Genital Warts (HPV)

By: Dr. Mark Becker

  • Genital warts are the most common sexually transmitted infection in the U.S.
  • They are sometimes referred to as “condyloma”, “condylomata acuminata” or “venereal warts”
  • Genital warts are soft, moist, pink or flesh-colored, and sometimes appear in clusters resembling cauliflower-like bumps.
  • Genital warts on women can show up at the opening of the vagina, inside the vagina (including the cervix), and inside and surrounding the anus. Symptoms of genital warts in women can include bleeding after sex, abnormal vaginal discharge, or (rarely) bleeding or urinary obstruction if the wart appears on the urethra.
  • Genital warts on men usually appear on the tip of the penis, but may be found on the shaft, scrotum or around the anus.
  • Genital warts are caused by the human papillomavirus (HPV). There are more than 100 types of HPV. Some HPV viruses cause common warts (verruca vulgaris) that appear on the fingers or hands. Other HPV viruses cause genital warts. HPV viruses are also the cause most cases of cervical cancer, but the HPV viruses that cause genital warts are not the same as those that can cause cancer.
  • Genital warts are very contagious and are spread by skin-to-skin contact, including sexual intercourse, oral or anal sex, or any other contact involving the genital area.
  • Most people with the HPV virus do not have visible warts but can still transmit the virus.
  • HPV in women may be diagnosed with a Pap test.
  • Genital warts can be treated in several ways, including topical medications or surgical removal. Genital wars may recur after treatment.
  • The best way to prevent an HPV infection is to avoid direct sexual contact with anyone who has the virus.
  • Some, but not all, HPV infections can be prevented by the HPV Vaccine (Cervarix, Gardasil).

What is the human papillomavirus (HPV)?

More than 100 different types of HPV exist, most of which are harmless.

  • About 40 types are spread through sexual contact and cause genital warts.
  • Other types may cause an abnormal Pap smear and lead to cervical cancer and other cancers in women and penile cancer in men.

HPV infection is common and does not usually lead to the development of warts, cancers, or even symptoms. In fact, many people infected with HPV show no signs or symptoms.

How are genital warts spread?

Genital warts are very contagious and are spread by direct skin-to-skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (for example, hand-to-genital contact).

About two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within 3 months of contact. You cannot become infected with HPV from contact with a toilet seat.

Most people with the virus do not have visible warts but can still transmit the virus. Treating the warts may not decrease the chance of spreading the virus. Therefore, all people who are sexually active should be regarded as potential sources of HPV, not just those with visible warts.

A person infected with HPV may not see warts appear for weeks to a year or more after being exposed; it is not usually possible to know when or how you became infected.

How is HPV diagnosed?

The most common way of diagnosing HPV is with a Pap test. While a Pap test by itself doesn’t usually definitely diagnose an HPV infection, it can identify infected abnormal cells and precancerous changes in the cervix that may be precursors to cancer.

If there is an abnormal pap smear, the doctor often will do advanced testing on the material to determine if, and which kind, of HPV may be present.

In some cases, during a physical examination, the appearance of genital warts in any sexually exposed area will prompt some doctors to diagnose HPV without futher testing. Some physicians may confirm the diagnosis by doing a biopsy (collecting a tissue sample from the wart) and sending it to a to a lab for analysis.

How are genital warts treated?

There are several safe and effective treatments for genital warts. Your doctor may choose a medication, a removal method, or a combination of both.

Medications

Depending on factors such as the size and location of your genital warts, your doctor will offer one of several treatment options, including:

  • Imiquimod (Aldara®, Zylcara®) cream
  • Podofilox (Condylox®) solution or gel
  • Podophyllin resin
  • 5-fluorouracil cream or gel
  • Trichloroacetic acid (TCA) or bichloracetic acid (BCA) solution
  • Interferon alpha injections

In some cases, the patient applies the topical medication, but several of these options (podophyllin, TCA, BCA) require application by a doctor.

Pregnant women should not use podophyllin, podofilox, or  5-fluorouracil, because these medications are absorbed by your skin and may cause damage to the fetus.

Removal

Depending on the size of the warts, some doctors may choose to remove them by one the following methods.

  • Freezing (cryosurgery)
  • Burning (electrocautery)
  • Laser treatment
  • Surgical removal (especially for large genital warts that have not responded to other treatments)

Although treatments can get rid of the warts, none get rid of the virus. Because the virus is still present in your body, warts often come back after treatment.

Sometimes warts disappear  without treatment, but there is no way to predict whether the warts will grow or disappear. Therefore, if you suspect you have genital warts, get examined and treated, if necessary.

How can genital warts be prevented?

The best way to prevent an HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact.  If you or your sexual partner has warts that can be seen in the genital area, avoid skin-to-skin and sexual contact until the warts are treated.

The Food and and Drug Administration (FDA) has approved the use of HPV vaccines (Cervarix, Gardasil) for the prevention of infection from some of the most common types of HPV viruses.

The HPV vaccines do not provide protection from all types of HPV virus, so about 30 percent of cervical cancers and 10 percent of genital warts will not be prevented by the current vaccines. In addition, the HPV vaccines do not prevent other sexually transmitted diseases, nor does it treat existing cases of HPV infection or cervical cancer.

What are the complications from genital warts?

Cancer

Some types of HPV can cause cervical cancer. Other types are associated with vulvar cancer, anal cancer, oral cancer, and cancer of the penis (a rare cancer).

Most HPV infections do not progress to cervical cancer. If you are a woman with abnormal cervical cells, a Pap smear will detect them. If you have abnormal cervical cells, it is particularly important for you to have regular pelvic exams and Pap smears so you can be treated early, if necessary.

Pregnancy and childbirth

Genital warts may cause a number of problems during pregnancy. Because genital warts can multiply and become brittle, your health care provider will discuss options for their removal, if necessary.

Genital warts also may be removed to ensure a safe and healthy delivery of the newborn. Sometimes they get larger during pregnancy, making it difficult to urinate if the warts are in the urinary tract. If the warts are in the vagina, they can make the vagina less elastic and cause obstruction during delivery.

Rarely, infants born to women with genital warts develop warts in their throats (respiratory papillomatosis). Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent blocking of the breathing passages.