts, or may have an abnormal pap smear suggestive of dysplasia or precancerous changes of the cervix.

Symptoms

Genital warts affect the moist tissue of the genital area. They may appear as small, flesh-colored bumps or as a group of bumps in the genital area. They can vary in size and sometimes appear shaped like a cauliflower. In most instances, the warts are too small to be seen. Only half of women, and a smaller percentage of men, develop genital warts when infected by the HPV strains which cause genital warts.

In women, genital warts most commonly occur on the labia and near the opening of the vagina. On men, they are most common at the tip of the penis, but may occur along the shaft as well. Both men and women may develop warts around the opening to the anus. Anal sex is not necessary for these to occur. Men and women may also develop genital warts in the mouth or throat related to oral sex.

Diagnosis

Regular testing for HPV is recommended in order to screen for cervical cancer and other complications of HPV. There is no standard test to diagnosis HPV. It is important that women undergo regular pap screenings to detect abnormalities that may indicate an HPV infection.

If there is an abnormality, a DNA test, which can test for high-risk strains of HPV, can be conducted. If warts or lesions appear in the genital area, you should seek medical attention and testing for HPV.

It's important to note, however, that the HPV tests for HPV that you may have done do not test for the genital-wart-causing strains of the virus.

Risk Factors

HPV can be contracted by anyone who is sexually active. Factors that increase the risk of developing genital warts include:

  • Unprotected vaginal sex
  • Anal sex
  • Oral sex
  • Genital-to-genital contact
  • Childbirth
  • Previous sexually transmitted diseases
  • Multiple sexual partners
  • Smoking does not increase the risk of contracting HPV, but may delay the body's ability to clear the virus.

While certain cases of HPV may resolve on their own, certain types of HPV can lead to the development of cervical, penile, and anal cancers, among others.

In these cases, the virus does not directly cause the cancers, but rather leads to inflammation that can, in turn, lead to cancer. Other factors, such as smoking, which slow the clearance of the virus from the body, may contribute to the development of cancer.

Treatment

There is no cure for HPV. Treatment is available for symptoms, such as genital warts, cervical cancer and cervical changes. But, treatment will depend on the diagnosis and the severity of the infection.

Genital warts can be treated with:

  • Medication—There are both over-the-counter medications and medications which are applied by a physician available. Self treatments include Podofilox, Imiquimod, and Sinecatechins. Physician-applied treatments include podophylline, trichloroacetic acid, and bichloroacetic acid. These treatments are usually applied once a week by a physician.
  • Cryotherapy (freezing)
  • Electrocautery (burning)
  • Injection of interferon into the warts
  • Laser treatment
  • Surgery to remove the warts

Treatment will remove the warts but not the infection. So, even if treated, you may still be able to transmit the infection to your partner.

Prevention

Avoiding risk factors, such as multiple sexual partners, can reduce your risk of contracting HPV and thus genital warts. Condoms may lessen your risk but do not always prevent the spread of HPV, as only skin-to-skin contact alone is needed. If you are between the ages of nine and 26, immunization may help prevent infection.

Immunization

Immunization is available which may protect you against contracting the HPV virus. There are now three different types of shots available, but only two of these are designed to protect against the genital wart and cervical cancer causing strains of the virus. 

Immunizations currently available and the HPV strains which they are designed to prevent include:

  • Gardisil (approved in 2006) protects against HPV 6, 11, 16, and 18
  • Cervarix (approved in 2009) protects against HPV 16 and 18
  • Gardisil 9 (approved 2014) protects against HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58

Sources:

Carusi, D. Patient education: Genital warts in women (Beyond the Basics). UpToDate. 6/22/15.

Centers for Disease Control and Prevention. Genital HPV Infection—Fact Sheet. 1/03/2017.

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