Genital warts

Definition

Genital warts, or condylomata acuminata, are also called venereal warts. These warts are painless, pink or grayish growths on the skin and mucous membranes of the genitals and anal area. They are usually found in clusters. Genital warts are very contagious and spread through sexual contact with an infected person.

Description

Genital warts are the most common sexually transmitted disease (STD) in the general population of the United States. It is estimated that 1% of sexually active people between the ages of 18 and 45 have genital warts; however, studies indicate that as many as 40% of sexually active adults may carry the virus that causes genital warts. Certain strains of the virus that cause genital warts may also cause cervical changes and cancer .

Causes & symptoms

Genital warts are caused by several subtypes of HPV, the same virus that causes warts on other parts of the body. Symptoms develop about one to six months after being exposed to the virus. Once contracted, the virus remains in the infected person's body. This is true even if the warts are not visible. In addition to the visible warts, symptoms may include bleeding, pain , odor, itching , and redness in affected areas. These symptoms may appear without the warts, and the warts may appear without other symptoms. Stress may contribute to recurrent outbreaks.

Genital warts may be difficult to detect. At any given time, at least a quarter of all HPV infections are in a state of regression, in which the infection remains dormant in the body and there are no outbreaks of warts or other readily detected symptoms. In addition, warts that occur deep inside the vagina, on the cervix, or within the anus may go undetected.

HPV can be transmitted through oral, anal, or genital contact with an infected person, even if warts are not visible. Care must be taken, because the virus may also be transmitted via objects that have been recently exposed to the virus. These may include unwashed or improperly cleaned medical equipment, as well as underwear, tanning beds, and sex toys.

Risk factors for contracting genital warts include:

• multiple sex partners
• infection with another sexually transmitted disease (STD)
• pregnancy
• anal intercourse
• poor personal hygiene
• heavy perspiration

Genital warts vary somewhat in appearance. They may either be flat or resemble raspberries in appearance. The warts begin as small, red or pinkish growths. They may grow in clusters as large as four inches across, and may interfere with intercourse and childbirth . The warts grow on warm, moist tissue. In women, they occur on the external genitalia, the cervix, and the walls of the vagina. In men, they develop in the urethra and on the shaft of the penis. The warts may also spread to the area surrounding the anus.

Diagnosis

Genital warts are usually identified and diagnosed by their characteristic appearance. A sexual history should be taken, and tests for other STDs may be administered. If cervical warts are suspected, a colposcopy exam to view the cervix is necessary for diagnosis. A Papanicolaou (pap) smear may be performed, and the doctor may order a biopsy of the warts to rule out cancer.

Treatment

Genital warts are contagious, and should be assessed and treated under the supervision of a healthcare practitioner. A traditional Chinese medicine practitioner or an acupuncturist will probably recommend treatments to cleanse the liver and enhance immune functioning. A generally recommended homeopathic remedy is the application of a tincture of Thuja occidentalis (common names thuja , northern white cedar, and arborvitae, or tree-of-life) directly to the warts. A homeopathic physician should be consulted for a work-up for further treatment.

The direct topical application of vitamin A , thuja, lomatium (Lomatium dissectum ) isolate, or tea tree oil (Melaleuca alternifolia ) helps resolve warts and prevent recurrence of outbreaks. With the exception of the tea tree oil, these herbs should also be taken internally in addition to direct application. It has also been noted that deficiencies of folic acid and vitamins A and C contribute to this condition. Such deficiencies may be risk factors for a progression to abnormal cervical cells and cancer; therefore, supplementation is recommended. It should be noted that beta-carotene is often suggested as an alternative to taking high dosages of vitamin A.

Treatments that focus on emotional and psychological factors have been shown to be effective in reducing or eliminating outbreaks of warts. Hypnotherapy and techniques of stress reduction and relaxation are highly recommended.

Allopathic treatment

There is no cure for genital warts, as the virus cannot be destroyed once it enters the body. The warts themselves may be burned off with electrocautery or lasers; frozen with liquid nitrogen for easy removal; or surgically removed. Podophyllum resin, trichloroacetic acid, interferon inducers, 5-fluorouracil cream, bichloroacetic acid, or trichloroacetic acid can be used as a topical treatment. These medications require several weeks of treatment and may irritate the skin. Pregnant women should be sure to inform their health care provider of this condition, as some of the medications for warts may cause fetal abnormalities. Genital warts can also be treated with injections of interferon, either into muscle tissue or directly into the lesions.

Unfortunately, regardless of the treatment regime, genital warts have a high rate of recurrence. Several courses of treatment may be required. Sexual partners should be diagnosed and treated as well. Because of the connection between certain strains of HPV and cervical cancer, infected women should also have yearly pap smears.

Expected results

As with many warts, genital warts may spontaneously disappear over time. Although the warts are not cancerous by themselves, HPV infection in women appears to increase the risk of later cervical cancer. Recurrence is common with all methods of treatment.

Prevention

The only reliable method of prevention is sexual abstinence. The use of condoms is often recommended; however, condoms protect only a limited area and should not be relied upon for complete protection from genital warts. Circumcision may sometimes prevent recurrence of the visible warts.

Resources

BOOKS

Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life Books, 1996.

Rakel, Robert E., ed. Conn's Current Therapy. Philadelphia: W. B. Saunders, 1998.

Tierney, Lawrence M., M.D., et al., eds. Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1998.

OTHER

"Genital warts." The Merck Manual Online. http://www.merck.com/pubs/mmanual/section13/chapter164/164l.htm.

Patience Paradox

Genital Warts

Definition

Genital warts, which are also called condylomata acuminata or venereal warts, are growths in the genital area caused by a sexually transmitted papillomavirus. A papillomavirus is a virus that produces papillomas, or benign growths on the skin and mucous membranes.

Description

Genital warts are the most common sexually transmitted disease (STD) in the general population. It is estimated that 1% of sexually active people between the ages of 18 and 45 have genital warts; however, polymerase chain reaction (PCR) testing indicates that as many as 40% of sexually active adults carry the human papillomavirus (HPV) that causes genital warts.

Genital warts vary somewhat in appearance. They may be either flat or resemble raspberries or cauliflower in appearance. The warts begin as small red or pink growths and grow as large as four inches across, interfering with intercourse and childbirth. The warts grow in the moist tissues of the genital areas. In women, they occur on the external genitals and on the walls of the vagina and cervix; in men, they develop in the urethra and on the shaft of the penis. The warts then spread to the area behind the genitals surrounding the anus.

Risk factors for genital warts include:

• multiple sexual partners
• infection with another STD
• pregnancy
• anal intercourse
• poor personal hygiene
• heavy perspiration

Causes and symptoms

There are about 80 types of human papillomavirus. Genital warts are caused by HPV types 1, 2, 6, 11, 16, and 18. HPV is transmitted by sexual contact. The incubation period varies from one to six months.

The symptoms include bleeding, pain, and odor as well as the visible warts.

Diagnosis

The diagnosis is usually made by examining scrapings from the warts under a darkfield microscope. If the warts are caused by HPV, they will turn white when a 5% solution of white vinegar is added. If the warts reappear, the doctor may order a biopsy to rule out cancer.

Treatment

No treatment for genital warts is completely effective because therapy depends on destroying skin infected by the virus. There are no drugs that will kill the virus directly.

Medications

Genital warts were treated until recently with applications of podophyllum resin, a corrosive substance that cannot be given to pregnant patients. A milder form of podophyllum, podofilox (Condylox), has been introduced. Women are also treated with 5-fluorouracil cream, bichloroacetic acid, or trichloroacetic acid. All of these substances irritate the skin and require weeks of treatment.

Genital warts can also be treated with injections of interferon. Interferon works best in combination with podofilox applications.

Surgery

Surgery may be necessary to remove warts blocking the patient's vagina, urethra, or anus. Surgical techniques include the use of liquid nitrogen, electrosurgery, and laser surgery.

KEY TERMS

Condylomata acuminata— Another name for genital warts.

Papilloma— A benign growth on the skin or mucous membrane. Viruses that cause these growths are called human papillomaviruses (HPVs).

Podophyllum resin— A medication derived from the May apple or mandrake and used to treat genital warts.

Prognosis

Genital warts are benign growths and are not cancerous by themselves. Repeated HPV infection in women, however, appears to increase the risk of later cervical cancer. Women infected with HPV types 16 and 18 should have yearly cervical smears. Recurrence is common with all present methods of treatment—including surgery—because HPV can remain latent in apparently normal surrounding skin.

Prevention

The only reliable method of prevention is sexual abstinence. The use of condoms minimizes but does not eliminate the risk of HPV transmission. The patient's sexual contacts should be notified and examined.

Resources

BOOKS

Foster, David C. "Vulvar and Vaginal Disease." In Current Diagnosis. Vol. 9. edited by Rex B. Conn, et al. Philadelphia: W. B. Saunders Co., 1997.

MacKay, H. Trent. "Gynecology." In Current Medical Diagnosis and Treatment, 1998, edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.

Genital Warts

What Are Genital Warts?

Resources

Genital warts are small fleshy growths of skin on or near the sexual organs that are caused by the human papillomavirus and are usually spread by sexual contact.

KEYWORDS

for searching the Internet and other reference sources

Condylomata acuminata

Human papillomavirus (HPV)

Sexually transmitted diseases

Venereal warts

What Are Genital Warts?

Genital warts may be dome shaped or nearly flat, but most commonly they grow on stalks in clumps that look like small heads of cauliflower. Warts of this shape are called condylomata acuminata (kon-dil-o-MAT-a a-koo-min-NAT-a). Genital warts usually cause no pain, but they can be very upsetting to have.

Human papillomavirus (HPV)

The human papillomavirus (pap-i-LO-ma vi-rus) is common and has many subtypes. Genital warts usually are caused by HPV-6 or HPV-11. Many people may become infected with HPV at some point during their lives but not know it because they do not get visible warts. Among sexually active people in the United States, about 1 percent (1.4 million people) have genital warts and another 14 percent (19 million) have HPV infection without warts.

Cervical cancer

Other kinds of HPV (mainly HPV-16 or HPV-18) can cause cancer of the cervix, part of the female reproductive tract. Even though visible genital warts usually do not contain cancer-causing forms of the virus, women who have warts should be sure to get the yearly test for cervical cancer, called the Pap test, that is recommended for all women.

Removing genital warts

Genital warts can be removed in a number of ways—by surgery, laser* treatment, freezing (cryotherapy), or repeated treatment with chemicals that the doctor paints directly on the warts. They often recur after being removed. If untreated, they may grow, remain the same, or disappear on their own.

* laser surgery

uses a very narrow and intense beam of light that can destroy body tissue.

Preventing genital warts

The surest protection is sexual abstinence, that is, not having sex at all. Those who have sex with multiple partners have a higher chance of getting infected (though all it takes is having sex with one partner with an HPV infection to become infected). It is not known for certain whether using condoms protects against HPV, or whether getting rid of visible warts makes a person s infection less contagious.

See also

Pregnancy, Complications of

Sexually Transmitted Diseases

Viral Infections

Warts

Resources

The U.S. Centers for Disease Control and Prevention (CDC) has a National STD Hotline that is open from 8 AM to 11 PM EST. Telephone 800-227-8922

The U.S. National Institute of Allergy and Infectious Diseases posts a fact sheet about human papillomavirus and genital warts at its website. http://www.niaid.nih.gov/factsheets/stdhpv.htm

The American Social Health Association has an HPV Support Program and posts an HPV Questions and Answers fact sheet at its website. Its Sexually Transmitted Diseases Information and Referral Center has a hotline that takes calls from 9 AM to 7 PM EST. Telephone 800-653-4325 http://www.ashastd.org/hpv/hpvref.html

The American Cancer Society posts a fact sheet about cervical cancer and human papillomavirus at its website, http://www3.cancer.org/cancerinfo/main

genital warts see human papillomavirus .