Alternate Names: Condylomata acuminata; Penile warts; Human papilloma virus (HPV); Venereal wart; Condyloma
Causes and Risks: Genital warts are caused by the human papilloma virus (HPV). Papilloma viruses cause small growths (warts) on the skin and mucous membranes. Infection of the genital and anal regions with HPV can cause warts (anogenital condyloma) on the penis, vulva, urethra, vagina, cervix, and around the anus (perianal).
More than 70 different types of HPV have been classified. Several types, including 6, 11 and 42, are associated with raised, rough, easily visible genital warts (especially in women). Other types are associated with flat warts. More importantly, several types are associated with pre-malignant and malignant changes in the cervix (abnormal Pap smears). These include types 16, 18, 31, 33, 35, 39, 45, 51, and 52. Research also shows that the presence of both HPV and herpes virus together is a good predictor of cervical cancer.
Lesions on the external genitalia are easily recognized. On the penis, genital warts tend to be drier and more limited than on the female genitalia or around the anus of either sex. They grow best in the moist genital area. They are raised, rough, flesh-colored "warty" appearing tumors that may occur singly or in clusters. Left untreated, warts around the anus and vulva may rapidly enlarge, taking on a "cauliflower-like" appearance. Keeping the infected area dry may be a problem because the warts are usually damp.
In women, HPV can invade the vagina and cervix. These warts are flat and not easily visible without special procedures. Because HPV can lead to premalignant changes in the cervix (cervical dysplasia), it is important that this condition be diagnosed and treated. Regular Pap smears are important for detecting HPV.
Infection with HPV is very common, although the majority of people have no symptoms (asymptomatic). In several studies done on college women, nearly half were positive for HPV; although only 1 to 2% had visible warts and less than 10% had ever had any visible genital warts. The incidence of genital warts appears to be increasing rapidly, although this may be a result of increased diagnostic ability and awareness.
Risk factors for genital warts include multiple sexual partners, unknown partners, early onset of sexual activity, tobacco use, nutritional status, hormonal influences, age, stress and concurrent viral infections (such as flu, HIV, Epstein-Barr and herpes).
In children, although the virus is often transmitted sexually, non-sexual transmission is possible, particularly if the child is still in diapers. The presence of genital warts (condylomata acuminata) should raise the question of sexual abuse. However, if all of the following are true, then non-sexual transmission is more likely:
- the warts are somewhat distant from the anal or vaginal openings
- the warts are present in close contacts (especially gential warts in mothers
)- the child is younger than 9 months at the time the warts first appear
- there is no evidence for child abuse
Prevention: As with all sexually transmitted diseases, total abstinence remains the only 100% assured way of avoiding venereal warts. A monogamous sexual relationship with a known healthy (disease-free) partner is the most practical way of avoiding sexually transmitted diseases.
According to the American Cancer Society and the Centers for Disease Control, recent research has shown that Condoms ("rubbers") cannot protect against infection with HPV. This is because HPV can be transmitted with any skin-to-skin contact with any HPV-infected area of the body, such as the skin of the genital or anal area not covered by a condom.
The absence of visible warts cannot be used to decide whether caution is warranted, since HPV can be passed on to another person even when there are no visible warts or other symptoms. HPV can be present for years with no symptoms. Abstinence (no skin-to-skin, mucus membrane contact) is the only effective means of prevention. See safer sex practices.
Symptoms:
- raised "warty" appearing tumors on the genitals
- raised, flesh colored lesions
- genital lesions
- cauliflower-like appearing growths around the anus or female genitalia
- increased dampness or moisture in the area of the growths
- itching of the penis, scrotum, anal area, or a vulvar itch
- increased vaginal discharge
- abnormal vaginal bleeding (not associated with a menstrual period) after sexual intercourse (postcoital)
Note: Frequently no symptoms are noted.
Signs and Tests: A genital examination reveals flesh-colored to white, flat or raised, single or clustered lesions anywhere on the external genitalia. In women, a pelvic examination may reveal growths on the vaginal walls or the cervix. Magnification (colposcopy) may be used to see lesions invisible to the naked eye. The tissue of the vagina and cervix may be treated with acetic acid to make the warts visible.
Additional tests for women:
A Pap smear may note changes associated with HPV. A colposcopy may be done to see either external or internal genital lesions which are invisible to the naked eye.
Treatment: Topical treatments to eradicate the lesions include trichloroacetic acid, podophyllum, and liquid nitrogen.
Surgical treatments include cryosurgery, electrocauterization, laser therapy, or surgical excision.
Sexual partners need to be examined by a health care provider and treated if warts are noted.
A follow-up examination by the health care provider should be done every few weeks after initial treatment, then self examination can be initiated, with the patient returning to the health care provider if warts reoccur.
Women with a history of genital warts, and women partners of men with a history of genital warts, should have Pap smears at least every 6 months (affected women may be advised to have Pap smears every 3 months after initial treatment of cervical warts).
Prognosis: With adequate identification and treatment, HPV outbreaks can usually be controlled. Lesions frequently reappear after treatment. Current treatment of HPV-associated lesions may reduce, but probably does not eliminate, the infectiousness of the genital warts. Normal skin and mucosa in the vicinity of HPV-associated lesions often contains HPV. It is thought that perhaps reactivation of latent infection rather than reinfection is responsible for wart recurrence, but this is still unknown. It is still unclear as to whether treatment of the lesions has an impact on future transmission.
Complications: At least 70 types of human papilloma virus have been identified, several of which have been associated with cervical and vulvar cancer. Lesions may become numerous and quite large, requiring more extensive treatment and follow-up procedures.
Call for an appointment with your health care provider if a sexual partner is found to have genital warts, or if any of the described symptoms are noted. Adolescents appear to be extremely susceptible to HPV, and those having intercourse at a young age should be evaluated for HPV infection.
