Genital Warts

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:

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.