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External Genital Warts Information

M

Mary Anne PA

[font=Arial, Helvetica, sans-serif]What are the symptoms of genital warts?
Only certain types of HPV cause genital warts. Other types, not related to genital warts, can cause abnormal cell changes on the genital skin, usually on a female's cervix.

What do warts look like?
Genital warts appear as growths or bumps. Warts may be raised or flat, single or multiple, small or large. They tend to be flesh-colored or whitish in appearance. Warts usually do not cause itching or burning.

Sometimes genital warts are so small that they can not be seen with the naked eye. This is sometimes called "subclinical warts." Therefore, a person may not even know he or she has the type or types of HPV that cause genital warts.

The types of HPV that cause raised external genital warts are not linked with cancer. These types are usually harmless.

Where can genital warts appear?
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<TABLE cellSpacing=0 cellPadding=5 width=387 border=0><TBODY><TR><TD width=210>[font=Arial, Helvetica, sans-serif]Females[/font]</TD><TD width=157>[font=Arial, Helvetica, sans-serif]Males[/font]</TD></TR><TR><TD width=210>[font=Arial, Helvetica, sans-serif]Vulva (entire outer female genital area)[/font]</TD><TD width=157>[font=Arial, Helvetica, sans-serif]Penis[/font]</TD></TR><TR><TD width=210>[font=Arial, Helvetica, sans-serif]In or around the vagina [/font]</TD><TD width=157>[font=Arial, Helvetica, sans-serif]Scrotum (balls)[/font]</TD></TR><TR><TD width=210>[font=Arial, Helvetica, sans-serif]In or around the anus [/font]</TD><TD width=157>[font=Arial, Helvetica, sans-serif]In or around the anus[/font]</TD></TR><TR><TD width=210>[font=Arial, Helvetica, sans-serif]Groin (where the genital area meets the inner thigh)[/font]</TD><TD width=157>[font=Arial, Helvetica, sans-serif]Groin (where the genital area meets the inner thigh)[/font]</TD></TR><TR><TD width=210>[font=Arial, Helvetica, sans-serif]Cervix (less common than external warts)[/font]</TD><TD width=157> </TD></TR></TBODY></TABLE>

[font=Arial, Helvetica, sans-serif]How often can episodes of genital warts occur? [/font]

  • [font=Arial, Helvetica, sans-serif]Some people only have one episode, while others have recurrences [/font]
  • [font=Arial, Helvetica, sans-serif]When warts are present, the virus is considered active [/font]
  • [font=Arial, Helvetica, sans-serif]When warts are gone, the virus is latent (sleeping) in the skin cells - it may or may not be contagious at this time [/font]
  • [font=Arial, Helvetica, sans-serif]Genital warts may or may not return after the first episode[/font]
  • [font=Arial, Helvetica, sans-serif]A healthy immune system helps fight the virus [/font]
  • [font=Arial, Helvetica, sans-serif]Warts may appear within several weeks after sex with someone who has the wart-types of HPV, or it may take several months or years to appear. Or, warts may never appear. This makes it hard to know exactly when or from whom someone got the virus.[/font]
[font=Arial, Helvetica, sans-serif]How can a person get genital warts? [/font]

  • [font=Arial, Helvetica, sans-serif]Any person who is sexually active can get genital warts. [/font]
  • [font=Arial, Helvetica, sans-serif]The types of HPV that cause genital warts are usually spread by direct skin-to-skin contact during vaginal, anal or (rarely) oral sex with someone who has this infection. [/font]
  • [font=Arial, Helvetica, sans-serif]Very little is known about passing subclinical HPV to sex partners. HPV may be more likely transmitted when warts are present, but the virus can be transmitted even when ther are no visible symptoms.[/font]
  • [font=Arial, Helvetica, sans-serif]The types of HPV that cause genital warts do not usually seem to cause warts on other body parts such as the hands. [/font]
  • [font=Arial, Helvetica, sans-serif]Warts on other parts of the body, such as the hands, are caused by different types of HPV. People do not get genital warts by touching warts on their hands or feet. [/font]
  • [font=Arial, Helvetica, sans-serif]Warts are not commonly found in the mouth, so some experts believe that transmission through oral sex is not likely.
    [/font]
[font=Arial, Helvetica, sans-serif]How can a person find out if they have genital warts?
Sometimes, warts can be very hard to see. Also, it can be hard to tell the difference between a wart and normal bumps on the genital area. If someone thinks he or she has warts or have been exposed to HPV, they should go to a doctor or clinic. A doctor or nurse will check more closely and may use a magnifying lens to find smaller warts.

A biopsy is not necessary for diagnosing genital warts. This is only done if the bump is unusual looking or discolored.

To look for warts or other abnormal tissue, doctors or nurses may put acetic acid (vinegar) on the genitals. This causes warts to turn white and makes them easier to see, especially if they are viewed through a magnifying lens such as a colposcope. However, the vinegar can sometimes cause other normal bumps to be highlighted, so this method of diagnosis can be misleading.

There are no blood tests available to diagnose a person for HPV.

How can someone reduce the risk of getting genital warts?
Any person who is sexually active can come across this common virus. Ways to reduce the risk are:[/font]

  • [font=Arial, Helvetica, sans-serif]Not having sex with anyone.[/font]
  • [font=Arial, Helvetica, sans-serif]Having sex only with one partner who has sex only with you. People who have many sex partners are at higher risk of getting other STDs. [/font]
  • [font=Arial, Helvetica, sans-serif]If someone has visible symptoms of genital warts, he or she should not have sexual activity until the warts are removed. This may help to lower the risk of giving the virus. [/font]
  • [font=Arial, Helvetica, sans-serif]Condoms (rubbers), used the right way from start to finish each time of having sex may help provide protection - but only for the skin that is covered by the condom. Condoms do not cover all genital skin, so they don't protect 100%. [/font]
  • [font=Arial, Helvetica, sans-serif]Spermicidal foams, creams and jellies are not proven to act against HPV and genital warts, but they work against some other STDs. These are best used along with condoms, not in place of condoms. [/font]
  • [font=Arial, Helvetica, sans-serif]When someone has HPV, they are not likely to be reinfected if exposed again to the same type. This is probably due to the immune system's response to the virus. However, it is possible to be infected with a different type of HPV from a new partner.[/font]
  • [font=Arial, Helvetica, sans-serif]It is important for partners to understand the "entire picture" about HPV so that both people can make informed decisions based on facts, not fear or misconceptions.
    [/font]
[font=Arial, Helvetica, sans-serif]How are genital warts treated?[/font]

  • [font=Arial, Helvetica, sans-serif]While there is no medical cure for HPV, there are several treatment options available for genital warts. [/font]
  • [font=Arial, Helvetica, sans-serif]The goal of any treatment should be to remove visible genital warts to get rid of annoying symptoms. No one treatment is best for all cases. [/font]
  • [font=Arial, Helvetica, sans-serif]Treating the warts may possibly help reduce the risk of transmission to a partner who may have never been exposed to the wart-types of HPV. [/font]
  • [font=Arial, Helvetica, sans-serif]When choosing what treatment to use, the health care provider will consider the size, location and number of warts, changes in the warts, patient preference, cost of treatment, convenience, adverse effects, and their own experience with the treatments. [/font]
  • [font=Arial, Helvetica, sans-serif]Some treatments are done in a clinic or doctor's office; others are prescription creams that can be used at home for many weeks.[/font]
[font=Arial, Helvetica, sans-serif]Treatments done in the doctor's office include: [/font]

  • [font=Arial, Helvetica, sans-serif]Cryotherapy (freezing off the wart with liquid nitrogen). This can be relatively inexpensive, but must be done by a trained doctor or nurse. [/font]
  • [font=Arial, Helvetica, sans-serif]Podophyllin (a chemical compound that must be applied by a doctor or nurse). This is an older treatment and is not as widely used today. [/font]
  • [font=Arial, Helvetica, sans-serif]TCA (trichloracetic acid) is another chemical applied to the surface of the wart by a doctor or a nurse. [/font]
  • [font=Arial, Helvetica, sans-serif]Cutting off warts. This has the advantage of getting rid of warts in a single office visit [/font]
  • [font=Arial, Helvetica, sans-serif]Electrocautery (burning off warts with an electrical current) [/font]
  • [font=Arial, Helvetica, sans-serif]Laser therapy (using an intense light to destroy warts).This is used for larger or extensive warts, especially those that have not responded well to other treatments. Laser can also cost a lot of money. Most doctors do not have lasers in their office and the doctor must be well-trained with this method. [/font]
  • [font=Arial, Helvetica, sans-serif]Interferon (a substance injected in to the wart). This is rarely used anymore due to extensive side effects and high cost. Less expensive therapies work just as well with fewer side effects.[/font]
[font=Arial, Helvetica, sans-serif]At-home prescription creams:
These are only available by a prescription from a doctor: [/font]

  • [font=Arial, Helvetica, sans-serif]Podofilox cream or gel (Condylox®). This is a self-applied treatment for external genital warts. It may be less expensive than treatment done in a health care provider's ofice, is easy to use and is safe, but it must be used for about 4 weeks.. [/font]
  • [font=Arial, Helvetica, sans-serif]Imiquimod cream (Aldara®). This is also a self-applied treatment for external genital warts. It is safe, effective and easy to use. This cream is different than other commonly-used treatments, which work by destroying the wart tissue. Aldara actually boosts the immune system to fight HPV.

    [/font]
[font=Arial, Helvetica, sans-serif]IMPORTANT: Over-the-counter wart treatments should not be used in the genital area.

What about pregnancy and genital warts? [/font]

  • [font=Arial, Helvetica, sans-serif]Most pregnant women who have had genital warts previously but no longer do would be unlikely to have any complications or problems during pregnancy or birth. [/font]
  • [font=Arial, Helvetica, sans-serif]Most children are born healthy to women with a history of genital warts. [/font]
  • [font=Arial, Helvetica, sans-serif]Because of hormone changes in the body during pregnancy, warts can grow in size and number, bleed, or, in extremely rare cases, make delivery harder.[/font]
  • [font=Arial, Helvetica, sans-serif]Very rarely, babies exposed to the wart-types of HPV during birth may develop growths in the throat. [/font]
  • [font=Arial, Helvetica, sans-serif]This so seldom happens, however, that women with genital warts do not typically need to have a cesarean-section delivery unless warts are blocking the birth canal. It is important that a pregnant woman notify her doctor or clinic if she or her partner(s) has had genital warts. This way they can determine if they need to treat the warts, or not, during the pregnancy.[/font]
[font=Arial, Helvetica, sans-serif]Is it normal to feel upset about genital warts?
Yes, it is normal. Some people feel very upset. They feel ashamed, fearful, confused, less attractive or less interested in sex. They feel angry at their sex partner(s), even though it is usually not possible to know exactly when or from whom the virus was spread.
Some people are afraid that the genital warts could lead to cancer (they cannot) or that they will never be able to find a sexual partner again. It is normal to have all, some or none of these feelings. It may take some time, but it is important to know that it is still possible to have a normal, healthy life, even with warts.[/font]
 
The Rock

The Rock

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Genital human papillomavirus (HPV) infection is probably the most common of infections that can be sexually transmitted and is an important public health problem because of its clear association with cervical cancer in women and its potential association with other anogenital malignancies [1, 2]. HPV specifically infects and replicates in the lower levels of stratified epithelium; these infections manifest clinically as warty growths and dysplastic areas of cellular proliferation [3, 4]. HPVs are classified and referred to as “types” on the basis of their genetic similarities; the terms “serotype” and “strain” are not appropriate characterizations. Currently, >80 different HPV types have been sequenced and officially classified, ∼30 of which have been found to infect genital epithelium [5, 6]. Seminal work has shown and clinical trial data continue to demonstrate that HPV types 6 and 11 are most often associated with external genital warts (EGWs) [7–25].
Clinical warts are the most common recognized clinical manifestation of genital HPV infection. Although HPVs infect the squamous epithelium at a variety of anatomical locations, the present review focuses on EGWs; these are visible warts that occur on the perigenital and perianal region: the penis, scrotum, and vulva; pubic, perineal, and perianal areas; and crural folds. We focus primarily on the available treatments, including studies published since our prior review [26], and factors that influence treatment decisions. In addition, we briefly review diagnostic criteria and issues pertinent to prevention, including approaches relevant to EGW-affected patients and their partners and the prevention of transmission, both sexual and perinatal.


 
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