Genital Warts

What are genital warts?

Genital warts (condylomata acuminata) are the most common sexually transmitted disease (STD) and a symptom of human papillomavirus (HPV) infection — a very common and highly contagious skin infection. Although HPV comes in over 100 different types, 90 percent of all cases of genital warts are caused by strains 6 and 11.[1] Accordingly, only 10 percent of those who contract the virus will develop visible warts.

Even if they are unaware of its presence, most sexually active people will contract the virus at some point during their lifetime. It is passed on through skin-to-skin contact, most commonly through oral, vaginal or anal intercourse. Although the warts rarely cause any long-term harm, they are generally considered unsightly and may cause psychological distress. There is no cure for genital warts or HPV, meaning treatment options are limited to managing the physical impact.

Symptoms of genital warts

Most people who contract the virus will not develop any visible symptoms. If genital warts do appear, it can sometimes be a significant amount of time – weeks or even months – after first contracting the infection.[2]

The warts themselves generally form in clusters, though can also appear singularly. They normally form on the outside of the body in the genital or anal area, typically on the vagina, labia majora, penile shaft or scrotum. They can also less commonly appear internally; inside the anus, the vagina, the opening of the urethra or on the cervix.

The warts usually take the form of small bumps of roughly two to three centimeters in diameter and are sometimes described as resembling miniature cauliflowers. They typically cause no pain and minimal discomfort, are red or skin-colored in appearance, and can be either soft or hard to touch. If scratched or excessively disturbed, genital warts may bleed.

Causes of genital warts

The human papillomavirus (HPV) causes genital warts. This is a skin infection that comes in over 100 different types, each of which affecting a different part of the body. There are roughly 30 types of HPV that can affect the genital and anal areas, but only two (6 and 11) that cause the vast majority (90 percent) of all cases of genital warts. Both men and women can contract the virus and are then able to pass it on to others.

Transmission

Genital warts are spread through skin-to-skin contact, primarily through oral, vaginal or anal sex.[3] Penetrative sex, however, is not necessary for contraction; close genital contact can be enough for the virus to be passed on between two sexual partners.

The virus that causes genital warts is extremely contagious, however, it cannot be passed on through such physical interactions as hugging or kissing, nor through items of clothing or towels. After HPV has been contracted, it is typical for the genital warts to appear in between two weeks and eight months.[4]

Latency and reappearance

HPV naturally clears from the body in two years or under in 90 percent of cases. For those who have developed genital warts and seen them disappear, there is a chance of the warts recurring within, or in a small amount of cases, outside of this timeframe.

Diagnosing genital warts

Most commonly, visible genital warts will be diagnosed through a routine doctor’s examination and the review of the patient’s medical history. If, however, there is a suspicion of the presence of HPV without any visible symptoms, other diagnostic routes may be explored. For women, this will most often involve a gynecological exam and Pap test, followed by a tissue biopsy if abnormal cells are detected. Biopsies for men are much more rare and are generally not recommended by doctors.

Gynecological exam / Pap test

For women without visible genital warts, diagnosing the presence of HPV will often involve undergoing a gynecological exam. This exam will typically include a Pap test (sometimes called a Pap smear).[5] A procedure usually used to test for cervical cancer, the Pap test screens the cervix for abnormal cells, which are a possible sign of HPV infection. If abnormal cells are found, further tests will be carried out to screen for HPV infection, as well as the presence of cervical cancer.

Genital warts treatment

There is no cure for genital warts – no way to remove the virus from the patient's system – meaning that treatment is focussed on removing the warts or preventing them from spreading. The direction that treatment will take depends on the amount of warts present, their location and their physical appearance.[6]

Some patients will choose to undergo no treatment. This option is perfectly safe but will generally prolong the problem. If the patient does opt for treatment, there are a number of different options to explore:

Application of antiviral gels or creams. These solutions are marketed in a number of different varieties but are generally applied by the patient themselves over the course of a number of days or weeks. Side-effects may include itching and mild scarring.

Cryotherapy (freezing). Liquid nitrogen is used to rapidly freeze the affected area, resulting in a mild burning sensation. This procedure is usually used for small warts around the penis or vulva.

Excision. The warts are surgically removed while the patient is under a local anesthetic. Typically used for small, hardened warts.

Electrosurgery. Generally used for large clusters of warts that have not responded to other treatments, this option involves cutting away the bulk of the warts, pressing a metal rod against the affected area and sending an electric current through it to burn away what remains.

Laser surgery. Generally used for large clusters of warts or those that are difficult to reach (inside the anus, for example). A specialist will use a laser to burn away the mass of warts while the patient is under regional or general anaesthetic.

Prevention of genital warts

Although they are not 100 percent reliable, the use of condoms remains the most effective way of preventing the contraction genital warts. There are also HPV vaccines available. These vaccines do not protect against all strains of HPV but may be effective in preventing genital warts.

Condoms

To help protect against genital warts, condoms should be used every time vaginal, anal or oral intercourse is engaged in. Apart from celibacy, this is the most effective prevention method currently known of. However, using a condom does not guarantee full protection. The virus may be able to spread from genital skin not covered by the condom.

Vaccines

HPV vaccines can be effective in preventing genital warts, as well as other conditions including cervical cancer. The vaccination is most effective if given before a young person becomes sexually active, and is usually given between 11 and 13 years of age. Catch-up programs are sometimes available up to the age of 26, but vaccination in people over 26 has been shown to be ineffective .[7]

There are a number of vaccines available, each protecting against a number of different HPV strains. No vaccine is able to protect against all strains of the virus, nor guarantee defence against all types of genital warts. However, vaccination does significantly lower one’s chances of contracting the virus.

Other names for genital warts

  • Anogenital warts
  • Condyloma acuminatum
  • Condylomata acuminata

  1. NHS Choices. “Genital Warts - Symptoms.” August 22, 2017. Accessed June 23, 2017.

  2. DrEd. “Early Signs of Genital Warts.” Accessed June 23, 2017.

  3. In the know ZONE. “How are genital warts spread.” Accessed June 23, 2017.

  4. NCBI. “Genital HPV infection and related lessons in men.” October, 2011. Accessed June 23, 2017.

  5. WebMD. “Genital Warts.” Accessed June 26, 2017.

  6. fpa. “Genital Warts.” July, 2014. Accessed June 26, 2017.

  7. CDC. “HPV Vaccination Information for Young Women.” December 28, 2016. Accessed June 26, 2017.