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Genital warts

Genital warts are sexually transmitted diseases (STI) caused by infection with the wart-causing HPV virus. Genital warts are rough, crest-like polyps on the genitals, groin, or anus, causing itching, burning, or discharge. Typically, genital warts are viral infections that thrive in humid conditions, causing lesions or abnormal tissue. Genital warts are curable, but HPV remains in the body for life. However, the virus is preventable by getting the HPV vaccine.

What causes genital warts?

Genital warts, or condyloma acuminate, are caused by infection with the human papillomavirus (HPV), which typically has over 40 different strains, through direct contact with the mucous membranes of the skin of a person who carries them, such as through sexual contact or from mother to child during natural childbirth. The infection damages the tissue and causes lesions, particularly HPV-6 and HPV-11 variants, the major causes of external and internal genital warts. Typically, warts are not associated with cancer unless co-infected with multiple high-risk HPV strains that may lead to cervical cancer or anal cancer.

What are the transmission modes of genital warts?

• Sexual contact through penile-vaginal, penile-anus, and vaginal-vaginal intercourse.
• Contact with HPV-infected lesions on other sites, such as the mouth, hands, fingers, toes, and hairy skin.
• Sharing personal items such as glasses, lipstick, towels, soap, razors, or sex toys
• Giving oral sex to an infected person with HPV-6 and HPV-11 strains
• Receiving oral sex from an infected person with HPV-6 or HPV-11 in their mouth, lips, tongue, or genitalia.
• Skin-to-skin contact or even having sex without ejaculation
• Having a low-immunity condition, such as an infection, brittle diabetes, or using an immunosuppressive medication
• Has herpes simplex or previously had herpes simplex?
• Infection from mother-child transmission during natural childbirth.

What are the symptoms of genital warts?

Genital wart symptoms include bumps or polyps that protrude from the mucosal surface internally inside the body or externally from the skin and spread outward like cauliflower or cockscomb. Genital warts thrive in warm, humid, and moist environments, as well as in immunocompromised people. In some cases, genital warts can occasionally only be seen as a small, visible lesion, or they can be completely absent. Genital warts have the following specific characteristics:

• Smooth skin polyps or rough, convex polyps protruding from the skin.
• Polyps or bumps of various sizes.
• Polyps of various colors, such as brown, pink, or red
• A single or cluster of polyps, or bumps, form on the skin.
• Itching, a burning sensation, discomfort, or soreness in the vicinity of genital warts
• Bleeding from a polyp or the vagina, particularly while having sex.

Where genital warts are commonly found?

• Clitoris
• Foreskin, penis, or scrotum
• Mouth, lips, and pharynx
• Cervix, vagina
• Urethra
• Vicinity of the anus, perineum
• Groin
• Rectum
• Vicinity of the vulva and vaginal wall
• Labia minora
• Labia majora

How are genital warts diagnosed?

The doctor will make a preliminary diagnosis of genital warts based on their physical characteristics, followed by a biopsy to confirm the disease. The gynecologist will perform additional examinations to ensure thoroughness in diagnosing genital warts that may hide in organs such as the cervix through the following methods:

• Pelvic exam: an examination performed by a gynecologist to detect abnormalities of the female pelvic organs both internally and externally, including neighboring organs, such as the vicinity of the vulva, labia, vaginal wall, or cervix, for thoroughness in diagnosis. Additionally, the gynecologist may use colposcopy, a laparoscopy, to detect abnormalities in the vaginal area, epithelial tissue, and female external genitalia.
• ThinPrep Pap Test: For those with vaginal bleeding, pus, or vaginal secretions, the gynecologist may request an additional ThinPrep Pap test to screen for cervical cancer since high-risk HPV can cause cervical cancer.
• HPV DNA Test is a comprehensive test that looks for HPV variants associated with genital warts and high-risk HPV strains that may lead to cervix cancer.
• Rectal exam: Examines abnormalities within the anal sphincter and the outer surface of the anus with an anoscope.

A correct diagnosis leads to appropriate disease treatment. If you have genital warts or polyps with bleeding or discharge or are at risk of sexually transmitted disease, it is crucial to seek medical attention as soon as possible.

What are the treatments for genital warts?

Once diagnosed with genital warts, the doctor will consider several treatment options to achieve desired treatment outcomes, including topical medication, surgical techniques, or other efficient treatments to stop genital warts from spreading to others or becoming large and more numerous. For those with good immunity, genital warts may come and go without any treatment. However, the virus remains in the body for life without showing any symptoms, and there is a chance that the disease will recur when the body's immunity is low. Treatments for genital warts are as follows:

• Medications: The doctor will schedule a once-weekly appointment at the hospital to apply topical medication to the internal and external organs where genital warts develop. They will stimulate the immune system, helping in slowing down genital wart growth and accelerating cell degeneration and falloff. Topical medications are 5% imiquimod, 0.5% podofilox, or 80–90% trichloroacetic acid. The doctor will instruct you to urinate before administering the medication to prevent the applied area from being exposed to water for at least 4-6 hours.
• Surgical excision: The doctor may consider surgical treatment, particularly for large genital warts or lesions unresponsive to medication or a biopsy for further examination. Doctors tend to advise a cesarean section for mothers with genital warts about to give birth to prevent mother-to-child transmission.
• Electrocautery is used to cauterize warts with high heat to remove abnormally growing tissue.
• Liquid nitrogen cryotherapy inhibits wart growth, promotes skin healing, and allows the lesion to fall away.
• Laser treatments: Doctors consider this treatment for more widespread genital warts, as well as difficult-to-treat warts.

What are the complications of genital warts?

Typically, the HPV variants that cause genital warts do not also cause cancer. However, if infected with multiple HPV strains, particularly the high-risk ones, the infection can lead to genital wart complications such as abnormal vaginal discharge, cervical, vulvar, mouth, or pharyngeal cancers in women, and penile or anal cancers in men.

In addition, genital warts or condyloma acuminate can pass down from mother to child during natural childbirth. The baby becomes infected with genital warts through vaginal secretions, resulting in warts in the respiratory tract, trachea, or pharynx blocking the airway, eventually leading to death. As a result, the doctor usually advises performing a cesarean section to avoid infection.

What are the preventive measures for genital warts?

The best way to prevent genital warts is to get the HPV vaccination, which protects against infection with all nine types of HPV strains, including types 6 and 11, which cause genital warts. The HPV vaccination can start at age 11 - 12, or as early as 9 for both genders. The following are preventive measures against genital warts:

• Consult a doctor promptly when you notice lesions on your skin or genitalia.
• To prevent the spread of infection to others, avoid having sex if you have the disease lesions
• Screening for sexually transmitted diseases
• Pre-marital checkup
• Always use a condom before sex
• Avoid touching persons with genital warts
• Avoid sharing personal items with others.
• Not frequently changing sexual partners and avoiding sexually provocative behavior
• Always maintain the best hand-washing routine
• Maintain good physical health at all times
• Annual health checkup

Can genital warts recur?

When healed, genital warts can recur up to 70% of the time within six months of the visit to the doctor for treatment. The recurrence of the disease can be due to ineffective medication, recurrent infections caused by having sex with an infected person, the recrudescence of latent HPV, lesions in the body due to low immunity, or serious diseases such as cancers or AIDS.

Genital warts, early detection, and prompt treatment can restore confidence in a couple's relationship.

Besides affecting physical health, genital warts also affect mental health. Genital warts may cause individuals to experience embarrassment, stress, anxiety, or loss of confidence, which can negatively impact fertility, raise the risk of complications, and alter marital relationships.

Though genital warts are not life-threatening, the disease is preventable by vaccination and urgently seeing the doctor for a thorough assessment once the symptoms appear to receive the appropriate treatment to prevent spreading warts to others. Those cured of genital warts should maintain a healthy lifestyle to maintain healthy immunity. Only by adhering to the best routine hygiene practices can the likelihood of a disease recurrence decrease.

Article by
Dr Sarwinee Ratchanon

An obstetrician specializing in reproductive endocrinology
Doctor profile

FAQ

• How can I prevent genital warts from spreading?
  What you can do to stop the transmission of genital warts is to always use a condom during sexual activity and avoid having sexual intercourse when you have visible warts.
  
  
• What sets genital warts apart from herpes?
  Herpes can appear similar to genital warts and both are sexually transmitted infections. However, herpes causes the formation of sores and fluid-filled blisters on the genital area whereas genital warts are characterized by small, raised bumps that typically do not result in open sores. Both conditions can be transmitted through vaginal and anal intercourse.
  
  
• If I have a genital wart, does it mean I have an STI?
   Yes, because genital warts are caused by the human papillomavirus (HPV), which is primarily transmitted through sexual contact