Genital Warts - External (Condyloma)
What are genital warts?
Genital warts are a sexually transmitted disease (STD) caused by human papillomavirus (HPV).
Most people who become infected with HPV will not have any symptoms and will clear the infection on their own.
Some of these viruses are called "high-risk" and may cause abnormal Pap tests. They may also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called "low-risk" and may cause mild Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area.
How common is HPV?
Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year.
How do people get genital HPV infections?
The types of HPV that infect the genital area are spread primarily through genital contact. Most HPV infections have no signs or symptoms; therefore, most infected persons don’t know they are infected and can unknowingly transmit the virus to a sex partner. Rarely, a pregnant woman can pass HPV to her baby during vaginal delivery. A baby that is exposed to HPV very rarely develops warts in the throat or voice box.
What are the signs and symptoms of genital HPV?
Most people who have a genital HPV infection do not know they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis. Very rarely, HPV infection results in anal or genital cancers.
Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower-shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.
Visible genital warts can be removed by medications the patient applies, or by treatments performed by a health care provider. Some individuals choose to forego treatment to see if the warts will disappear on their own. No treatment regimen for genital warts is better than another, and no one treatment regimen is ideal for all cases.
How is genital HPV infection diagnosed?
Genital warts are diagnosed by visual inspection. Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. Also, a specific test is available to detect HPV DNA in women. The test may be used in women with mild Pap test abnormalities, or in women over 30 years of age at the time of Pap testing. The results of HPV DNA testing can help health care providers decide if further tests or treatment are necessary.
No HPV tests are available for men.
What are the treatments for HPV?
There is no cure for HPV infection, although in most women the infection goes away on its own. Treatments address changes in the skin or mucous membrane caused by HPV infection, such as warts and pre-cancerous changes in the cervix.
The majority of patients have fewer than 10 genital warts. These respond to various treatments.
Your doctor or health care provider will recommend a treatment based on the size of the warts, the number of warts, their location, and your personal preferences.
Most people require a course of therapy rather than a single treatment.
Warts on normal dry skin, such as the vulva or penis, are referred to as external warts. Warts on moist mucosal linings, such as inner part of the vagina, are called internal warts. These two types of warts are treated differently.
At-home treatment of genital warts
- Aldara (imiquimod) Cream, 5%
- Podofilox (0.5% solution or gel)
Professional treatment of genital warts
- Cryotherapy with liquid nitrogen “freezes” off the warts. Repeat applications every 1–2 weeks.
- Podophyllin is a resin that is applied to each wart and allowed to air dry. After several hours it should be washed off to prevent side effects. The treatment can be repeated weekly, if necessary. The safety of podophyllin during pregnancy has not been established. Not recommended for internal warts.
- Trichloroacetic acid (TCA). A small amount should be applied only to the warts and allowed to dry, at which time a white “frosting” develops.
- Surgical removal options include tangential scissor excision, tangential shave excision, curettage, and electrosurgery.
- Laser surgery uses a focused beam of intensive light to treat the warts, while leaving surrounding skin intact.
Genital warts should only be treated with physician-recommended medications. Over-the-counter remedies for common warts are not safe to use in genital HPV infections.
What is the connection between HPV infection and cervical cancer?
All types of HPV can cause mild Pap test abnormalities that do not have serious consequences. Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to cervical cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Persistent infection with high-risk types of HPV is the main risk factor for cervical cancer.
A Pap test can detect pre-cancerous and cancerous cells on the cervix. Regular Pap testing, careful medical follow-up, and treatment (if necessary) help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life-threatening cervical cancer. The Pap test used in U.S. cervical cancer screening programs is responsible for greatly reducing deaths from cervical cancer. Most women who develop invasive cervical cancer have not had regular cervical cancer screening.
How can people reduce their risk for genital HPV?
A vaccine called Gardasil has recently become available. It is protective against four of the HPV strains most commonly linked to genital warts and cervical cancer in women. The vaccine is administered as a series of three shots and is given to women only.
The surest way to eliminate risk for genital HPV infection is to refrain from any genital contact with another individual.
HPV infection can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.
Reference: CDC
This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.
Be sure to follow specific instructions given to you by your physician or health care professional.
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