Genital warts also known as venereal warts, anal or anogenital warts are characterized by soft growths arising from the skin and mucous membrane of the genital areas. This is the most common presenting symptom of Human Papilloma Virus (HPV) infection, one of the highly contagious sexually transmitted diseases. It is estimated that about half of the adult sexually active population suffer from genital warts at least once in their lifetime.
Genital warts spread through any sort of sexual contact namely oral, anal or vaginal from an infected partner. Not all the types of HPV cause genital warts; usually infection by type 6 and 11 are the most cause. HPV infection is also known to cause cancer of the cervix and anal area, but type 6 and type 11 are not known to be associated with cancer of these areas. Although it is possible to be infected with high risk HPV and low risk genital wart causing HPV at the same point of time.
Genital warts may develop a solitary lesion or in clusters. Sometimes the lesion is so small that it is easily missed. The most common appearance of genital warts is flesh colored growths which are either raised in comparison to the adjacent skin surface or flat and they may also have an appearance similar to the top of the cauliflower. Some of the warts appear to be bleeding.
The most common locations of genital warts are
1. In females: on the inner or outer wall of the vagina and or anus, inside the cervical canal and on the adjacent skin
2. In males: penis, scrotal sac, groin and thigh area and also on the inner and outer part of the anus.
Other than genital or anogenital area these warts may also be located on the lips, mouth, throat and tongue area.
Genital warts are often the only presenting symptom of an underlying HPV infection. In many cases genital warts may lead to intense itching, reddish discoloration and discomfort in the patient, especially if they are located in the anal area.
Genital warts are caused by the infection with HPV. There are about 40 strains of HPV which typically causes lesions in the genital area. These strains are highly contagious; about 75% of the unaffected people who come in sexual contact with an infected person develops genital warts within 8 months.
Penetrative sex is with an infected person the most common way of transmission of HPV infection although participating in non penetrative sex with an infected person may also lead to infection. There are conflicting results regarding the role of condoms in the prevention of HPV transmission; currently it is considered that condoms are effecting in the prevention of HPV infection to a greater extent in males in comparison to females.
Within a year or two about 90% of the infecting HPV are killed by the immune system of the infected person. But there is a high chance of recurrence (in about one third of the infected persons) of symptoms after several months or years as the virus remain in latent phase in some of the infected cells of the body. These people other than suffering from recurrence of genital warts are also capable of spreading infection to a previously uninfected person; the chance being 70%.
Genital warts may also appear in newborn babies after passing through the vaginal canal of an infected mother. These lesions may also be present in children less than 4 years of age, the causes being autoinoculation from warts on the hands, sharing swimwear, underwear or towels of an infected person, through non sexual contact as during change of diapers with a person having warts on the hands and in the unfortunate circumstances of child abuse. In children usually the infecting types of HPV are not the type causing genital warts in adults (type 6 and 11) rather the types which cause warts usually on the hands (cutaneous types).
Common risk factors for genital warts include having multiple sexual partners, having unprotected sex, starting sexual life at an early age, having sexual relationship with a partner with promiscuous sex life etc.
Usually treatment is not required if there is no symptom other than visible skin lesions; however, treatment is offered if there is associated itching, pain, burning sensation or bleeding from the lesions or emotional distress due to the lesions.
Commonly used drugs that can be applied on the skin include imiquimod, podophyllin, podofilox, trichloroacetic acid etc.
Surgical interventions like cryotherapy (freezing with liquid nitrogen), electrocautery, laser therapy and direct surgical removal of the lesions are also helpful.
Vaccines are also available to prevent HPV infection.