Genital Warts

What is Genital Warts?

Genital warts are soft wart-like growths on the genitals caused by a viral skin disease. Genital warts are a type of sexually transmitted disease (STD), also called a sexually transmitted infection (STI).

Alternative names

Condylomata acuminata; Penile warts; Human papilloma virus (HPV); Venereal warts; Condyloma

Causes

The virus responsible for genital warts is called human papilloma virus (HPV). This virus can cause warts on the penis, vulva, urethra, vagina, cervix, and around the anus.

HPV infection around the genitals is common, although most people have no symptoms. Even if you do NOT have symptoms, however, you must be treated to avoid complications and spreading the condition to others.

There are more than 70 different types of HPV. Several types are associated with genital warts. Other types are associated with common or flat warts elsewhere on the skin. Some types have been found to cause cancer of the cervix and vulva.

HPV grows well in the moist genital area. Warts on the outer genitals are easily recognized. They are raised, flesh-colored lesions that may occur singly or in clusters. Left untreated, warts may rapidly enlarge, taking on a "cauliflower-like" appearance.

In women, HPV can invade the vagina and cervix. These warts are flat and not easily visible without special procedures. Because HPV can lead to cancerous and precancerous changes in the cervix, it is important that this condition be diagnosed and treated. Regular Pap smears are necessary to detect HPV or other abnormal changes related to this virus. Having both HPV and herpes virus together may put you at increased risk for cervical cancer.

The following factors put you at higher risk for getting genital warts and other complications of HPV:

• Multiple sexual partners
• Not knowing if someone you had sex with had STDs
• Early age when you start to be sexually active
• Tobacco and alcohol use
• Stress and other viral infections (such as HIV or herpes) at the same time

If a child has genital warts, you should suspect sexual abuse as a possible cause.

Symptoms & Signs

Genital warts are raised, flesh-colored lesions on the genitals, anus, or surrounding skin. They may appear as cauliflower-like growths around the anus or genitals. However, there are often no symptoms. Symptoms that may occur include:

• Abnormal vaginal bleeding (not associated with a menstrual period) after sexual intercourse
• Increased dampness or moisture in the area of the growths
• Itching of the penis, scrotum, anal area, or vulva
• Increased vaginal discharge

Exams and Tests

A genital examination reveals flesh-colored to white, flat or raised, single or clustered lesions anywhere on the genitalia.

In women, a pelvic examination may reveal growths on the vaginal walls or the cervix. Magnification (colposcopy) may be used to see lesions invisible to the naked eye. The tissue of the vagina and cervix may be treated with acetic acid to make the warts visible. A Pap smear may note changes associated with HPV.

Treatments

Genital warts must be treated by a doctor. Do NOT use over-the counter remedies meant for other kinds of warts. Your doctor may treat genital warts by applying a skin treatment in the office. Or, the doctor may prescribe a medication that you apply at home several times per week.

Surgical treatments include cryosurgery, electrocauterization, laser therapy, or cutting them out.

If you develop genital warts, all of your sexual partners must be examined by a health care provider and treated if genital warts are found.

After your initial treatment, your doctor will schedule follow-up examinations to see if the warts have returned.

Women who have had genital warts, and women whose partners have ever had genital warts, should have Pap smears at least once a year. For warts on the cervix, women may be advised to have Pap smears every 3 to 6 months after initial treatment.

Prognosis

With proper treatment, genital wart outbreaks usually can be controlled. However, the warts frequently reappear after treatment. Even after you have been treated for HPV, you may still infect others.

Certain types of genital warts increase a woman's risk for cancer of the cervix and vulva.

Possible Complications

At least 70 types of HPV have been identified, several of which have been linked to cervical and vulvar cancer. The warts may become numerous and quite large, requiring more extensive treatment and follow-up procedures.

When to contact a medical professional

Call your doctor if a current or past sexual partner is found to have genital warts. Call if you have visible warts on your external genitals, itching, discharge, or abnormal vaginal bleeding. Keep in mind that genital warts may not appear for months to years after having sexual contact with an infected person.

Call your doctor if a young child is thought to possibly have genital warts.

Sexually active teens are very susceptible to HPV and should get screened for HPV infection regularly.

Prevention

Total abstinence is the only foolproof way of avoiding genital warts and other STDs. You can also avoid STDs by having a monogamous sexual relationship with a partner known to be disease-free.

Skin near the warts and around the genitals, anus, and other areas can pass the virus from one person to the next. Therefore, male and female condoms cannot fully protect you. Nonetheless, condoms should still be used. They reduce your chances of getting or spreading STDs. These precautions must be taken at all times. HPV can be passed from person to person even when there are no visible warts or other symptoms. See: Safe sex

A new vaccine called Gardasil prevents infection against four of the HPV strains responsible for the majority of genital warts and cervical cancer in women. The vaccine is given as a series of three shots. It is recommended for girls and women ages 9 to 26.

References

Diaz ML. Human papilloma virus: prevention and treatment.Obstet Gynecol Clin North Am. 2008;35(2):199-217.

Armstrong C. ACIP releases recommendations on quadrivalent human papillomavirus vaccine. Am Fam Physician. 2007;75(9):1391.

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Review Date: .5/26/2008

Reviewed By: Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.5/26/2008