Genital warts, also known as condylomata acuminata or venereal warts, 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 as small as 1 millimeter in diameter — smaller than the width of a ballpoint pen refill — or may multiply into large clusters.
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.
Although genital warts can be treated with medications and surgery, they are a serious health concern. The virus that causes them — the human papillomavirus (HPV) — has been associated with cervical cancer. It has also been linked with other types of genital cancers, such as cancer of the penis.
Signs and symptoms
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, however, genital warts cause no symptoms. Or they may be so small and flat that they can't be seen with the naked eye.
Pregnancy may sometimes trigger a dormant infection, or an active infection may worsen during pregnancy.
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
Having unprotected sex with multiple partners increases your risk of becoming infected with HPV. Other risk factors include:
- 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
When to seek medical advice
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
Screening and diagnosis
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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.
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
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 those who've been infected with certain higher risk types of HPV, to have regular Pap tests.
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.
Your doctor can help you clear an outbreak of warts with medications or surgical treatments. The underlying virus is never completely eliminated, however, and genital warts may reappear even after treatment.
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.
- Podofilox (Condylox). Podofilox works by destroying genital wart tissue. Your doctor may want to administer the first application, 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, or 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 may be necessary 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.
HPV can spread through skin-to-skin contact with any infected part of the body — but using a condom every time you have sex can significantly reduce your risk of contracting HPV.
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.
While it won't completely prevent genital warts or cervical cancer, 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.