Genital Warts

woman talking to doctorHuman papillomavirus (HPV) is one of the most common causes of sexually
transmitted infection (STI) in the world. More than 100 different types of HPV
exist, most of which are harmless. About 30 types are spread through sexual
contact. Some types of HPV cause genital warts—single or multiple bumps that
appear in the genital areas of men and women including the vagina, cervix, vulva
(area outside of the vagina), penis, and rectum. Many people infected with HPV
have no symptoms.

There are high-risk and low-risk types of HPV. High-risk HPV may cause
abnormal Pap smear results, and could lead to cancers of the cervix, vulva,
vagina, anus, or penis. Low-risk HPV also may cause abnormal Pap results or
genital warts.

Health experts estimate there are more cases of genital HPV infection than
any other STI in the United States. According to the American Social Health
Association, approximately 5.5 million new cases of sexually transmitted HPV
infections are reported every year. At least 20 million people in this country
are already infected.

WHAT ARE GENITAL WARTS?

Genital warts (sometimes called condylomata acuminata or venereal warts) are
the most easily recognized sign of genital HPV infection. Many people, however,
have a genital HPV infection without genital warts.

Genital warts are soft, moist, or flesh colored and appear in the genital
area within weeks or months after infection. They sometimes appear in clusters
that resemble cauliflower-like bumps, and are either raised or flat, small or
large. Genital warts can show up in women on the vulva and cervix, and inside
and surrounding the vagina and anus. In men, genital warts can appear on the
scrotum or penis. There are cases where genital warts have been found on the
thigh and groin.

CAN HPV CAUSE OTHER KINDS OF WARTS?

Some types of HPV cause common skin warts, such as those found on the hands
and soles of the feet. These types of HPV do not cause genital warts.

HOW ARE GENITAL WARTS SPREAD?

Genital warts are very contagious and are spread during oral, vaginal, or
anal sex with an infected partner. They are transmitted by skin-to-skin contact
during vaginal, anal, or (rarely) oral sex with someone who is infected. About
two-thirds of people who have sexual contact with a partner with genital warts
will develop warts, usually within 3 months of contact.

In women, the warts occur on the outside and inside of the vagina, on the
opening to the uterus (cervix), or around the anus.

In men, genital warts are less common. If present, they usually are seen on
the tip of the penis. They also may be found on the shaft of the penis, on the
scrotum, or around the anus.

Rarely, genital warts also can develop in your mouth or throat if you have
oral sex with an infected person.

Like many STIs, genital HPV infections often do not have signs and symptoms
that can be seen or felt. One study sponsored by the National Institute of
Allergy and Infectious Diseases (NIAID) reported that almost half of women
infected with HPV had no obvious symptoms. If you are infected but have no
symptoms, you can still spread HPV to your sexual partner and/or develop
complications from the virus.

HOW ARE HPV AND GENITAL WARTS DIAGNOSED?

Your health care provider usually diagnoses genital warts by seeing them. If
you are a woman with genital warts, you also should be examined for possible HPV
infection of the cervix.

Your provider may be able to identify some otherwise invisible warts in your
genital tissue by applying vinegar (acetic acid) to areas of your body that
might be infected. This solution causes infected areas to whiten, which makes
them more visible. In some cases, a health care provider will take a small piece
of tissue from the cervix and examine it under the microscope.

If you have an abnormal Pap smear result, it may indicate the possible
presence of cervical HPV infection. A laboratory worker will examine cells
scraped from your cervix under a microscope to see if they are cancerous.

HOW ARE HPV AND GENITAL WARTS TREATED?

HPV has no known cure. There are treatments for genital warts, though they
often disappear even without treatment. There is no way to predict whether the
warts will grow or disappear. Therefore, if you suspect you have genital warts,
you should be examined and treated, if necessary.

Depending on factors such as the size and location of your genital warts,
your health care provider will offer you one of several ways to treat them.

• Imiquimod cream
• 20 percent podophyllin antimitotic solution
• 0.5
percent podofilox solution
• 5 percent 5-fluorouracil cream

Trichloroacetic acid (TCA)

If you are pregnant, you should not use podophyllin or podofilox because they
are absorbed by your skin and may cause birth defects in your baby. In addition,
you should not use 5-fluorouracil cream if you are expecting.

If you have small warts, your health care provider can remove them by one of
three methods.

• freezing (cryosurgery)
• burning (electrocautery)
• laser
treatment

If you have large warts that have not responded to other treatment, you may
have to have surgery to remove them.

Some health care providers use the antiviral drug alpha interferon, which
they inject directly into the warts, to treat warts that have returned after
removal by traditional means. The drug is expensive, however, and does not
reduce the rate that the genital warts return.

Although treatments can get rid of the warts, none get rid of the virus.
Because the virus is still present in your body, warts often come back after
treatment.

HOW CAN HPV INFECTION BE PREVENTED?

The only way you can prevent getting an HPV infection is to avoid direct
contact with the virus, which is transmitted by skin-to-skin contact. If you or
your sexual partner has warts that are visible in the genital area, you should
avoid any sexual contact until the warts are treated.

Research studies have not confirmed that male latex condoms prevent
transmission of HPV, but studies do suggest that using condoms may reduce your
risk of developing diseases linked to HPV, such as genital warts and cervical
cancer. Unfortunately, many people who don’t have symptoms don’t know that they
can spread the virus to an uninfected partner.

POSSIBLE COMPLICATIONS OF HPV AND GENITAL WARTS

Cancer

Some types of HPV can cause cervical cancer. Other types are associated with
vulvar cancer, anal cancer, and cancer of the penis (a rare cancer).

Most HPV infections do not progress to cervical cancer. If you are a woman
with abnormal cervical cells, a Pap test will detect them. If you have abnormal
cervical cells, it is particularly important for you to have regular pelvic
exams and Pap tests so you can be treated early, if necessary.

Pregnancy and Childbirth

Genital warts may cause a number of problems during pregnancy. Sometimes they
get larger during pregnancy, making it difficult to urinate. If the warts are in
the vagina, they can make the vagina less elastic and cause obstruction during
delivery.

Rarely, infants born to women with genital warts develop warts in their
throats (laryngeal papillomatosis). Although uncommon, it is a potentially
life-threatening condition for the child, requiring frequent laser surgery to
prevent obstruction of the breathing passages. Research on the use of interferon
therapy with laser surgery indicates that this drug may show promise in slowing
the course of the disease.

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