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Genital warts

Definition:

Genital warts are soft growths on the skin and mucus membranes of the genitals. They may be found on the penis , vulva , urethra, vagina , cervix , and around and in the anus.

Genital warts are a sexually transmitted infection (STI).



Alternative Names:

Condylomata acuminata; Penile warts; Human papilloma virus (HPV); Venereal warts; Condyloma; HPV DNA test; Sexually transmitted disease (STD) - warts; LSIL-HPV; Low-grade dysplasia-HPV; HSIL-HPV; High-grade dysplasia HPV; HPV



Causes, incidence, and risk factors:

The virus that causes genital warts is called human papilloma virus (HPV). More than 70 different types of HPV exist. Certain types of HPV can lead to precancerous changes in the cervix , cervical cancer , or anal cancer. These are called high-risk types of HPV.

Not all types of HPV cause genital warts. Other types of HPV cause warts on other parts of the skin, such as the hands. This article focuses on warts on the genitals.

HPV infection around the genitals is common. Most people have no symptoms. In women, HPV can spread to areas inside, on the walls of the vagina and cervix. They are not easy to see without special procedures.

Important facts about HPV:

  • HPV infection spreads from one person to another through sexual contact involving the anus, mouth, or vagina. You can spread the warts even if you do not see them.
  • You may not see warts for 6 weeks to 6 months after becoming infected. You may not notice them for years.
  • Not everyone who has come into contact with the HPV virus and genital warts will develop them.

You are more likely to get genital warts and spread them more quickly if you:

  • Have multiple sexual partners
  • Do not know if you had sex with someone who had STIs
  • Are sexually active at an early age
  • Use tobacco and alcohol
  • Have a viral infection such as herpes and are stressed at the same time
  • Are pregnant
  • Have a weakened immune system due to an illness or medication

If a child has genital warts, you should suspect sexual abuse as a possible cause.



Symptoms:

Genital warts can be so tiny, you cannot see them.

The warts can look like:

  • Flesh-colored spots that are raised or flat
  • Growths that look like the top of a cauliflower

In females, genital warts can be found:

  • Inside the vagina or anus
  • Outside the vagina or anus, or on nearby skin
  • On the cervix inside the body

In males, genital warts can be found on the:

  • Penis
  • Scrotum
  • Groin area
  • Thighs
  • Inside or around the anus

Genital warts can also occur on the

  • Lips
  • Mouth
  • Tongue
  • Throat

Other symptoms are rare, but can include:



Signs and tests:

The health care provider will perform a physical exam.

In women, this will include a pelvic examination. Magnification (colposcopy ) is used to spot warts that cannot be seen with the naked eye. Your doctor may place watered-down vinegar (acetic acid) on the area. This helps better see any warts.

The virus that causes genital warts can cause abnormal results on a Pap smear . If you have these types of changes, you will probably need more frequent Pap smears for a while.

An HPV DNA test can tell if you have a high-risk type of HPV known to cause cervical cancer. This test may be done:

  • As a screening test for women over age 30
  • In women of any age who have a slightly abnormal Pap test result


Treatment:

Genital warts must be treated by a doctor. Do NOT use over-the-counter medicines meant for other kinds of warts.

Treatment may include:

  • A skin treatment done in the doctor's office
  • Prescription medicine that you apply at home several times per week

Prescription medicines include:

  • Imiquimod (Aldara)
  • Podophyllin and podofilox (Condylox)
  • Trichloroacetic acid (TCA)

The warts may be removed with surgery, including:

If you have genital warts, all of your sexual partners must be examined by a health care provider and treated if warts are found. Even if you do NOT have symptoms, you must be treated to prevent complications and spreading the condition to others.

You will need to return to your health care provider after treatment to make sure all the warts are gone.

Regular Pap smears are recommended if you are a woman who has had genital warts, or if you partner had them. If you had warts on your cervix, you may need to have Pap smears every 3 to 6 months after the first treatment.

Women with precancerous changes caused by HPV infection may need further treatment.



Expectations (prognosis):

Many sexually active young women become infected with HPV. In many cases, HPV goes away on its own.

Most men who become infected with HPV never develop any symptoms or problems from the infection. However, they can pass it on to current and sometimes future sexual partners.

Even after you have been treated for genital warts, you may still infect others.



Complications:

Some types of HPV have been found to cause cancer of the cervix and vulva. They are the main cause of cervical cancer.

The types of HPV that can cause genital warts are not the same as the types that can cause penile or anal cancer.

The warts may become numerous and quite large, requiring more extensive treatment and follow-up procedures.



Calling your health care provider:

Call your doctor if:

  • A current or past sexual partner has genital warts
  • You have visible warts on your external genitals, itching, discharge, or abnormal vaginal bleeding. Keep in mind that genital warts may not appear for months to years after having sexual contact with an infected person.
  • You think a young child might have genital warts

Women should begin having Pap smears at age 21.



Prevention:

Not having sexual contact is the only way to avoid genital warts and other STIs. You can also decrease your chance of getting an STI by having a sexual relationship with only one partner who you know is disease-free.

Male and female condoms cannot fully protect you. This is because the virus or warts can be on nearby skin. Condoms reduce your risk and you should still use them at all times. HPV can be passed from person to person even when there are no visible warts or other symptoms. Praticing safer sex  can help prevent you from getting HPV.

Two vaccines are available that protect against four of the HPV types that cause most cervical cancers in women. The vaccine is given as a series of three shots. It is recommended for girls and women ages 9 to 26.

One of the two vaccines protects against genital and anal warts in boys and men. The vaccine is given as a series of three shots. It is recommended for boys and men ages 9 to 26.

Ask your health care provider whether the HPV vaccine is right for you.



References:

Advisory Committee on Immunization Practices (ACIP). Recommendations on the use of quadrivalent human papillomavirus vaccine in males. MMWR2011;60(50):1705-1708.

Diaz ML. Human papilloma virus: prevention and treatment.Obstet Gynecol Clin North Am. 2008;35(2):199-217.

Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357:1579-1588.

Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009;361:271-278.




Review Date: 11/8/2012
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

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