OhioHealth Online

Genital warts, also known as venereal warts or condylomata acuminata, are one of the most common types of sexually transmitted diseases.

As the name suggests, genital warts affect the moist tissues of the genital area. They may look like small, flesh-colored bumps or have a cauliflower-like appearance. Genital warts may be very small, or they may multiply into large clusters.

Although genital warts can be treated with medications and surgery, they are a serious health concern. The virus that causes genital warts — the human papillomavirus (HPV) — has been associated with cervical cancer. It has also been linked with other types of genital cancers.

In women, genital warts can grow on the vulva, the walls of the vagina, the area between the external genitals and the anus, and the cervix. In men, they may occur on the tip or shaft of the penis, the scrotum or the anus. Genital warts can also develop in the mouth or throat of a person who has had oral sexual contact with an infected person.

The signs and symptoms of genital warts include:

• Small, flesh-colored or gray swellings in your genital area
• Several warts close together that take on a cauliflower shape
• Itching or discomfort in your genital area
• Bleeding with intercourse

Often, genital warts cause no symptoms. They may be so small and flat that they can't be seen with the naked eye. Sometimes, however, genital warts may multiply into large clusters.

Pregnancy may sometimes trigger a dormant infection, or an active infection may worsen during pregnancy.

When to see a doctor
See a doctor if:

• You've developed bumps or warts in your genital area
• Your sexual partner has developed genital warts or has been diagnosed with them

Like warts that appear on other areas of your skin, genital warts are caused by a virus — HPV — that infects the top layers of your skin. There are more than 100 different types of HPV, but only a few can cause genital warts. These strains of the virus are highly contagious and spread through sexual contact with an infected person.

About two-thirds of people who have sexual contact with someone who has genital warts develop the condition — usually within three months of contact, but in some cases not for years.

Risk factors of becoming infected with HPV include:

• Having unprotected sex with multiple partners
• Having had another sexually transmitted disease
• Having sex with a partner whose sexual history you don't know
• Becoming sexually active at a young age

• Cancer. Cervical cancer has been closely linked with HPV infection. Certain types of HPV also are associated with cancer of the vulva, cancer of the anus and cancer of the penis. Human papillomavirus infection doesn't always lead to cancer, but it's still important for women, particularly if you've been infected with certain higher risk types of HPV, to have regular Pap tests.
• Problems during pregnancy. Genital warts may cause problems during pregnancy. Warts could enlarge, making it difficult to urinate. Warts on the vaginal wall may reduce the ability of vaginal tissues to stretch during childbirth. Rarely, a baby born to a mother with genital warts may develop warts in his or her throat. The baby may need surgery to prevent airway obstruction.

You're likely to start by first seeing your family doctor or a general practitioner. If you are a woman, you may wish to schedule your initial appointment with your obstetrician and gynecologist (OB-GYN).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
• Write down any symptoms you've been experiencing, and for how long. Also note whether your sexual partner has ever had similar symptoms.
• Make a list of all recent exposures to possible sources of infection. These may include engaging in unprotected sex or sex with a new partner.
• Make a list of your key medical information, including other conditions you're being treated for and the names of any medications, vitamins or supplements that you're taking.
• Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

For genital warts, some basic questions to ask your doctor include:

• Do I have genital warts?
• Are there any other possible causes for my symptoms?
• What tests do you recommend?
• Should I also be tested for other sexually transmitted diseases (STDs)?
• What treatment approach do you recommend, if any?
• If the first treatment doesn't work, what will we try next?
• How soon after I begin treatment can I expect improvement?
• Am I contagious? How can I reduce the risk of passing this infection to others?
• Should my partner be tested for this condition?
• When can I safely resume sexual activity?
• How likely am I to experience future outbreaks of genital warts?
• Am I at risk of complications related to genital warts?
• How often should I be screened for other health conditions related to genital warts?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

• What are your symptoms, if any?
• When did you first begin experiencing symptoms?
• How severe are your symptoms?
• Do you practice safe sex? Have you done so since you became sexually active?
• Have you recently had sex with a new partner?
• Has your partner been tested for STDs?
• Have you had the HPV vaccine? When?
• Are you pregnant or planning to become pregnant?
• Do you or did you smoke? How much?

What you can do in the meantime
While you wait for your appointment, avoid all sexual contact that could put your partner at risk of contracting genital warts. This includes sexual intercourse, oral sex and any skin-to-skin contact with your genitals. Let your sex partner or partners know about your signs and symptoms so that they can also seek testing.

Detecting genital warts
Because it's often difficult to detect genital warts, your doctor may apply an acetic acid solution to your genitals to whiten any warts. Then, he or she may view them through a special microscope called a colposcope.

The importance of Pap tests
For women, it's important to have regular pelvic exams and Pap tests, which can help detect vaginal and cervical changes caused by genital warts or the early signs of cervical cancer — a possible complication of HPV infection.

Have an initial Pap test within three years of having sex or at age 21, whichever comes first. You may be able to reduce the frequency of your Pap tests if you're older than 30 and you've had three normal tests in a row. Talk with your doctor about the right screening schedule for you.

If you've had genital warts, you may need to have a Pap test every three to six months, depending on the severity of your condition.

Up to 30 percent of genital warts go away without treatment. If your warts aren't causing discomfort, you may not need treatment. However, if your symptoms include itching, burning and pain or if visible warts are causing emotional distress, your doctor can help you clear an outbreak with medications or surgical treatments. The underlying virus is never completely eliminated, however, and genital warts may reappear even after treatment.

Medications
Genital warts treatments that can be applied directly to your skin include:

• Imiquimod (Aldara). This cream appears to boost your immune system's ability to fight genital warts. Avoid sexual contact while the cream is on your skin. It may weaken condoms and diaphragms and may irritate your partner's skin.
• Podophyllin and podofilox (Condylox). Podophyllin is a plant-based resin that destroys genital wart tissue. Your doctor must apply this solution. Podofilox contains the same active compound, but can be safely applied by you at home. Your doctor may want to administer the first application of podofilox, and will recommend precautionary steps to prevent the medication from irritating surrounding skin. Never apply podofilox internally. Additionally, this medication isn't recommended for use during pregnancy.
• Trichloroacetic acid (TCA). This chemical treatment burns off genital warts. TCA must always be applied by a doctor.

Don't try to treat genital warts with over-the-counter medications. These medications aren't intended for use in the moist tissues of the genital area. Using over-the-counter medications for this purpose can cause even more pain and irritation.

Surgery
You may need surgery to remove larger warts, warts that don't respond to medications, or — if you're pregnant — warts that your baby may be exposed to during delivery. Surgical options include:

• Freezing with liquid nitrogen (cryotherapy). Freezing works by causing a blister to form around your wart. As your skin heals, the lesions slough off, allowing new skin to appear. You may need repeated cryotherapy treatments.
• Electrocautery. This procedure uses an electrical current to burn off warts.
• Surgical excision. Your doctor may use special tools to cut off warts. You'll need local anesthesia for this treatment.
• Laser treatments. This approach, which uses an intense beam of light, can be expensive and is usually reserved for very extensive and tough-to-treat warts.

While many folk remedies — such as aloe, castor oil and vinegar — are promoted for the treatment of genital warts, there is little evidence to suggest that these approaches are effective.

• Use a condom. HPV can spread through skin-to-skin contact with any infected part of your body — but using a condom every time you have sex can significantly reduce your risk of contracting HPV.
• Avoid sexual contact. If warts are visible on your genital area or your partner's, avoid sexual contact until the warts are treated. If you've developed genital warts for the first time, inform your sexual partner so that he or she can be screened for infection and, if necessary, receive treatment.

• Consider vaccination. While it won't completely prevent genital warts or cervical cancer, a vaccine known as Gardasil protects against the two strains of HPV that cause 70 percent of cervical cancers and the two strains that cause 90 percent of genital warts.

  The national Advisory Committee on Immunization Practices recommends routine vaccination for girls ages 11 and 12, as well as girls and women ages 13 to 26 if they haven't received the vaccine already. The vaccine is most effective if given to girls before they become sexually active.