Genital Warts HPV Infection

Genital Warts (HPV) Overview

Genital warts are flesh–colored or gray growths found in the genital area and anal region in both men and women. It is the most common sexually transmitted disease caused by a virus. The warts are caused by the human papillomavirus (HPV). Infection with genital warts may not be obvious.

Genital warts affect both men and women and can occur at any age.
Most patients with genital warts are seen between the ages of 17–33 years. Genital warts are highly contagious. You have a 60% risk of getting the infection in a single sexual contact with someone who has genital warts.
In children younger than three years, genital warts are thought to be transmitted by nonsexual modes such as direct manual contact. The presence of genital warts in children should raise the suspicion for sexual abuse.


Genital Warts Causes (HPV)

Genital warts are caused by the human papillomavirus (HPV). Over 100 types of HPVs have been identified; about 40 of these types have the potential to infect the genital area.

About 90% of genital warts are caused by two specific types of the virus (6 and 11), and these HPV types are considered "low risk," having a low cancer–causing potential. Other HPV types have been strongly associated with premalignant changes and cervical cancers in women. HPV–16 is responsible for about 50% of cervical cancers, and types 16, 18, 31, and 45 together account for 80% of cancers.

Common warts are not the same as genital warts and are caused by different HPV types that infect the skin.

The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years may occur.

Generally, two–thirds of people who have sexual contact with a partner who has genital warts develop them within three months (after one episode or many).

Genital warts are associated with use of birth control pills due to increased sexual contact without the use of barrier protection, multiple sex partners, and having sex at an early age.


Genital Warts Symptoms (HPV)

Although genital warts are painless, they may be bothersome because of their location, size, or due to itching.
The size may range from less than one millimeter across to several square centimeters when many warts join together.

Men and women with genital warts will often complain of painless bumps, itching, and discharge.

In rare cases, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral opening (the opening where urine exits the body.)

Warts in more than one area are common.

There may be a history of previous sexually transmitted diseases.

Specific descriptions

In men, genital warts can infect the urethra, penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many fingerlike projections (anal warts). Others may appear pearly, cauliflower–like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Infection with HPV may be dormant or undetectable, with some lesions hidden by hair or in the inner aspect of the uncircumcised foreskin in males.

In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals require a thorough examination of the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. Rarely, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.


When to Seek Medical Care

If you have genital warts, see your doctor and discuss treatment options.

Bleeding of warts that cannot be controlled with direct pressure should be seen by a doctor. Warts that obstruct the urethral opening and don't allow you to urinate are an emergency and should be treated as soon as possible.


Exams and Tests

Diagnosis is often based on findings from the history and appearance of the genital warts.
Sometimes, lesions are only visible with an enhancing technique called acetowhitening. This technique involves the application of 5% acetic acid solution to the lesion for about 5–10 minutes. Infected areas will turn white.
Magnification of the area (colposcopy) using a scope may be necessary to see the lesions. In females, a colposcope may be used to look for lesions in the vaginal canal and on the cervix.
A routine Pap smear should always be done in order to look for evidence of HPV infection and abnormal cells on the cervix.
A biopsy can be performed if the lesion appears unusual or recurs after treatment.
Special tests can also be used to confirm the presence of HPV infection.


Genital Warts Treatment (HPV)

Self–Care at Home

Because genital warts essentially have no symptoms, there is little need for home treatment. It is important, however, to recognize that the warts exist.
You need to take the necessary precautions to prevent trauma to the area, which can result in bleeding.
You should take care to prevent transmission to sexual partners.
Because the warts themselves are infectious, avoid touching them. Do not pick or squeeze the warts.


Medical Treatment

No single treatment is effective in eliminating warts and preventing them from coming back. Genital warts may go away on their own in about 10–20% of people over a period of three to four months.
Cryotherapy: This technique freezes the wart using liquid nitrogen or a "cryoprobe." It is an excellent first–line treatment because response rates are high with few side effects.
Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. The laser physically destroys the HPV–induced lesion. Disadvantages include high cost, increased healing time, scarring, and potentially infectious viral particles in the air caused by the laser plume.
Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia. The resulting smoke plume may be infectious.


Medications

Several medications exist for treating genital warts and can be used as an alternative to other treatments.
podophyllum resin (Pod–Ben–25, Podofin) – Topically applied by a doctor
podofilox (Condylox) – Can be topically applied at home, higher cure rates than Podophyllum resin, useful for prevention
trichloroacetic acid – Topically applied, response is often incomplete and recurrence is higher, may cause pain and burning
5–Fluorouracil (Efudex) – Applied as a cream, long treatment time, can cause burning and irritation, many side effects
Interferon alpha–n3 (Alferon N) – Used as an injection for warts that do not respond to other therapies, many side effects
imiquimod (Aldara) – New treatment, applied as a cream, local skin irritation is a common side effect