Genital Warts

Author: Michelle Badash, MS
En Español (Spanish Version)

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
  • In the mouth or throat (rare)

The warts may be raised or flat, single or multiple, small or large. Some may cluster to form a cauliflower-like shape. This condition 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.

Genital Warts

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Causes

Genital warts are caused by the human papillomavirus (HPV). HPV is a family of more than 80 common viruses. Many types of HPV cause harmless skin warts. These warts are often found on the fingers or feet. Only a few types are thought to cause genital warts.

HPV is easily spread during oral, genital, or anal sex with an infected partner. About two-thirds of people who have sex with a partner who has genital warts will also develop them. Warts can take several weeks or months to appear.

Risk Factors

Risk factors for HPV and genital warts include:

  • Age 15-30 years old
  • Multiple sexual partners
  • Women whose first male sexual partner has had two or more previous sexual partners
  • Sex without condoms
  • Sex at an early age
  • Skin-to-skin contact with an infected partner
  • Previous history of genital warts
  • Pregnancy
  • Smoking
  • Taking oral contraceptives

Symptoms

Genital warts often look like fleshy, raised growths. They have a cauliflower shape. They often appear in clusters.

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

The following symptoms may also occur:

  • Bleeding
  • Itching
  • Irritation
  • Burning
  • Secondary bacterial infection with redness, tenderness, or pus

Complications of HPV

Cancer

Most strains of HPV that produce genital warts do not cause cancer. But, certain strains may cause cervical cancer. Less commonly, cancers of the vulva, anus, or penis occur.

For women, it is important to have Pap tests, which can detect any HPV-related problems, including cervical cancer. The current recommendations for this screening test are:

  • If you are aged 21-29 years—have the Pap test every two years
  • If you are aged 30 or older—have the Pap test every three years
  • If you are aged 65 or older—You may be able to stop having Pap tests if you have had three normal results in a row and no abnormal results in the past 10 years.
  • Note: You will need to have Pap tests done more often if you have abnormal results or certain conditions, like a suppressed immune system or a history of cervical dysplasia or cervical cancer. Talk to your doctor about the right screening schedule for you.

Pregnancy and Childbirth Complications

Genital warts may get larger during pregnancy. This may make it hard to urinate. Warts in or near the vaginal opening may also block the birth canal during delivery.

Diagnosis

Genital warts may be diagnosed by:

Visual Exam

A doctor can 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.

Pap Test

If you get abnormal Pap test results, this may indicate HPV. But, your doctor will order more accurate tests, like a colposcopy, to diagnose HPV.

Colposcopy and Biopsy

During a colposcopy, the doctor uses a special device to see if warts are in the cervix and vagina. For a biopsy, the doctor takes a tissue sample and tests it.

HPV Testing

During an HPV test, a swab of cells from the affected area can be checked for certain types of HPV.

Treatment

Your treatment depends on the size and location of the warts. Treatment helps the symptoms, but does not cure the virus. The virus stays in your body. Warts or other problems may recur.

Treatments may include:

Topical Treatments

Your doctor may recommend one of these medications to be applied to the affected areas:

Cryosurgery, Electrocautery, or Laser Treatment

Methods that instantly destroy warts include:

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

These methods are used on small warts and on large warts that have not responded to other treatment. A large wart can also be removed surgically. For warts that keep coming back, an antiviral drug, called alpha-interferon, can be injected into the wart.

Prevention

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

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

Other ways to prevent infection include:

  • Abstaining from sex
  • Having a monogamous relationship
  • Getting regular check-ups for STDs

Vaccine

The vaccine Gardasil protects against four types of HPV. Studies have shown that the vaccine reduced the number of precancerous cervical cell changes for up to three years after the shot. The vaccine is routinely given to girls aged 11-12 years old, and a "catch-up" vaccine is given to young women who haven't been vaccinated. The Food and Drug Administration (FDA) has also approved the use of Gardasil in males aged 9-26 years old.

Special Considerations

Genital warts are rare in children. This diagnosis may indicate sexual abuse. Abuse needs to be reported.

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/index_e.html/

Sex Information and Education Council of Canada

http://www.sieccan.org/

References:

American College of Obstetricians and Gynecologists. First cervical cancer screening delayed until age 21 less frequent Pap tests recommended. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/from_home/publications/press_rele...s/nr11-20-09.cfm. Published November 20, 2009. Accessed November 23, 2009.

Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics. 17th ed. Philadelphia PA: Saunders; 2004.

Condyloma acuminatum. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 2008. Accessed June 24, 2008.

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

Genital wart. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/genital-warts/DS00087. Updated June 2009. Accessed July 21, 2009.

Genital warts. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/treatment/2006/genital-warts.htm. Published 2006. Accessed June 24, 2008.

Grady D. Guidelines push back age for cervical cancer tests. The New York Times website. Available at: http://www.nytimes.com/2009/11/20/health/20pap.html?_r=1. Published November 20, 2009. Accessed November 23, 2009.

Hanna E, Bachmann G. HPV vaccination with Gardasil: a breakthrough in women's health [review]. Expert Opin Biol Ther. 2006;6:1223-1227.

HPV vaccine information for young women. CDC website. Available at: http://www.cdc.gov/std/Hpv/STDFact-HPV-vaccine.htm. Accessed February 20, 2009.

Human papillomavirus and genital warts. National Institute of Allergy and Infectious Disease website. Available at: http://www3.niaid.nih.gov/healthscience/healthtopics/hu..._papillomavirus/. Updated June 2007. Accessed June 24, 2008.

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

McLemore MR. Gardasil: introducing the new human papillomavirus vaccine. Clin J Oncol Nurs. 2006;10:559-560.

New vaccine prevents cervical cancer. FDA Consum. 2006;40:37.

5/18/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356:1915-1927.

5/11/2009 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.

10/23/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: 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/PressAnnounce...ts/ucm187003.htm. Published October 16, 2009. Accessed October 22, 2009.

Last reviewed September 2009 by David Horn, MD, FACP

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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