Guide to the Symptoms and Treatment of Genital Warts


Overview

Skin growths found in the groin, genital and anal areas are called genital warts. In females, they may also be found in the vagina and cervix, and in males, on the thighs, scrotum, and penis. They are the most common type of STD.

Signs of warts may be of different shapes and sizes. While some are flat and white, others look like tiny cauliflowers. However, some are not visible to the naked eye.

Genital warts (condylomata acuminate) are also known as venereal warts. Although other types of skin warts are harmless, genital warts may need more serious attention. They are a viral sexually transmitted infection (STI).

Many people get the virus but do not show any symptoms. It is caused by the human papillomavirus (HPV - read on for more information on causes).  Warts can appear years, months or weeks after exposure to the disease.

A person may still be contagious after treatment or wart removal. Warts will not turn into cancer if left untreated. Without treatment they can go away on their own, grow in number or size, or not change.

The disease is not spread by sharing towels, a bathroom, kissing, hugging, toilet seats, cutlery, plates or cups.

HPV warts picturesPictures of Genital Warts (HPV Warts Pictures) and Vaginal Warts

Causes

Warts are caused by a common virus called human papilloma viruses (HPV), of which there are more than a hundred types. 30 of these types can live around the anal and genital areas.  Of these, more than forty types infect the genital tract, including the anus and surrounding areas of both men and women. The most common HPV types that cause genital warts are HPV types 6, 11, 16, and 18. HPV-6 and HPV-11 are "low-risk" HPV types and they are most commonly linked to benign (not cancerous) lesions. However, HPV-16 and HPV-18 are "high-risk" HPV types that are associated with most cancers that affect the cervix, penis, and anogenital areas.

Genital Wart on Male PenisPictures of Genital Warts on Male Penis

Warts usually spread by sexual transmission  during anal and vaginal sex and the risk of infection increases with the number of sexual partners.They are spread by skin to skin contact, so it isn't necessary for penetration to take place.

In very rare cases, warts can spread from a hand to the genitals.

Genital Warts and Men

Almost all men will get HPV during their lifetime if they are sexually active. In the majority of cases, the infection will heal on its' own.  Symptoms in men include genital warts are certain types of cancer.

The infection is caught through sexual contact with an infected individual. 

Symptoms

Symptoms of genital warts are varied:

  • They may be visible, but some are not.
  • Some do not cause any symptom at all, while some are bothersome, causing pain, itching or bleeding.
  • Their appearance varies in color, size, and shape.
  • They may appear as small bumps that are scattered or clustered like bunches of cauliflower.
  • They may be white, skin colored or even darker.
  • Women: warts can appear on the lips around the vagina opening (vulva), upper thighs, vagina, anus (on, inside) and the cervix.
  • Men: Genital warts can be located on the urethra (where urine exists the body), scrotum and penis.
  • A change in urine flow could indicated the presence of urethral warts.

Visible warts indicate active infection. However, HPV may spread even if the warts are not visible. Depending on their location, genital warts can cause pain and bleeding during intercourse. Warts can also spread to the mouth and throat after having oral sex or to the anal region after having anal sex with an infected person.

Symptoms usually appear two to three months after infection, and these may last from three weeks to many years.  About 90% of infected people do not develop visible warts or even know that they are a carrier of the virus.

Treatment only removes any visible warts, it does not remove the virus. It also does not prevent the possibility of spreading the virus to a partner. Therapies are not always successful in bringing long term relief from the warts.

Genital Wart in Male Pubic HairGenital Warts Outside the Penis or Vagina Do Not Protect Partners When Wearing a Condom or Other Type of Protection

Diagnosis

A doctor can usually diagnose the disease after a complete medical history and physical examination. However, the doctor may take a biopsy for confirmation. Women may need a Pap test and an HPV test for high-risk types of the virus.

There is not blood test for the disease.

cryotherapy being applied to genital wartCryotherapy (freezing) technique being used to Remove Genital Warts

Treatment: How to get rid of genital warts

There is no cure for HPV infection, but genital warts may be removed. A healthy immune system is thought to be able to fight toff HPV. Still, genital warts can recur and HPV can still be transmitted.

Here are some ways to remove genital warts:

  • Application of a 0.5% solution or gel of podofilox (Condylox) twice a day for three days. This is followed by four days without treatment. Podofilox treatment should be given for 3-4 weeks or until the warts are gone. It may also be applied every other day for three weeks.
  • Application of a 5% cream of imiquimod (Aldara) three times a week at bedtime. This is washed off 6-10 hours later with water and mild soap. Treatment is applied for up to 16 weeks or until the warts are gone.
  • Weekly treatment with a small amount of 10-25% solution of podophyllin resin on the warts, which is later washed off.  The treatments are done by a doctor.
  • Weekly treatment with 80-90% solution of trichloroacetic or bichloracetic acid.
  • Injection of 5-flurouracil epinephrine gel into the warts.
  • Injection of interferon alpha, which stimulates the immune response. Treatment is given every other day for 8 to 12 weeks.
  • Other treatments include cryotherapy, surgical removal, or laser surgery.

Note that some creams can weaken condoms, so ask your Doctor.

Cauliflower shaped genital wartsGenital Warts in Some People can take on a Cauliflower Shape

Will the Genital Warts Return After Treatment?

Warts frequently return 3 months after treatment.  Treatment does not reduce the risk of passing on HPV since it is not understood how long the HPV virus remains contagious after wart removal.

What Happens if Genital Warts are Not Treated?

Several things might happen if left untreated:

  • Warts may disappear on their own since it is thought that the immune system can naturally fight them
  • An increase in the number of warts
  • A decrease in the number of warts

How Long Does Treatment Take?

The time it takes for genital warts to disappear varies by person. In some people multiple treatments may be needed. Non-smokers tend to respond better than smokers.

Return visits to the Doctor can confirm is the warts are gone or if a different treatment method is needed.

When You Can Have Sex Again

Partners can resume having sex after the warts have cleared. This helps any treated areas heal by avoiding rubbing from skin contact. Condom use over treated areas can help to spread the disease.

Even with wart removal, the area can remain contagious.

Genital Warts and Pregnancy

The risk is low that a pregnant woman would pass on the disease to a baby. In very rare instances, a baby can develop warts in the voice box or throat. Spreading HPV to the baby is not prevented with a Cesarean birth.

Warts do not effect fertility.

Prevention

While condoms cannot prevent the spread of the disease, it does lower the risk of spreading it from person to person. The reason it is not 100% is that the wart may be in an area outside of the condom.  The risk of contracting genital warts can be improved by:

  • Using a condom (not 100% protection as noted above). The virus does not pass through the condom if it is covering an infected spot on the skin. 
  • Use the condom during oral sex or a polyurethane square (plastic) to cover the female or male anus or genitals.
  • Use a polyurethane or latex cover if two women are rubbing the vulva against each other.
  • Do not share sex toys or cover the toys with a new condom before use.
  • Being in a long term relationship with someone that has had sex with a small number or partners
  • Abstinence from sex

The vaccine Gardasil protects against HPV 11 and 6 (genital warts) and HPV 18 and 16 (the types that can lead to cancer). Young girls are frequently vaccinated.

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References

American Academy of Dermatology, Genital Warts

WebMD. Genital Warts (Human Papillomavirus) - Topic Overview

Genital Warts (HPV) in Women

Genital Warts Men - Human Paillomavirus (HPV)

The U.S. Centers for Disease Control and prevention will answer questions over the phone at 1-800-CDC-INFO (1-800-232-4636)