Genital Warts: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Prevention and Outlook

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Illustration of genital warts

1Overview

There are many types of sexually transmitted diseases (STD). One of the most common types is genital warts. These are found in nearly all sexually active individuals after being infected with at least one strain of the human papillomavirus (HPV).

Genital warts affect the moist tissues of the genital area. These lesions are cauliflower-like, too small to be visible and appear like bumps. Women are more likely to have genital warts then men. In women, genital warts appear on the vulva, vagina, anus, and urethra.
On the other hand, men develop genital warts on their penis, scrotum, and anus.

The lesions are usually painless and do not pose a serious health threat. However, genital warts may have a different effect on people with a suppressed immune system like those who suffer from illnesses such as HIV and AIDS, those who are undergoing chemotherapy, those who had an organ transplant and those taking immune-suppressing drugs like corticosteroids.

2Symptoms

Many individuals who have HPV infection will not develop any noticeable warts.
If genital warts appear, it can take about several months and years, after the person first came in contact with the HPV.

Warts in women

The most common areas where genital warts develop in women include:

  • Cervix or neck of the womb
  • Vulva
  • In and around the anus
  • Inside the vagina
  • Upper thigh

Warts in men

In men, the areas commonly affected are:

  • Scrotum
  • Anywhere on the penis
  • Inside the urethra
  • Upper thighs
  • Anus

Usually, genital warts are painless but in some people, warts may become inflamed and itchy. If the wart becomes swollen, bleeding may occur from inside the anus, vagina, and urethra.

The partner may not see or feel the presence of warts since they are small and hard to notice. Sometimes, warts may appear flat or smooth with small bumps or in some cases, large, pink and cauliflower-like.

3Causes

Genital warts are caused by an infection of the skin of the genitals and anal area with the human papillomavirus (HPV). Today, there are about 150 different types of HPV and they can appear in any part of the body. For genital warts, as the name implies, appear on the genital area or surrounding skin.

About 30 HPV types can live in and around the genitals but they generally, they are caused by two types – type 11 and type 6. These types, however, do not cause cancer.

Genital HPV is spread primarily through sexual contact. However, it can also spread through skin-to-skin contact. In most cases, the immune system fights and kills genital HPV and there will be no signs and symptoms of the infection.

Upon infection, it may take months or even years for warts to develop. Thus, if a person is in a relationship and they have genital warts, that doesn’t mean that he or she is having sex with other people. Also, when you develop warts, you cannot imply that your current partner is the one who transmitted it to you.

Moreover, the virus is most likely transmitted to other people when the warts are present but it is possible to pass it on before the lesions appear. In some cases, it can be spread even when warts disappeared.

4Risk Factors

According to the Centers for Disease Control and Prevention, nearly everyone who’s sexually active will become infected with at least one strain or type of HPV at some point in their lifetime. Some factors may heighten the risk of contracting the virus, including:

  • Having another sexually transmitted disease (STD)
  • Having multiple sexual partners
  • Having unprotected sex with many sexual partners
  • Becoming sexually active at a very young age
  • Having sex with a partner with unknown sexual history
  • Having sex with a partner who has multiple sexual partners
  • Those who did not receive HPV vaccination

The other risk factors include:

  • Individuals who are under 30 years old
  • Those who are smoking
  • People with a weakened immune system due to medications like chemotherapy and steroid therapy, diseases like HIV and AIDS and organ transplant.
  • Children of mothers who had the virus during childbirth

5Complications

HPV can alter the structure of the infected cells. For instance, genital warts can lead to serious health conditions if it affects someone with a suppressed immune system.
Some of the possible complications include:

Pregnancy problems – There is a small risk that a pregnant mother may pass genital warts to her child during delivery. A newborn can have a condition called laryngeal papillomatosis, wherein genital warts are present in the mouth.
During pregnancy, hormonal changes may cause genital warts to grow, bleed and proliferate. They would also enlarge, making it hard to urinate. On the other hand, when the wart is inside the vaginal wall, it may reduce the ability of the tissues to stretch during childbirth.

Cancer – HPV infection has been tied to the development of cervical cancer, as well as other cancers affecting the vulva, penis, anus, throat, and mouth. However, not all HPV infections lead to cervical cancer but it is important for women of reproductive age to undergo regular Pap smears.

6Diagnosis

Usually, the doctor will conduct a comprehensive physical examination and medical history interview. He will ask the patient about his or her sexual history and examine the lesions present. For genital warts, they may not appear noticeable so the doctor might need a solution to make warts turn to white. This way, he can examine the lesion to confirm a genital warts diagnosis.

The main test for genital warts is for the doctor to look and examine warts. They usually use a magnifying lens. In some cases, an internal examination of the vagina and anus is needed to see if there are warts inside. Rarely, the doctor can conduct a biopsy.

Pap Smear

In women, it is essential to have regular Pap smear tests to detect cervical and vaginal changes caused by genital warts. When there are changes in the secretions around these parts, these might signal the early signs of cervical cancer.

HPV test

Today, there is an available test called HPV test that can determine if there are cancer-causing HPV strains in the cervical area. This test is recommended for women who are 30 years old and above.

7Treatment

Like other treatment options for other HPV warts in the body, there are treatment options for genital warts, too. However, if warts do not cause any discomfort, you may not need any treatment.

For those who need treatment, here are the options:

Medicines

Salicylic acid – Some treatments can eliminate the layers of the wart gradually.
Though, this can irritate the skin so better read the instructions properly.

Imiquimod (Aldara, Zyclara) – This is a cream recommended by a physician that can increase the immune system’s ability to fight HPV.

Trichloroacetic acid – This is a chemical treatment that burns off warts on the soles, genitals, and palms. However, skin irritation is common.

Podofilox (Condylox) – This drug is applied topically to the wart. It works by injuring the wart tissue mainly on the genitals. Some individuals who use this drug may experience itching and pain upon application.

In some cases, medications are not effective. Doctors will suggest surgical interventions such as:

Cryotherapy – As the name suggests, this treatment option freezes the abnormal skin areas with liquid nitrogen.

Electrocautery – This is a method that uses electric currents to burn warts.

Interferon injection – This treatment is not often used due to the increased risk of side effects and it is expensive.

Laser therapy – This treatment uses a light beam to remove the abnormal parts of the skin.

Surgery – This method is done by manually removing the wart or lesion through surgery. This is just a minor operation and can be done as an out-patient.

8Prevention

Safe sex is one of the best ways to reduce the risk of acquiring genital warts. But, even if it can dramatically decrease the risk, it is not 100 percent effective. A person can still get warts on the parts the condom does not protect.

Still, the best way to reduce the risk is through vaccination. The vaccine protects against four major strains of HPV that can cause cancer. It is used to protect against genital warts and in 2014, another type of vaccine has been approved. This time, it can protect against nine strains of the virus.

These vaccines are most effective if they are given to teens or children before they even become sexually active.

9Outlook

There is no cure for the virus but it can go away on its own without any treatment. However, there is a great risk of the wart to reappear even after several years.

The goal of the treatment is to eradicate visible lesions on the skin but if it’s left untreated, about 10 to 30 percent will resolve on their own within three months.

After treatment, a follow-up visit is needed to monitor the condition and make sure that the patient is wart-free. If a patient is concerned with the reappearance or recurrence of warts, an evaluation will be conducted to make sure the treatment is successful.