Genital Warts

Genital warts (condylomata acuminata or venereal warts) are caused by only a few of the many types of HPV. Other common types of HPV infections, such as those that cause warts on the hands and soles of the feet, do not cause genital warts. Genital warts are spread by sexual contact with an infected partner and are very contagious. Approximately two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within three months of contact. Scientists estimate that as many as 1 million new cases of genital warts are diagnosed in the United States each year.

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In women, the warts occur on the outside and inside of the vagina, on the cervix (the opening to the uterus), or around the anus. In men, genital warts are less common. If present, they are seen on the tip of the penis; however, they also may be found on the shaft of the penis, on the scrotum, or around the anus. Rarely, genital warts also can develop in the mouth or throat of a person who has had oral sexual contact with an infected person. Genital warts often occur in clusters and can be very tiny or can spread into large masses on genital tissues. Left untreated, genital warts often disappear. In other cases, they eventually may develop a fleshy, small raised growth with a cauliflower-like appearance. Because there is no way to predict whether the warts will grow or disappear, however, people who suspect that they have genital warts should be examined and treated, if necessary.

Diagnosis

A doctor usually can diagnose genital warts by direct visual examination. Women with genital warts also should be examined for possible HPV infection of the cervix. The doctor may be able to identify some otherwise invisible changes in the tissue by applying vinegar (acetic acid) to areas of suspected infection. This solution causes infected areas to whiten, which makes them more visible, particularly if a procedure called colposcopy is performed. During colposcopy, a magnifying instrument is used to view the vagina and uterine cervix. In some cases, it is necessary to do a biopsy of cervical tissue. This involves taking a small sample of tissue from the cervix and examining it under the microscope.

A Pap smear test also may indicate the possible presence of cervical HPV infection. A Pap smear is a microscopic examination of cells scraped from the uterine cervix in order to detect cervical cancer. Abnormal Pap smear results are associated with HPV infection. Women with abnormal Pap smears should be examined further to detect and treat cervical problems.

Treatment

Depending on factors such as their size and location, genital warts are treated in several ways. Although treatments can eliminate the warts, none eradicate the virus and warts often reappear after treatment. Patients should consult their doctors to determine the best treatment for them.

The U.S. Food and Drug Administration (FDA) has approved imiquimod cream, which the patient can apply to the affected area, to treat genital warts. Other treatments include a 20 percent podophyllin solution, which the patient can apply to the affected area and later wash off, and a 0.5 percent podofilox solution, which also is applied to the affected area, but is not washed off. Pregnant women should not use podophyllin or podofilox because they are absorbed by the skin and may cause birth defects in babies. The doctor may also prescribe 5 percent 5-fluorouracil cream, which also should not be used during pregnancy, or trichloroacetic acid (TCA).

Small warts can be removed by cryosurgery (freezing), electrocautery (burning), or laser treatment. Occasionally, surgery is needed to remove large warts that have not responded to other treatment.

Some doctors use the antiviral drug alpha interferon, which they inject directly into the warts, to treat warts that have recurred after removal by traditional means. The drug is expensive, however, and does not reduce the rate of recurrence.

Complications

Low-risk papilloma viruses cause warts but not cervical cancer. High-risk viruses, however, cause cervical cancer and also are associated with vulvar cancer, anal cancer, and cancer of the penis (a rare cancer). Although most HPV infections do not progress to cancer, it is particularly important for women who have cervical dysplasia to have regular Pap smears. Potentially pre-cancerous cervical disease is readily treatable.

Genital warts may cause a number of problems during pregnancy. Sometimes they enlarge during pregnancy, making urination difficult. If the warts are on the vaginal wall, they can make the vagina less elastic and cause obstruction during delivery.

Rarely, infants born to women with genital warts develop laryngeal papillomatosis (warts in the throat). Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent obstruction of the airways. Research on the use of interferon therapy in combination with laser surgery indicates that this drug may show promise in slowing the course of the disease.

Prevention

The only way to prevent HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact. If warts are visible in the genital area, sexual contact should be avoided until the warts are treated. Using a latex condom during sexual intercourse may provide some protection.

Researchers are working to develop two types of HPV vaccines. One type would be used to prevent infection or disease (warts or pre-cancerous tissue changes); another type would be used to treat cervical cancers. Clinical trials are in progress for both types of vaccines.

Treatment Options

Medical treatments include drug therapy (usually the first-line treatment), cryosurgery (“freezing” the wart to destroy tissue), electrosurgery, lasers, and cutting out the wart. Unless your wart is causing significant problems, you should avoid treatments that have risks or could result in scarring.

Drug Therapies

Common, flat, and plantar warts: nonprescription preparations using salicylic acid are available over the counter.

Genital warts: in most cases, your health care provider will either apply podophyllin weekly or prescribe a podofilox for you to apply.

Complementary and Alternative Therapies

Nutritional and herbal support may enhance immune function and minimize recurrence of HPV, the virus that causes warts.

Nutrition

Some changes you can make in your diet include the following.

  • Eliminate caffeine, alcohol, refined foods, and sugar.
  • Avoid saturated fats (animal protein and dairy products).
  • Increase whole grains, fresh vegetables, fruits, legumes, and essential fatty acids (nuts, seeds, and cold-water fish).
  • Vitamin C (250 to 500 mg two times per day), beta-carotene (100,000 IU per day), vitamin E (400 IU per day), and zinc (15 to 30 mg per day) support immune function and healing. Vitamin E may also be put directly on a wart to treat it.
  • B complex (50 to 100 mg per day) helps reduce the effects of stress, which can weaken your immune system.
  • Folic acid (800 mcg per day) is recommended for genital warts.
  • Selenium (200 mcg per day) supports immune function.