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Genital warts

Definition

Genital warts are soft, wart-like growths on the skin and mucus membranes of the genitals in men and women. Genital warts are a type of sexually transmitted infection (STI).

Alternative Names

Condylomata acuminata; Penile warts; Human papilloma virus (HPV); Venereal warts; Condyloma; HPV DNA test; Sexually transmitted disease (STD)

Causes, incidence, and risk factors

The virus that causes genital warts is called human papilloma virus (HPV). More than 70 different types of HPV exist.

• Several types of HPV cause genital warts, which may be found on the penis, vulva, urethra, vagina, cervix, larynx, and around and in the anus.
• Other types of HPV cause common or flat warts on other parts of the skin, such as the hands. However, warts on the hands or other parts of the body do not cause genital warts.

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.

• HPV infection is passed from one person to another through sexual contact involving the skin of the anus, mouth, or vagina, or the mucus membrane. It is possible for genital warts and HPV to spread, even when no warts can be seen.
• 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, so 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
• Being pregnant
• 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.

Symptoms

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:

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

Signs and tests

Flesh-colored to white, flat or raised, single or clustered warts may be seen anywhere on the genitals.

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 whether you have a high-risk type of HPV that is known to cause cervical cancer. This test may be done:

• As a screening test for women over age 30
• In women of any age who have a slightly abnormal Pap test result

Treatment

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:

• Imiquimod (Aldara)
• Podophyllin and podofilox (Condylox)
• Trichloroacetic acid (TCA)

Surgical treatments include:

• Cryosurgery
• Electrocauterization
• Laser therapy
• Surgical excision (cutting them out)

If you develop genital warts, all of your sexual partners must be examined by a health care provider and treated if genital warts are found.

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 need to have Pap smears every 3 to 6 months after the first 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.

Expectations (prognosis)

Most sexually active young women become infected with HPV. 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.

Complications

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.

Calling your health care provider

Call your doctor if:

• A current or past sexual partner has genital warts
• 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.
• You think a young child might have genital warts

Women should begin having Pap smears at age 21.

Prevention

Total abstinence is the only foolproof way to avoid genital warts and other infections that are spread through sexual contact (STIs). You can also decrease your chance of getting an STI by having a sexual relationship with only one partner who you know is disease-free.

Male and female condoms cannot fully protect you, because the virus or warts can be on the skin. Nonetheless, condoms reduce your risk and you should still use them at all times. HPV can be passed from person to person even when there are no visible warts or other symptoms. See: Safe sex

Stop smoking.

Two vaccines are available that protect against four of the HPV types that cause most cervical cancer in women. The vaccine is given as a series of three shots. It is recommended for girls and women ages 9 to 26.

See: HPV vaccine for more detailed information.

References

Diaz ML. Human papilloma virus: prevention and treatment.Obstet Gynecol Clin North Am. 2008;35(2):199-217.

Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357:1579-1588.

Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009;361:271-278.

HPV and Men - CDC Fact Sheet. April 3, 2008. Accessed December 20, 2009.