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Genital Warts(Anogenital Warts; Condyloma Acuminata; Human Papillomavirus [HPV]; Penile Warts; Venereal Warts; Warts, Genital)
Definition

Genital warts are growths or bumps that appear:

  • On the vulva
  • In or around the vagina or anus
  • On the cervix
  • On the penis, scrotum, groin, or thigh
  • Rarely, in the mouth or throat

Genital Warts

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Genital warts is one of the most common sexually transmitted diseases (STDs). Most people will be exposed to a form of HPV at some point in their lives. Not everyone will become infected or develop symptoms.

Causes

Genital warts are caused by the human papillomavirus (HPV). There are many different types of HPV. Only a few types are thought to cause genital warts. Many types of HPV are associated with harmless skin warts found on the fingers or feet.

Certain types of HPV may cause cervical cancer . Less commonly, certain strains of HPV can cause cancers of the vulva, anus, or penis.

HPV is easily spread during oral, genital, or anal sex with an infected partner. Most people who have sex with an infected partner will also develop genital warts.

Warts can also be spread to an infant during delivery if the mother has genital warts.

Risk Factors

Factors that may increase your risk for HPV and genital warts include:

  • Multiple sexual partners
  • First male sexual partner has had two or more previous sexual partners (for women)
  • Sex without condoms
  • Having a weakened immune system
  • Sex at an early age
  • Skin-to-skin contact with an infected partner
  • Previous history of genital warts or other STDs
Symptoms

Genital warts often look like fleshy, raised growths. They can have a cauliflower shape, and often appear in clusters. Some warts may be flat. The warts may not be easy to see with the unaided eye. Warts can take several weeks or months to appear after the infection.

In women, warts may be found in the following areas:

  • Vulva or vagina
  • Inside or around the vagina or anus
  • Cervix

In men, warts are less common. If present, they are usually found in these areas:

  • Tip or shaft of the penis
  • Scrotum
  • Around the anus

While warts do not usually cause symptoms, the following may occur:

  • Bleeding
  • Itching
  • Irritation
Diagnosis

Genital warts may be diagnosed by:

Visual Exam

A doctor can usually diagnose genital warts by looking at them. If external warts are found on a woman, then the cervix is usually also checked. A doctor may use a special solution to help find lesions that do not have classic features.

Biopsy

A sample of tissue will be taken and tested for HPV.

Treatment

Treatment help the symptoms, but does not cure the virus. The virus stays in your body. This means the warts may recur.

Your treatment depends on the size and location of the warts. Not all warts need to be treated. If left untreated, some may go away on their own, but others may stay. Some warts may also get larger or spread.

Treatments may include:

Topical Treatments

Topical medication is applied directly to the skin. Your doctor may recommend one of these medications:

  • Imiquimod cream
  • Sinecatechins ointment
  • Podophyllin resin
  • Podofilox solution
  • Trichloroacetic acid or bichloroacetic acid
Cryosurgery, Electrocautery, or Laser Treatment

Methods that instantly destroy warts include:

  • Cryosurgery (freezing)
  • Electrocautery (burning)
  • Laser treatment

These methods are used on small warts. It may be used on larger warts that have not responded to other treatment. A large wart can also be removed with surgery.

Prevention

The only way to completely prevent HPV from spreading is to avoid physical contact with infected partners.

Latex condoms may help reduce the spread of HPV infection and genital warts. Condoms are not 100% effective because they do not cover the entire genital area.

Other ways to help prevent infection include:

  • Abstain from sex
  • Have a monogamous relationship
  • Get regular check-ups for STDs
Vaccine

There is a vaccine for HPV. It is given over a series of three injections to girls and boys aged 11-12 years old. If you are aged 26 or younger and were not vaccinated, you can receive a catch-up vaccine series.

RESOURCES:

Centers for Disease Control and Prevention
http://www.cdc.gov

Planned Parenthood
http://www.plannedparenthood.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

Sex Information and Education Council of Canada
http://www.sieccan.org

References:

Genital Warts. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/treatment/2010/genital-warts.htm . Updated February 8, 2012. Accessed May 23, 2013.

Cervical cancer screening. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq085.pdf?dmc=1&ts=20130205T1433163887 . Published February 2013. Accessed May 23, 2013.

Batista CS, Atallah AN, et al. 5-FU for genital warts in non-immunocompromised individuals. Cochrane Database Syst Rev . 2010 Apr 14;4:CD006562.

Condyloma acuminatum. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated March 8, 2013. Accessed May 23, 2013.

Dunne EF, Markowitz LE. Genital human papillomavirus infection. Clin Infect Dis . 2006; 43:624.

Human papillomavirus (HPV). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/hpv . Updated February 1, 2013. Accessed May 23, 2013.

Human papillomavirus and genital warts. National Institute of Allergy and Infectious Disease website. Available at: http://www.niaid.nih.gov/topics/genitalwarts/Pages/default.aspx . Updated October 21, 2010. Accessed May 23, 2013.

Lowy DR, Schiller JT. Papillomaviruses and cervical cancer: pathogenesis and vaccine development. J Natl Cancer Inst Monogr . 1998;23:27-30.

Workowski KA, Berman S, Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR . 2010;59(No. RR-12):1-110.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356:1915-1927.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Winer RL, Feng Q, Hughes JP, O'Reilly S, Kiviat NB, Koutsky LA. Risk of female human papillomavirus acquisition associated with first male sex partner. J Infect Dis . 2008;197:279-282.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : FDA approves new indication for Gardasil to prevent genital warts in men and boys. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187003.htm . Published October 16, 2009. Accessed October 22, 2009.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Screening for cervical cancer. United States Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm . Published March 2012. Accessed March 19, 2012.

Saslow D, Soloman D, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA: A Cancer Journal for Clinicians . 2012 Mar 14 early online.



Last reviewed May 2013 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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