• Genital Warts

    (Anogenital Warts; Condyloma Acuminata; Human Papillomavirus [HPV]; Penile Warts; Venereal Warts; Warts, Genital)

    Definition

    Genital warts are growths or bumps that appear:
    • On the vulva
    • In or around the vagina or anus
    • On the cervix
    • On the penis, scrotum, groin, or thigh
    • In the mouth or throat (rare)
    Genital Warts
    Nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.
    Genital warts is one of the most common sexually transmitted infections (STIs). Most people will be exposed to a form of HPV at some point in their lives. Not everyone will become infected or develop symptoms.

    Causes

    Genital warts are caused by the human papillomavirus (HPV). There are many different types of HPV. Only a few types are thought to cause genital warts. Many types of HPV are associated with harmless skin warts found on the fingers or feet.
    HPV is easily spread during oral, genital, or anal sex with an infected partner. Almost two-thirds of people who have sex with an infected partner will also develop genital warts.

    Risk Factors

    Factors that may increase your risk for HPV and genital warts include:
    • Multiple sexual partners
    • First male sexual partner has had two or more previous sexual partners (for women)
    • Sex without condoms
    • Having a weakened immune system
    • Sex at an early age
    • Skin-to-skin contact with an infected partner
    • Previous history of genital warts or other STIs

    Symptoms

    Genital warts often look like fleshy, raised growths. They can have a cauliflower shape, and often appear in clusters. Some warts may be flat. The warts may not be easy to see with the unaided eye. Warts can take several weeks or months to appear after the infection.
    In women, warts may be found in the following areas:
    • Vulva or vagina
    • Inside or around the vagina or anus
    • Cervix
    In men, warts are less common. If present, they are usually found in these areas:
    • Tip or shaft of the penis
    • Scrotum
    • Around the anus
    While warts do not usually cause symptoms, the following may occur:
    • Bleeding
    • Itching
    • Irritation

    Complications of HPV

    Cancer
    Certain types of HPV may cause cervical cancer. Less commonly, cancers of the vulva, anus, or penis occur.
    For women, it is important to have Pap tests. This test can detect HPV-related problems before they become cancerous. During the Pap test, a sample of cells is taken from the cervix. The sample is studied to look for abnormal cells and HPV.
    If you are a healthy woman, many professional health organizations offer these recommendations for screening:
    • If you are aged 21-29 years—Pap test every three years
    • If you are aged 30-65—Pap test along with the HPV test every five years or you can continue to have just the Pap test every three years
    • If you are aged 65 or older—you may be able to stop having Pap and HPV tests if you have had three normal results in a row and no abnormal results in the past 10 years
    You may need to have Pap tests done more often if you have had abnormal results or certain conditions. Your doctor can help determine the right screening schedule for you.
    Pregnancy and Childbirth Complications
    Genital warts may get larger during pregnancy. This may make it hard to urinate.
    Warts in the vagina can also disrupt the normal stretching process of the vagina during labor. Warts can also be spread to the infant during delivery.

    Diagnosis

    Genital warts may be diagnosed by:

    Visual Exam

    A doctor can usually diagnose genital warts by looking at them. If external warts are found on a woman, then the cervix is usually also checked. A doctor may use a special solution to help find lesions that do not have classic features.

    Pap Test

    An abnormal Pap test result may indicate HPV. Your doctor will order more accurate tests, like a colposcopy, to diagnose HPV.

    Colposcopy and Biopsy

    During a colposcopy, a special device is used to see if there are warts in the cervix and vagina. A sample of tissue will be taken and tested for HPV.

    HPV Testing

    An HPV test only requires a swab of cells from the affected area. This test will be able to identify the specific type of HPV causing the problems.

    Treatment

    Treatment helps the symptoms, but does not cure the virus. The virus stays in your body. This means the warts or other problems may recur.
    Your treatment depends on the size and location of the warts. Not all warts need to be treated. If left untreated, some may go away on their own, but others may stay. Some warts may also get larger or spread.
    Treatments may include:

    Topical Treatments

    Topical medication is applied directly to the skin. Your doctor may recommend one of these medications:
    • Imiquimod cream
    • Sinecatechins ointment
    • Podophyllin resin
    • Podofilox solution
    • Trichloroacetic acid or bichloroacetic acid

    Cryosurgery, Electrocautery, or Laser Treatment

    Methods that instantly destroy warts include:
    • Cryosurgery (freezing)
    • Electrocautery (burning)
    • Laser treatment
    These methods are used on small warts. It may be used on larger warts that have not responded to other treatment. A large wart can also be removed with surgery.

    Prevention

    The only way to completely prevent HPV from spreading is to avoid physical contact with infected partners.
    Latex condoms may help reduce the spread of HPV infection and genital warts. Condoms are not 100% effective because they do not cover the entire genital area.
    Other ways to help prevent infection include:
    • Abstain from sex
    • Have a monogamous relationship
    • Get regular check-ups for STIs

    Vaccine

    There is a vaccine for HPV. It is given over a series of three injections to girls and boys aged 11-12 years old. If you are aged 26 or younger and were not vaccinated, you can receive a catch-up vaccine series.

    Special Considerations

    Genital warts are rare in children. This diagnosis may indicate sexual abuse. Abuse needs to be reported.

    RESOURCES

    Centers for Disease Control and Prevention http://www.cdc.gov

    Planned Parenthood http://www.plannedparenthood.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Sex Information and Education Council of Canada http://www.sieccan.org

    References

    Genital Warts. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/treatment/2010/genital-warts.htm. Updated January 28, 2011. Accessed October 7, 2012.

    American College of Obstetricians and Gynecologists. First cervical cancer screening delayed until age 21 less frequent Pap tests recommended. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq085.pdf?dmc=1&ts=20130205T1433163887. Published November 20, 2009. Accessed October 7, 2012.

    Baker CJ, Pickerling LK, et al. Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2011. Ann Intern Med. 2011;154(3):168-173.

    Batista CS, Atallah AN, et al. 5-FU for genital warts in non-immunocompromised individuals. Cochrane Database Syst Rev. 2010 Apr 14;4:CD006562.

    Behrman RE, Kliegman RM, et al. Nelson Textbook of Pediatrics. 17th ed. Philadelphia PA: Saunders; 2004.

    Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2011. MMWR. 2011;60(5).

    Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR. 2010;59(No. RR-12):1-110.

    Condyloma acuminatum. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated September 28, 2012. Accessed October 7, 2012.

    Dunne EF, Markowitz LE. Genital human papillomavirus infection. Clin Infect Dis. 2006; 43:624.

    Hanna E, Bachmann G. HPV vaccination with Gardasil: a breakthrough in women's health [review]. Expert Opin Biol Ther. 2006;6:1223-1227.

    HPV vaccine information for young women. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/hpv. Accessed October 7, 2012.

    HPV vaccine: what you need to know. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hpv-gardasil.pdf. Updated February 22, 2012. Accessed October 7, 2012.

    Human papillomavirus and genital warts. National Institute of Allergy and Infectious Disease website. Available at: http://www.niaid.nih.gov/topics/genitalwarts/Pages/default.aspx. Updated October 21, 2012. Accessed October 7, 2012.

    Lowy DR, Schiller JT. Papillomaviruses and cervical cancer: pathogenesis and vaccine development. J Natl Cancer Inst Monogr. 1998;23:27-30.

    McLemore MR. Gardasil: introducing the new human papillomavirus vaccine. Clin J Oncol Nurs. 2006;10:559-560.

    New vaccine prevents cervical cancer. FDA Consum. 2006;40:37.

    1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356:1915-1927.

    1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Winer RL, Feng Q, Hughes JP, O'Reilly S, Kiviat NB, Koutsky LA. Risk of female human papillomavirus acquisition associated with first male sex partner. J Infect Dis . 2008;197:279-282.

    1/4/2011 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: FDA approves new indication for Gardasil to prevent genital warts in men and boys. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187003.htm. Published October 16, 2009. Accessed October 22, 2009.

    1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Screening for cervical cancer. United States Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Published March 2012. Accessed March 19, 2012.

    Saslow D, Soloman D, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA: A Cancer Journal for Clinicians. 2012 Mar 14 early online.

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