HPV and Genital Warts

What are genital warts?

Genital warts (condyloma) are small, fleshy growths that are found on the skin in the genital region. Most warts are painless, and many people don’t realize they have them. Occasionally, they spread and enlarge, looking like very tiny cauliflowers. The warts may be raised or reddened. Warts may sometimes also hurt or cause itching. They may grow on the large and small lips surrounding the vagina (vulva), around the anus, or on the urethra, cervix, vagina, rectum, bladder, penis, or scrotum. Genital warts vary greatly in size, color, shape, and texture, depending on where they are found.

What causes genital warts?

Genital warts are caused by human papillomavirus (HPV). Both men and women can be infected with HPV. Genital HPV is usually spread through sexual contact when the virus enters the body through small cuts or breaks in the skin. Following a short incubation period of several weeks or months, the virus may cause a wart to grow on the skin.

How common is HPV?

HPV is very common. Most men and women who have had sex get HPV. Fortunately, most HPV infections go away on their own without causing any problems for the infected person. Of the many people who have HPV, only a few display genital warts. Most infected people don’t even know they have had HPV.

Is HPV infection serious?

Some people are especially worried when they learn they are infected with the HPV virus. There are lots of different kinds of HPV, and most are not serious. This is particularly true for the types of HPV that generally cause genital warts. Sometimes, however, people are infected with more than one type of HPV. Certain less common types of HPV are associated with serious problems such as cancer of the cervix, vagina, vulva, anus, penis or scrotum.

How did I get genital warts?

You probably got HPV through skin-to-skin contact with an infected person during sex. You may not have noticed genital warts on your sexual partner(s). HPV may be passed to another person even when no wart is seen. Warts on the cervix, inside the anus, vagina, or urethra are not easily seen and, therefore, some people may not know they have warts. Your partner or former partner(s) may have given you genital warts unknowingly. Most people who have HPV do not have any signs of it and do not know they have it.

What increases my chances of getting genital warts?

The more sexual partners you have, the greater your chances are of getting genital warts. Using condoms may reduce your chances of getting warts, but condoms do not always help. Your immune system also determines whether you may develop genital warts. People with poorly functioning immune systems are more likely to get warts.

How long have I had genital warts?

It is impossible to know exactly how long you have had genital warts or HPV. If you have had more than one sexual partner in your lifetime, it is impossible to tell which partner gave you HPV. Therefore, it is very hard to determine when you were infected with HPV. You may have been infected with HPV for a long time but no warts grew immediately. You also may not have noticed very small warts that have since enlarged. If you had sexual contact with an infected person who gave HPV to you, it may take a few weeks or a few months or even longer for genital warts to appear.

How are genital warts diagnosed?

Genital warts often look similar to other types of skin growths. Usually genital warts can be diagnosed after careful examination by your health care provider. To diagnose genital warts on the outside of the body, your health care provider may apply vinegar to the external genitals. This may sting slightly. The vinegar solution may temporarily cause the skin growth to appear white. Very small warts can be diagnosed by magnifying the tiny white areas with a magnifying lens or a colposcope (a type of microscope). To diagnose genital warts on the inside of the body, a colposcope is used to shine a light on and magnify the cervix, vaginal walls, or anus. Occasionally, a tiny sample of tissue, called a biopsy, needs to be collected to find out whether the growth is a genital wart or something else.

How are genital warts treated?

Fortunately there are many ways to get rid of warts or reduce the number of warts. Sometimes warts will go away without any treatment. The location, size, and number or your genital warts determine the best treatment option for you. Treatments, when necessary, may be uncomfortable. At times, local or general anesthesia is required to prevent pain during the treatment.

Treatment
Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA)

How Treated
Applied once weekly by health care provider until the warts are gone.

Side Effects
Skin irritation, scars, pain

Treatment

Podofilox gel (Condylox ®)

How Treated
Applied by the patient at home twice a day for 3 consecutive days, then followed by 4 consecutive days of no therapy. Applied for a maximum of 4 weeks.

Side Effects
Skin irritation, burning, redness

Treatment
Imiquimod cream (Aldara ™)

How Treated

Applied by the patient at home. A thin layer is applied and rubbed into the warts at bedtime on Monday, Wednesday and Friday for up to 16 weeks. After it has been on the skin for 6-10 hours, it needs to be washed off using a washcloth with soap and water.

Side Effects
Local irritation, reddening, swelling, itching, skin flaking

Treatment
Podophyllin

How Treated
Applied weekly by the clinician; must wash off with soap and water in 6-8 hours

Side Effects

Burning; skin breakdown, particularly if not washed off

Treatment
Interferon

How Treated
Injections may be used for warts that do not go away

Side Effects
Flu-like symptoms; expensive

Treatment
Laser surgery (requires anesthesia)

How Treated
Burns away the wart

Side Effects
Tissue injury, pain

Treatment
Cryotherapy

How Treated
Freezes the wart. Repeat every 1-2 weeks, until cleared

Side Effects
Tissue injury, pain

Treatment
Knife or scissors (requires local anesthesia)

How Treated
Cuts off warts

Side Effects
Pain, bleeding

Treatment
LEEP (loop electroexcision procedure) (requires local anesthesia)

How Treated
Removal of tissue with an electric wire cutting procedure

Side Effects
Tissue injury, bleeding, pain

Will the warts recur after treatment?

Many warts disappear after treatment. But sometimes genital warts reappear again months or years after successful treatment. Some types of treatment may work better than others for you. No single type is always successful in treating warts in everyone.
Therefore, it is important to watch for new warts.

Why would warts come back after treatment?

Genital warts can be treated, however, currently there is no cure for the HPV infection itself. The goal of treatment is to remove the wart (skin that is that is abnormal-appearing) without damaging normal tissue around the wart. Yet normal appearing tissue surrounding the wart may also be infected with HPV. Treatment will often stimulate the body’s natural immune system to eliminate the small amount of HPV that may be left behind in the normal appearing tissue. However, a small amount of HPV in the normal skin may resist the treatment. Therefore, the remaining HPV may cause warts to return at a later time. If warts do reappear, it does not necessarily mean that you have been re-infected. New warts usually come from the same HPV that was already present in your normal appearing skin.

What should I do to take care of myself?

You may want to check yourself for the development of new warts following treatment.

  • If you discover new genital warts, have them treated as soon as possible.
  • Having genital warts may mean that you are at a slightly greater risk for getting
  • cervical cancer.
  • Women should have regular Pap tests.
  • If you smoke tobacco, stop! Tobacco weakens your immune system and increases your risk for getting HPV again.
  • Try to keep your stress level low, get enough sleep, and eat a nutritionally balanced diet.

How can I prevent spreading genital warts to others?

Genital warts are extremely contagious. Once the warts disappear after treatment, it is less likely that you will transmit HPV to your sexual partner. Now that you know you have genital warts, you should tell your current (and past) sexual partner(s), so that they can be examined. The virus (HPV) that causes genital warts can be transmitted through oral, anal, and vaginal sex. HPV may be present anywhere in the anal or genital area. Using condoms during vaginal or anal intercourse and dental dams during oral sex may help to reduce the chance of spreading infection. Condoms or dams may not always completely prevent the spread of HPV infection, because HPV may be in the skin that is not protected by the condom.

Will having genital warts cause problems if I become pregnant?

If you have genital warts, there is a very small chance that your baby could inhale the HPV virus while passing through the birth canal. This rarely happens, but if it did, your baby could develop warts on the vocal cords in the throat. This could cause breathing problems and would require treatment. Usually, women with genital warts have regular deliveries. If your warts were so large that they blocked the opening through which the baby must pass, then your baby would be delivered by Cesarean section.

How can I cope with genital warts?

Be sure to get regular check-ups, including Pap tests. If you see genital skin changes, make an appointment with your health care provider for an exam. It is common for people with genital warts to feel angry, upset, depressed or ashamed about their condition. These feelings are normal, but you should seek counseling if the feelings interfere with your relationships and life activities. Some women may also be concerned about the risk for cancer. Keep in mind that genital warts can be managed and cervical cancer can almost always be prevented. Talk to your health care provider about your concerns. Keeping yourself healthy and not smoking can help boost you body’s natural defense system to fight the virus.

Copyright © 2003, 2008 ASCCP. All Rights Reserved.

These materials were developed by the American Society for Colposcopy and Cervical Pathology (ASCCP) Patient Education Committees and approved by the Board of Directors for use by patients.

This material is provided for informational purposes only. It does not constitute medical advice and is not intended to replace professional care. Please consult your health care provider with any questions or concerns you may have regarding your condition. The ASCCP National Office does not provide individual consultation on cases or diagnoses.
While you may download, print and distribute these materials freely, they are copyrighted materials and all rights are owned by ASCCP. Therefore, they may not be changed, edited or altered in any way.

PG

Author: H. Sandra Chevalier-Batik

I started the Inconvenient Woman Blog in 2007, and am the product of a long line of inconvenient women. The matriarchal line is French-Canadian, Roman Catholic, with a very feisty Irish great-grandmother thrown in for sheer bloody mindedness. I am a research analyst and author who has made her living studying technical data, and developing articles, training materials, books and web content. Tracking through statistical data, and oblique cross-references to find the relevant connections that identifies a problem, or explains a path of action, is my passion. I love clearly delineating the magic questions of knowledge: Who, What, Why, When, Where and for How Much, Paid to Whom. My life lessons: listen carefully, question with boldness, and personally verify the answers. I look at America through the appreciative eyes of an immigrant, and an amateur historian; the popular and political culture is a ceaseless fascination. I have no impressive initials after my name. I’m merely an observer and a chronicler, an inconvenient woman who asks questions, and sometimes encourages others to look at things differently.