Genital Warts

1 What are Genital Warts?

Genital warts are soft flesh colored growths in the genitals, hence the name genital warts. It is a common sexually transmitted infection (STI) caused by some strains of human papillomavirus (HPV).

HPV affects at least 50% of all sexually active people. It is more common in women than in men. Many cases of genital warts often go unnoticed since the warts are too small to be noticed. While some strains of HPV can cause genital warts, some may cause cancer also. There are vaccines which can protect against certain strains of genital HPV.

2 Symptoms

The signs and symptoms of genital warts include:

  • Small, soft, flesh-colored or gray growths in the genitals
  • They may appear like a cauliflower when numerous warts develop in proximity
  • Sensation of itching or discomfort in the genitals
  • Blood may appear while having intercourse 

As the name suggests, genital warts are present in the genitals and the surrounding areas. Women have them on the vulva, the walls of the vagina, the area between the external genitals and the anus, the anal canal, and the cervix while men have them on the tip or shaft of the penis, the scrotum, or the anus. If the virus is transmitted by oral sexual contact with an infected person, the warts can also develop in the mouth or throat.

Many cases of genital warts may not be noticeable because the warts are not visible with naked eyes. However, in some cases, many warts grow together to form a cauliflower shape.

When to see a Doctor

Visit your doctor if you or your partner notice warts in the genital area. Remember that some strains of genital HPV can also cause cancer.

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3 Causes

Genital warts are caused by some strains of human papillomavirus (HPV).

More than 40 different strains of HPV have been found to specifically affect the genital area.

The virus is spread through sexual contact with an infected person.

Commonly, you may not experience any signs or symptoms even if you harbor the virus because they are kept in check by your immune cells.

4 Making a Diagnosis

Making a diagnosis of genital warts is done by performing several tests.

Visit your doctor if you or your partner notice warts in the genitals.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all your or your partner’s symptoms.

Mention if you have been exposed to risky situations like unprotected sex.

Write down your key medical information.

Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor. Some typical questions can be:

  • Do my symptoms indicate genital warts? 
  • What tests do I need? 
  • Is there a risk for other sexually transmitted infections? 
  • What are the treatment options available? 
  • Do I need to refrain from sex during or after treatment? 
  • Is my partner likely to be infected? 
  • When can I resume my sex life? 
  • Is there any possibility that the warts will come back? 

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

  • Do you have any symptoms? If yes, how severe are they?
  • When did you start noticing them? 
  • How about your sexual behavior, is it safe? 
  • Have you recently had sex with a new partner? 
  • Has your partner been tested for sexually transmitted infections? 
  • When did you get vaccinated for HPV, if any? 
  • Are you pregnant or planning to become pregnant?

Viewing the warts through naked eyes is often difficult as the warts are small and flat. In such case, the warts can be made more noticeable by applying a mild acetic acid solution. Then they can be viewed through a special magnifying instrument, a colposcope.

The tests for female genital warts include:

  • Pap tests: Women are recommended to have a regular pelvic examination and Pap tests as they are more likely to have HPV infections. These tests not only detect genital warts but also early signs of cervical cancer, a possible complication of genital HPV infection. A Pap test involves collection of a small sample of cells from the passage between vagina and uterus, called cervix. The cells are then analyzed to detect abnormalities.
  • HPV test: The sample used in a Pap test can also be tested for detecting the presence of strains of HPV that cause cancer. However, this test is most commonly used for women of 30 and older because immune cells in younger women are strong enough to kill the cancer-causing strain of HPV, even without treatment.

5 Treatment

Not all cases of genital warts need treatment, many cases with benign symptoms may not need any treatment. However, if you are bothered by symptoms such as itching, burning and pain, seek a medical treatment with your doctor. Many medical and surgical interventions are available to help you. But remember that warts are stubborn and may come back after treatment.

The treatments for genital warts include:

Medications

Your doctor may prescribe any of the following medications to be applied directly to your skin:

  • Imiquimod: This cream may help you in fight against the warts by boosting your immunity. You are suggested not to indulge in sexual activity while the cream is on your skin as it can be irritating to your partner or may cause condom to break. Some common side effects are redness of the skin blisters, body aches or pain, cough, rashes, and fatigue.
  • Podophyllin and podofilox: Podophyllin is a resin derived from plant sources, which destroys genital wart tissue. Due to some safety reasons, you are not allowed to apply it on your own. Only your doctor can apply this solution. Podofilox is a similar drug that does not require a doctor to apply. For the first time, your doctor will apply Podofilox and teach you about precautions after which you can apply it on your own. DO NOT apply podofilox internally and during PREGNANCY. Common side effects include mild skin irritation, sores or pain.
  • Trichloroacetic acid (TCA): It is an acidic substance that burns off genital warts. Like Podophyllin, TCA should also be applied only by a doctor. Common side effects include mild skin irritation, sores or pain.

Remember not to use over-the-counter wart removers as these products can cause even more pain and irritation.

Surgery

If you have conditions like pregnancy, larger warts or those that are stubborn and resistant to treatment, you may consider surgery. The surgical options include:

  • Freezing with liquid nitrogen: This treatment called cryotherapy destroys genitals warts by freezing. Repeated cryotherapy treatments may be required in some cases. Main side effects of cryotherapy include pain and swelling.
  • Electrocautery: In this procedure, the warts are burnt off by an electrical current. The side effects are pain and swelling at the affected site.
  • Surgical excision: The warts are cut off under influence of a local or general anesthesia.
  • Laser treatments: It uses intense beam of light, laser to destroy warts that cannot be removed by other treatments. Side effects can include scarring and pain.

6 Prevention

The occurrence of genital warts can be prevented with:

  • Condom: Practicing safe sex and using a condom are sure shot ways to prevent genital warts. Remember that condoms are highly effective but not 100%.
  • Vaccines: Vaccines are available in the market that can be used to prevent genital warts. Some vaccines may provide protection against both cancer- and wart- causing strains while some may protect against a single condition. Refer to “The national Advisory Committee on Immunization Practices” for details on vaccination. Vaccines may cause side effects soreness at the injection site (the upper arm), headaches, low-grade fever or flu-like symptoms, dizziness or fainting after injection.

7 Risks and Complications

There are several risks and complications associated with genital warts.

According to The Centers for Disease Control and Prevention (CDC), at least 50% of all sexually active people will become infected with genital HPV at some point during their lives.

Risks

Factors that can increase your risk of genital warts include:

  • Unsafe sex
  • Sex with more than one partner
  • Presence of another sexually transmitted infection
  • Becoming sexually active at a young age

Complications

  • Cancer: There is a close link between cervical cancer and genital HPV infection. Some strains of HPV have also been linked to cancer of the vulva, cancer of the anus, cancer of the penis, and cancer of the mouth and throat. It is to be noted that not all HPV infection lead to cancer, a regular Pap test is always recommended for women, especially if you've have had infections from high risk HPV.
  • Problems during pregnancy: Warts might cause added problems if you are pregnant. Large warts interfere with urination, while warts on the vaginal wall may reduce flexibility of vagina during childbirth. Sometimes, bleeding can occur as large warts on vagina are stretched during delivery. 
  • In rare cases, mother may pass the infection to baby and warts may be present in his or her throat at the time of birth. In such cases, surgery may be considered to free the airway.
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