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Genital warts

(1997)

By themselves, genital warts — sometimes called venereal warts or condyloma — are mainly a nuisance because they have a tendency to recur. However, genital warts are caused by types of sexually transmitted human papillomavirus (HPV). If you have genital warts, it’s a good idea to be checked for other infections. The presence of genital warts should increase your suspicion that you may have been exposed to other sexually transmitted diseases (STDs), including those that may increase your risk for certain cancers.
Some non-wart-causing strains of HPV cause cervical cancer. In fact, in 95 percent of women with cervical cancer, HPV is present and believed to be the underlying cause. Some types of HPV have been linked to anal cancers.
o Cervical cancer - Preventable and treatable
There are approximately 60 varieties of human papillomaviruses. Beyond the wart-causing strains, most genital HPV infections do not cause symptoms. You can be infected with HPV and not get genital warts or cancer, and getting genital warts doesn’t mean you’ll get cancer. Most women’s and men’s immune systems naturally fight off the virus and they never have a problem with either warts or cancer.
That doesn’t mean HPV isn’t serious. Infections with HPV have reached almost epidemic proportions. It’s estimated that nearly 1 million cases of genital HPV infection are diagnosed each year, and as many as one-quarter to one-third of all sexually active U.S. teen-agers are believed to be exposed.
Since no cure for HPV infection has yet been identified, and a possible vaccine is still years away, it’s a good idea to arm yourself with knowledge about genital warts and HPV infection.
Transmission and risk
Genital HPV is transmitted through vaginal, anal or oral sexual contact with an infected person. The virus is passed from skin-to-skin contact, through microscopic skin tears and abrasions that occur during sexual activity. It was once thought that genital warts had to be present for viral transmission, but some studies have shown that HPV genetic material (DNA) has been found in semen, suggesting the virus also may be transmitted by contact with bodily fluids.
Not everyone who has been exposed to the virus will develop genital warts; but when a person has genital warts, there is a 60 percent to 90 percent chance that his or her sexual partner is also infected by the virus. As with many other viruses, once you’re infected with HPV, it may remain in your system. Infection does not confer immunity to infections with different strains of HPV.
Any sexually active person can be infected with genital HPV. It most often affects young people (ages 15 to 30) who have had multiple sex partners, but any sexually active person can contract genital warts. Genital HPV infection is a serious concern to those with compromised immune systems, who are less able to resist infection. Genital warts can also grow more rapidly during pregnancy, and HPV in rare instances can be transmitted to newborns by infected mothers.
Incubation
One difficulty with genital HPV exposure is that if symptoms appear at all, they may not appear for several months or years after infection. The average incubation period is one to six months, but that varies greatly. It’s possible for you to be in a monogamous relationship but still transmit the virus acquired during sexual contact with an infected partner months or years before.
Finding out that you have genital warts can be an upsetting experience. You may feel ashamed. You may feel angry at a partner, who may or may not have infected you. The first step toward treatment is diagnosis of genital warts.
Symptoms and detection
Generally, you will be able to see genital warts or feel them with your fingers. They are typically small, soft, flesh-colored cauliflower-like growths situated in clumps or singularly. They can also be flat and white, pink or brown. They typically grow on the outer genitalia, but can grow on the inside of the anus and the vagina, urethra, and cervix, making self-detection more difficult. They are frequently painless, but can sometimes be associated with itching and irritation. Genital warts also can appear in the throat.
Without treatment, the warts can continue to grow and spread, particularly in warm, moist areas. Vaginal infections from other organisms, particularly other STDs, encourage rapid growth of warts. These infections can be treated at the same time.
Seek treatment if:
• you notice any unusual growths, bumps, or skin changes on or near your penis, vagina, vulva, or anus;
• you notice any unusual itching, pain, or bleeding in or around the genital area;
• your sex partner tells you that he or she has genital warts.
A visual examination is often sufficient for a physician to confirm the presence of warts. Sometimes, your doctor may use a dilute vinegar solution, which turns the warts white, to confirm their presence. Sometimes genital HPV infection is not visible or identifiable at all. Even if there are no visible warts, special diagnostic methods such as colposcopy (a magnifying procedure) can be used. For women, an abnormal Pap smear may be the first indication that HPV is present. A Pap test may reveal precancerous cells from the cervix most likely caused by HPV infection. If you have had genital warts, be sure to have a Pap smear annually.
o Pap test - Still the best warning system for cervical cancer
Both men and women diagnosed with genital warts should encourage their partner(s) to be tested. If you are treated for warts and your partner still has warts, you can be reinfected.
What happens if your genital warts go untreated? If your immune system is working properly, your body can eventually recognize the HPV and attack it. However, your best bet for eliminating warts is prompt treatment by a physician.
Treatment
Don’t use over-the-counter treatments for warts. The genital tissues are often too sensitive for these products. See your physician for treatment. Most genital warts require two or more treatments to make them go away. There is no treatment for the virus itself, just the warts it causes. Treatment options for genital warts include:
Topical chemicals —
• Trichloroacetic acid (TCA) can be applied directly to genital warts to destroy them. There is some burning or discomfort, which may last for several minutes immediately following application by a physician. Mild discomfort may persist for several days after treatment. Treatments are generally done at one- to two-week intervals until the warts are no longer visible.
• Podophyllin resin can be applied directly to genital warts by a physician. The application process is somewhat painful, and some burning or discomfort can occur one to four days afterward.
• Interferon is a new drug that can be used to treat genital warts; it may be injected directly by your physician into the warts.
• 5-Fluorouracil (5 FU) Cream, a strong chemical in a cream base, is used for extensive vaginal and anal warts. It can be used at home. It is inserted into the vagina or rectum at bedtime for several nights. This causes the outer vaginal or anal skin layers to slough off, along with the warts. Follow your physician’s directions when using this product.
• Imiquimod (Aldara), a new cream treatment for genital warts, is expected to be approved by the Food and Drug Administration in June 1997. It can be used at home and must be used for several weeks. This treatment may be less irritating than most of the previous treatments mentioned.
Cryotherapy or freezing — Liquid nitrogen is applied directly to the warts, causing an initial cold sensation, and then throbbing or burning as the area thaws. After one to two days, a blister develops at the site, which heals within a few days or weeks; the blister should not be broken, and the area should be kept clean and dry.
Additional therapies — For persistent external genital warts, more potent treatments may be used, such as electrocautery (an electric current is used to burn away warts) or laser therapy (a beam of high-intensity light is used to destroy warts). Excisional biopsy (tissue removal) may be needed to remove large clusters of warts. Anesthesia may be used in these more extensive therapies.
The use of zinc oxide cream and taking baths in warm water may help alleviate discomfort before or after treatment.
Prevention
There are ways to limit your risk for exposure to genital warts and HPV infection. Practice abstinence or limit your number of sexual partners. Use a latex condom each and every time you have sexual contact. Condoms offer some protection against genital HPVs and most other STDs, but may not completely prevent development of warts, since warts can be present outside of the area protected by the condom. If you believe you have genital warts or have been exposed to HPV, see your physician before engaging in further sexual contact. If you are diagnosed with genital warts, encourage your partner(s) to be tested, and complete follow-up exams after being diagnosed.