Genital warts

• Alternative Names

  Condylomata acuminata; Penile warts; Human papilloma virus (HPV); Venereal warts; Condyloma; HPV DNA test; Sexually transmitted disease (STD)

• Causes, incidence, and risk factors

  The virus responsible for genital warts is called human papilloma virus (HPV). More than 70 different types of HPV exist. Several types cause genital warts.

  Genital warts may be found on the penis, vulva, urethra, vagina, cervix, larynx, and around and in the anus.

  Other types of HPV are associated with common or flat warts found on other parts of the skin, such as the hands. However, people will not get genital warts from contact with warts on the hands or other parts of the body.

  HPV infection around the genitals is common, although most people have no symptoms. Even if you do NOT have symptoms, however, you must be treated to prevent complications and spreading the condition to others.

  In women, HPV can invade the walls of the vagina and cervix. These warts are flat and not easy to see without special procedures.

  Certain types of HPV can lead to precancerous changes in the cervix, cervical cancer, or anal cancer. These are called high-risk types of HPV.

  The following are important facts about how HPV and genital warts can be spread:

  • HPV infection is passed from one person to another through sexual contact involving the anal, oral, or vaginal skin or mucus membrane. It is possible for genital warts and HPV to be spread, even when no warts are visible.
  • You may not see warts for at least 6 weeks to 6 months after becoming infected with HPV. It may also take longer, even years. Because of this, when you first notice genital warts, it does not mean that you or your partner has had sexual contact with someone outside of your relationship.
  • Not everyone who has been exposed to the HPV virus and genital warts wil develop them.

  The following factors put you at higher risk for getting genital warts, having them spread more quickly, having them return, or having other complications of HPV:

  • Having multiple sexual partners
  • Not knowing whether someone you had sex with had STIs
  • Becoming sexually active at an early age
  • Using tobacco and alcohol
  • Having stress and other viral infections (such as herpes) at the same time
  • Being pregnant
  • Having an immune system that does not work well, such as during cancer treatment or AIDS

  If a child has genital warts, you should suspect sexual abuse as a possible cause.

• Symptoms

  Genital warts can be raised or flat, and are usually flesh-colored. They may appear as cauliflower-like growths. Sometimes they are so small and flat that they cannot be seen with the naked eye.

  Common places to find genital warts:

  • Females most often have warts inside or around the vagina or anus, on the skin around these areas, or on the cervix.
  • Males most often have warts on the penis, scrotum, groin area, or thighs, as well as inside or around the anus in those who have anal intercourse.
  • Both males and females may have warts on the lips, mouth, tongue, palate, or throat (larynx)

  Other symptoms are rare, but may include:

  • Increased dampness or moisture in the area of the growths
  • Increased vaginal discharge
  • Itching of the penis, scrotum, anal area, or vulva
  • Vaginal bleeding, with or after sexual intercourse

  However, many people with HPV infection often have no symptoms.

• Signs and tests

  A genital examination reveals flesh-colored to white, flat or raised, single or clustered lesions anywhere on the genitalia.

  In women, a pelvic examination may reveal growths on the vaginal walls or cervix. Magnification (colposcopy) may be used to see lesions that are invisible to the naked eye. The tissue of the vagina and cervix may be treated with acetic acid (dilute vinegar) to make the warts visible.

  A Pap smear may note changes caused by HPV. Women with these types of changes often need more frequent Pap smears for a period of time.

  An HPV DNA test can identify the high-risk types of HPV that are known to cause cervical cancer. It may be done as a screening test for women over age 30, or for women of any age who have a slightly abnormal Pap test result.

• Treatment

  Genital warts must be treated by a doctor. Do NOT use over-the-counter remedies meant for other kinds of warts.

  Your doctor may treat genital warts by applying a skin treatment in the office. Or, the doctor may prescribe a medication that you apply at home several times per week. These treatments include:

  • Imiquimod (Aldara)
  • Podophyllin and podofilox (Condylox)
  • Trichloroacetic acid (TCA)

  Surgical treatments include:

  • Cryosurgery
  • Electrocauterization
  • Laser therapy
  • Surgical excision (cutting them out)

  If you develop genital warts, all of your sexual partners must be examined by a health care provider and treated if genital warts are found.

  After your first treatment, your doctor will schedule follow-up examinations to see if the warts have returned.

  Women who have had genital warts, and women whose partners have ever had genital warts, should have Pap smears at least once a year. For warts on the cervix, women may be advised to have Pap smears every 3 to 6 months after initial treatment.

  Women with precancerous changes caused by HPV infection may need further treatment.

  Young women and girls ages 9 - 26 shoul be vaccinated against HPV.

• Expectations (prognosis)

  Most sexually active young women become infected with HPV, but very few remain infected for more than 5 years. In many cases, HPV goes away on its own.

  Most men who become infected with HPV never develop any symptoms or problems from the infection. However, they can pass it on to current and sometimes future sexual partners.

  Even after you have been treated for genital warts, you may still infect others.

  Certain types of genital warts increase a woman's risk for cancer of the cervix and vulva.

• Complications

  Some types of HPV have been found to cause cancer of the cervix and vulva. They are the main cause of cervical cancer.

  The types of HPV that can cause genital warts are not the same as the types that can cause penile or anal cancer.

  The warts may become numerous and quite large, requiring more extensive treatment and follow-up procedures.

• Calling your health care provider

  Call your doctor if a current or past sexual partner is found to have genital warts. Call if you have visible warts on your external genitals, itching, discharge, or abnormal vaginal bleeding. Keep in mind that genital warts may not appear for months to years after having sexual contact with an infected person.

  Call your doctor if a young child is thought to possibly have genital warts.

  Women should begin to have Pap smears at age 21.

• Prevention

  Total abstinence is the only foolproof way of avoiding genital warts and other STIs. You can also avoid STIs by having a sexual relationship with only one partner who is known to be disease-free.

  Skin near the warts and around the genitals, anus, and other areas can pass the virus from one person to the next. Therefore, male and female condoms cannot fully protect you. Nonetheless, condoms reduce risk and should still be used. They reduce your chances of getting or spreading STIs. These precautions must be taken at all times. HPV can be passed from person to person even when there are no visible warts or other symptoms. See: Safe sex

  Stop smoking.

  Two vaccines are available that prevent infection against four of the HPV strains responsible for the majority of cervical cancer in women. The vaccine is given as a series of three shots. It is recommended for girls and women ages 9 to 26. See: HPV vaccine for more detailed information.

• References

  Diaz ML. Human papilloma virus: prevention and treatment.Obstet Gynecol Clin North Am. 2008;35(2):199-217.

  Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357:1579-1588.

  Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009;361:271-278.

  HPV and Men - CDC Fact Sheet. April 3, 2008. Accessed December 20, 2009.

Review Date: 12/20/2009

Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.