Genital Warts/HPV (Condyloma Acuminatum)

Basic Information

Genital warts (Condyloma Acuminatum) are caused by the human papilloma virus (HPV) of which there are approximately 60 subtypes, this one being one of the most contagious of them. Genital warts are usually sexually transmitted -- passed skin to skin -- with up to 66% of sexual partners contracting it from the infected partner.

It is estimated that over 40 million Americans are infected -- with one million new cases of genital warts being diagnosed per year. The general population seems unaware that this is one of the most common sexually transmitted diseases (STDs) -- more prevalent than herpes for instance. Young adults (late teens to mid-twenties) are among the groups most highly at risk to contract it.

Genital warts usually occur in groups, the lesions varying from the size of pinheads to large cauliflower-like clusters. They tend to appear on moist surfaces and can develop in the mouth, the vagina, the cervix, the anus, the vulva, the labia, the penis, and scrotum.

These warts have an average incubation period of 2 months, but can appear anywhere from 1--8 months.

As mentioned this is an extremely contagious viral disease spread by skin to skin contact. You may be at risk for contracting genital warts if you or your partner are sexually active outside of a monogamous relationship. If this is the case, the proper use of latex condoms will substantially reduce your risk factor for infection.

If you are diagnosed with genital warts it is important that you notify your sexual partners so that they may seek treatment. Left untreated, women may be at higher risk for developing cervical cancer while men may experience urinary obstruction. And be certain you do not engage in further sexual activity until you have followed up with your health care provider to determine that you are no longer infectious.

Symptoms

Asymptomatic infection is prevalent. In about 50% of cases the warts are not visible. And sometimes when visible, the infected person will assume that the wart tissue they do see is a normal skin variation. Sometimes there can be itching -- other times small, pink raised tissue, either solitary or in groups, may appear. Also, the virus can lie dormant in the skin, leaving patients unaware of their infectivity and the consequences for future sexual partners.

Diagnosis/Treatment

Genital warts need to be diagnosed and treated by your health care provider. Sometimes by applying vinegar to areas where infection is thought to be located, identification may be made since vinegar will cause a whitening of those infected areas. However true diagnosis is defined by a biopsy where a small amount of tissue is removed and sent to a pathologist for an absolute diagnosis. A biopsy will reveal if other abnormal cells are present. That likelihood is slim, but it is of critical importance to rule out a malignancy of any kind.

Women who test positive for HPV need to have pap smears as directed by their health care provider. At times an evaluation can be done via colonoscopy -- this is similar to a pap smear except that a clinician uses a large magnifier and is able to take biopsies of the cervix as needed for subsequent examination by a pathologist. Sexual partners of women with HPV should definitely be examined.

Besides a pap smear, a woman with HPV should have continued ongoing health care and be made aware that there can be complications during pregnancy for both mother and child. During pregnancy HPV can grow at a rapid rate.

Unfortunately, because of its viral origin, the wart itself can be treated but the infection with HPV can never be eradicated.

Genital warts can be treated in several different ways, depending on the size of the warts.

Your health care provider may recommend trichloroacetic acid, or TAC, which is applied to the infected areas and washed off several hours later. An alternative treatment is s 20% podophyllin solution, which again is applied to the infected areas and later washed off. (This should not be used by pregnant women because it is absorbed by the skin and may cause birth defects.) Applications of creams may also be recommended by your health care provider.

Small warts can also be removed by -- (especially if they have not responded to the typical solutions) --

Cryosurgery (freezing)
Burning

New studies have shown that alpha interferon injected directly into the wart shows promise. Also there is a new topical medication that promotes the interruption of the wart's growth and of its removal.

Women with genital warts should be examined for possible HPV infections of the acid treatment, deep freezing, electrocardiry, applications of acid creams, and surgery with laser or scalpel.

And despite any type of treatment, genital warts commonly reappear. That is why it is important to schedule follow-up visits with your health care provider -- a different treatment may be advised for reappearing warts.

In addition your health care provider will know that there is a definite association between HPV and cervical cancer as well as cancer of the vulva, anus and, though rare, of the penis. Though most HPV will not progress to cancer, constant vigilance regarding the virus should be shared between patient and health care provider.

A case of genital warts in a child is usually due to sexual abuse by an infected adult who is most often a relative of the child's. The child diagnosed with genital warts must be further investigated for the presence of other STDs (sexually transmitted diseases).

If you are diagnosed with genital warts, your health care provider will want to check for the presence of other sexually transmitted diseases such as gonorrhea, syphilis, chlamydia, hepatitis B and herpes.

Also, if you are diagnosed with genital warts, a discussion about HIV testing and counseling is important and indicated. When a person has at least one sexually transmitted disease, studies have shown that the risk for HIV transmission is much more likely. This is thought to be due to the body's altered defense mechanism when it is infected with an STD. And in the case of HIV infection, HPV can grow at a rapid rate.

Should you even suspect that you have a sexually transmitted disease, please see your health care provider promptly.

Additional Resource:

The CDC National STD Hotline 800-227-8922
The Naked Truth About STD's
National Women's Health Network 202-628-7814