Conditions & Diseases: Skin Diseases -

Genital Warts
(venereal warts, condyloma, condylomata acuminata)

Definition & Overview: Genital warts is a highly contagious sexually transmitted disease caused by the human papillomavirus (HPV) during vaginal, oral or anal sex. There are over 75 different strains of the HPV virus but only 10 of them are responsible for causing genital warts.

Also known as venereal warts, condyloma, condylomata acuminata, genital warts appear as small white, pink, red, or flesh-colored bumps that range in size from unnoticable, to single lesions to clusters similar in appearance to a cauliflower. In men, genital warts can grow on the penis, near the anus, between the anus and scrotum. In women, genital warts may grown on the vulva, perineum, in the vagina and on the cervix. Genital warts can also develop in the mouth or throat of a person who has oral sex with someone infected with HPV causing virus. Genital warts is a leading cause of cervical cancer in women and can cause penile cancer in men.

"The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years may occur." (1)

The latency period just means the HPV virus is in an incubation period. Having sex with a partner whose HPV infection is in the incubation period still leaves you vulnerable to becoming infected yourself. In other words, just because one can't see the genital warts, doesn't mean they are not there. The incubation period can last from 3 months to 2 years.

Common warts (that usually appear on the hands) are caused by different strains of the HPV virus and are not the same as genital warts.

Symptoms: Genital warts are generally painless, but are a nuisance due to their location, size and itching/irritation.

When genital warts grow from their incubation period, they often start out as small, gray, pink, red or white swellings in the genital area. The often begin as single lesions approximately 1 to 2 mm in size, but if left untreated, can rapidly grow in clusters which when form together, can be large and appear similar to a cauliflower head.

Besides itching, genital warts can cause pain during intercourse and in some cases, bleeding.

Tests & Diagnosis: Genital warts are often diagnosed through an examination by a doctor. However, in some cases, genital warts are only detectable through tests and techniques which include:

• Lesions are visibly enhanced with the application of a chemical called acetic acid solution which causes them to become white for about 5 to 10 minutes.
• A pap test for women can detect changes to the cervix which may occur as a result of the HPV virus.
• Magnification, also called colposcopy, may be used to see lesions that are not visible to the eye.
• Pelvic examination for women.

Treatment: Genital warts can be removed, however the HPV virus that causes genital warts can not be cured. The virus continues to live inside your skin and may cause the warts to return. Genital warts may need to be removed more than once.

Removal methods of genital warts include:

• Cryotherapy: A process that uses liquid nitrogen to "freeze off" the warts.
• Loop electrosurgical excision procedure (LEEP) involves a sharp instrument, shaped like a loop, which is passed underneath the wart and then used to cut it out from the skin.
• Laser treatment to physically destroy the lesion.
• Electric current to physically destroy the lesions.

Besides physical removal, your doctor may prescribe certain topical medications that are applied to the skin to treat the virus. As outlined by eMedicineHealth, these include:

• Podophyllum resin (Pod-Ben-25, Podofin)
• Podofilox (Condylox) - Can be topically applied at home, higher cure rates than Podophyllum resin, useful for prevention
• Trichloroacetic acid – Topically applied, response is often incomplete and recurrence is higher, may cause pain and burning
• 5-Fluorouracil (Efudex) – Applied as a cream, long treatment time, can cause burning and irritation, many side effects
• Interferon alpha-n3 (Alferon N) – Used as an injection for warts that do not respond to other therapies, many side effects
• Imiquimod (Aldara) – New treatment, applied as a cream, local skin irritation is a common side effect.

Genital warts MUST be treated by a doctor. Over the counter topical medications for other types of warts must never be used.

Prevention: Since no treatment for genital warts is 100 percent effective, prevention should be a top concern whether you are infected with the HPV virus or not.

Condoms do not offer iron-clad protection against genital warts since the infected spot may not be covered by a condom.(2) "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." (3)

Abstinence and monogamous sex with partner not infected with the HPV virus is the best method for prevention.

Good news for the prevention of genital warts is a new vaccine that was recently approved.

"A new vaccine known as Gardasil offers protection from the most dangerous types of HPV. The Food and Drug Administration (FDA) approved the vaccine in June 2006. The national Advisory Committee on Immunization Practices recommends routine vaccination for girls age 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." (4)

Complications: In worst cases, the HPV virus can lead to cancer of the cervix. Some experts believe that HPV is responsible for 90 percent of all cases of cervical cancer. (5) Certain types of the HPV strains have been associated with cancer of the vulva, anal cancer, rectal cancer and cancer of the penis.

Genital warts can lead to a number of different problems during pregnancy to include:

• Difficulty urinating
• Warts on the vaginal wall may reduce the vagina's ability to stretch
• Transmission of the virus to the baby, to include the baby's throat. Surgery may be needed to prevent airway obstruction. (5).

Article by Jason Morrow,
OmniMedicalSearch.com

Sources:
(1) eMedicineHealth.com, Genital Warts, August 2006
(2) American Family Physician
(3) MedlinePlus Medical Encyclopedia, Genital Warts, May 2006
(4) Mayo Clinic, Genital Warts, June 2006
(5) Wikipedia.org, Genital Wart, October 2006