Genital warts

GENITAL WARTS (HUMAN PAPILLOMA VIRUS) - a patient's guide
Dr Dion Martley - Family Doctor

Overview

Genital warts are caused by the human papilloma virus (HPV)

Wart-like abnormalities on the genitals can be caused by the virus

In most cases there are no visible signs

Some varieties (e.g. type 16) may be involved in cervical cancer and other genital cancers

About 50 percent of sexually active women have the virus (mostly without knowing)

Treatment can include freezing, laser removal, and burning with acid solutions

A recent advance includes the immune modifier Aldara, (applied to the area)

There is a significant recurrence rate with all treatments

Women who've had the condition should consider having annual cervical smears

Condoms provide some protection

What are genital warts?

Also known as the human papilloma virus (HPV), the condition causes wart-like abnormalities on the genitals that can be transmitted through genital contact.

It has become one of the most common sexually transmitted diseases, affecting up to 50 percent of sexually active women in the developed world.

Scientists have identified more than 60 different types of viruses, but it is type 16 that is the most likely to be implicated in pre-cancerous changes on cervical smear tests.

Men and women are equally affected but it's women who run the highest risk of the virus acting as a co-factor in leading to pre-cancerous cervical lesions.

High-risk forms of HPV can lead to cervical cancer and cancer of the vulva, anal cancer, and in extremely rare cases, cancer of the penis.

Other common types of HPV infections, such as warts on hand or the soles of the feet do not cause genital warts.

Genital warts are highly contagious. It is estimated that two-thirds of people who have sex with an infected person will develop the virus within nine months of contact.

What are the symptoms?

In most cases there are no visible symptoms, and the vast majority of people do not know that they have it.

One study in the US found almost half the women infected with HPV had no obvious symptoms. An abnormal cervical smear may be the first sign of infection.

Women get genital warts on the outside and inside of the vagina, near and around the anus and on the cervix. Genital warts are less prevalent in men, if contracted; they usually develop on the tip of the penis, shaft of the penis, the scrotum, or around the anus.

Flat warts on the cervix may not be detected with the naked eye.

In rare cases, genital warts can develop in the mouth or throat of a person who has had oral sex with a carrier.

Diagnosis involves a doctor recognising visible signs of the warts or they may show up in the cells shown on a cervical smear test.

What can be done?

The warts often disappear without treatment, otherwise they may lead to a fleshy, and small raised, cauliflower-like growth.

Current treatments involve removing visible warts and treating pre-cancerous changes. Treatment can include freezing, laser removal, burning with acid solutions, excision and drugs designed to improve the immune system.

Sometimes doing nothing is a reasonable option for small warts that are of no concern. Occasionally surgery is needed to remove large warts that have not been removed by other treatments. Patients should consult their doctors for the best treatment for them.

Warts may also signal the presence of other sexually transmitted diseases, and laboratory tests are recommended to exclude these.

Although most HPV infections do not progress to cancer, it is important for women who have genital warts to have regular cervical smears. Pre-cancerous changes of the cervix are easily treated at an early stage before they progress to actual cancer.

Generally problems in patients during pregnancy are rare although the virus can be passed to the baby.

How can genital warts be prevented?

The presence of visible warts requires the use of condoms to reduce the risk of acquiring the virus. However given the frequency of asymptotic infection, the absence of visible warts in a partner does not guarantee that they do not carry the virus.

Condoms used all the time in a stable relationship may offer some protection against contracting HPV. However, if the condition is diagnosed in one of the partners, condom use will not stop the other person getting it because infection is already likely.

Although treatments can eradicate warts, none get rid of the virus and the warts can reappear after treatment. Even the best treatments have a high recurrence rate. Once contracted, the virus can stay in the infected individual for life. Some doctors believe that wart recurrences can be reduced by the use of vitamins, a good diet, and adequate sleep and stress management.

Future trends

Researchers are currently developing two vaccines to prevent HPV. One vaccine would be used to stop the virus and the other would be used to prevent the development of cervical cancer.

Several new therapies are being investigated. A topical formulation of imiquimod (Aldara), available in some countries, has shown promising signs in the treatment of external warts.

There has been debate in medical circles about not treating the condition. A recent study showed the median duration of the condition was eight months and conservative management such as follow up without ablative treatment, may be advised in young women with low-grade squamous intraepithelial lesions associated with HPV.

Future research is focused on which strains of the virus may be most involved in the cause of cervical cancer and how early interventions and vaccination may help prevent this.

Getting help

Sexual Health or STD Clinics have staff trained in the management of genital warts.

Your doctor, gynaecologist, urologist or Family Planning Clinic can also help.