Randy Jacobs, M.D. Patient Education

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What You Should Know About Genital Warts

Can the wart virus cause cancer?

Certain types of HPV have been linked with a variety of premalignant and malignant conditions. Genital warts are the greatest cause for concern. Women who have had genital warts, or sexual contact with someone with genital warts, have a significantly increased risk of developing cervical neoplasia. For this reason,  it is critical that genital warts be treated.

Are men and women always aware that they are infected with genital warts?

No. The infection can be asymptomatic. This may help explain why genital warts are the most common sexually transmitted disease today.

How are genital warts diagnosed?

We now know that some genital warts, called microsize warts, are invisible to the naked eye. In women, a Pap smear will usually reveal the presence of genital warts. For best results, the physician may apply acetic acid to the affected area, then, may examine the tissue under high magnification. For women, this can be performed at a gynecologist's office. Men who have been exposed to genital warts should go to a dermatologist, who can detect the warts using a similar procedure.

Should women with a history of genital warts be followed up more closely by their physician?

Yes, because of the increased risk of cervical cancer, these women should have a Pap smear at least annually, perhaps every six months. Genital warts have become a very common sexually transmitted disease (STD), particularly among young adults. Genital warts look very much like the warts that might develop on other parts of the body. But the human papillomavirus (HPV) that causes genital warts can be dangerous to overall health. Most significantly, it can increase the risk of cervical cancer in women. It is important that all sexually active people know what genital warts are and why it is important to seek prompt attention from a physician or clinic if genital warts do develop.

What is the difference between genital warts and other types of warts on other parts of the body?

Genital warts can develop on the cervix, penis, or in the vaginal or rectal area. They look very much the same as warts that might appear on the hands, feet, or other parts of the body. All warts are infections caused by one or another strain of the virus. Some types of HPV cause genital warts whereas other types cause common skin warts. It is therefore important that anyone with genital warts, and their sexual partner(s), be diagnosed and treated as soon as possible.

How common are genital warts?

Millions of people in the United States are infected with HPV, and genital warts are the most common STD caused by a virus. They occur more frequently than genital herpes, which is also caused by a virus. The number of HPV or genital wart cases continue to increase each year. Many sexually active people are unaware of genital warts and the potential health risks of this very common STD.

How does a person develop HPV?

The genital strains of HPV, which cause genital warts, are primarily spread through sexual intimacy. Transmission can occur through all forms of sexual intercourse, including oral or rectal intercourse, and through heterosexual or homosexual contact. Genital warts generally develop an average of two to three months after exposure to a person with HPV infection.

What  do genital warts look like?

Genital warts, like warts on other parts of the body, are dry and painless, firm and rough in texture, and usually flesh or grayish in color. Some genital warts can be small and difficult to detect, even during a medical examination. Small and flat warts on a man's penis or a woman's cervix are particularly likely to go unnoticed. Warts can vary widely in appearance. They can be large or small, flat or raised, multiple or single. Untreated genital warts can grow large and numerous, and perhaps grow together to form an ugly growth that looks like a very small cauliflower.

Where do genital warts usually develop in women?

Genital wart infection most commonly develops on the vulva (the outer part or lips of the vagina), or inside the vagina, or on the cervix (the small opening leading from the vagina to the uterus), or on or near the anus. Genital warts often develop in several areas at the same time, and the cervix is involved in about half of the cases of genital warts in women.

Where do genital warts usually develop in men?

Genital wart infection in men most commonly occurs on the penis, but it also may involve the urethra or bladder. Infection of the urethra may cause bleeding, discharge, and the need to urinate frequently. Genital warts can also develop on or near the anus, or within the rectum. This is particularly likely among homosexual men who practice anal intercourse. Also, as is the case with women, wart infection often occurs in more than one genital area at a time.

Can a person have a genital wart virus infection and not know it

Yes. In fact, recent research suggest these most HPV infections, may be completely asymptomatic, that is, they never cause recognizable warts. Such persons probably can infect their sexual partners and may develop cervical cancer.

Do genital warts pose serious health risks?

Genital warts can be very dangerous to one's health, and all genital warts should be promptly treated. The most serious consequence is the possible development of cervical cancer in women. There are 40 known strains of HPV and several of these are strongly linked to the development of cervical cancer. Specifically, an abnormal cellular condition known as dysplasia often occurs among women with genital wart infection of the cervix. This condition poses a high risk for subsequent development of cervical cancer. Prompt diagnosis and treatment of genital warts is essential in order to avoid this precancerous condition on cervical cancer itself. Physicians usually remove a sample of genital wart tissue and have it examined under a microscope to determine possible abnormalities, dysplasia, and other pre-cancerous signs that can be detected by Pap smear.

What are the consequences of genital warts?

By far the most important is cervical cancer. HPV is closely associated with cervical cancer and may be the most common cause of this disease. Untreated genital warts can grow and multiply and perhaps group together to form cauliflower-like growths. These large growths can be very difficult to treat, and unfortunately, treatment, which might include surgery, may damage the tissue.  There is a risk of damage to the woman's reproductive system, which might reduce or eliminate her ability to have children. Untreated genital warts may simply disappear over time. But even if HPV infection seems to resolve itself, there is a strong risk of recurrence, transmission, and more extensive wart development. Diagnosis and treatment is essential.

How are genital warts diagnosed?

Dr. Jacobs can often diagnose genital warts by simple observation. But the fairly common small or flat warts can pass unnoticed by the physician or the patient, particularly because genital warts do not have symptoms of pain or irritation. For many women, the first indication of genital warts may be an abnormal Pap smear. For many men, the first clue to HPV infection might be an unusual discharge or the need to urinate often. Accurate diagnosis might require a colposcopy examination. This is a painless procedure in which a gynecologist uses a colposcope (a magnifying device with bright lights) to clearly identify the area(s) of infection. This diagnostic method is used for women and sometimes for men. One diagnostic difficulty with HPV infection is that genital warts can be readily confused with other conditions. Genital warts resemble the sores associated with syphilis. Skin cancer on a woman's vagina can also resemble genital warts. If there is any question about the diagnosis, a physician may recommended a colposcopic examination, a blood test, or a biopsy. Clinicians may also recommend tests for not only genital warts but also for other STD's such as chlamydia, gonorrhea, or syphilis. The reason for several tests is that sexually active people often have more than one STD at a time. In addition, researchers have recently learned that genital warts might increase the risks of acquiring or transmitting the AIDS virus, and many doctors routinely recommend an AIDS virus test for people with HPV.

How are genital warts treated?

There are several treatment methods. The severity of infection, the location of the warts, and other factors will influence the decision about which treatment might be best for a patient. Genital warts can be frozen with liquid nitrogen or cryosurgery. Although these techniques for freezing off the infection are effective, they can cause a temporarily annoying blistering of tissue. Some cases of genital wart infection are treated by applying certain caustic chemicals to the infected area. Genital warts can also be burned off, a procedure that requires the use of an anesthetic to reduce or eliminate pain or discomfort. Laser treatment or possible interferon therapy might be recommend for recurrent warts that have been resistant to other treatment methods. Most of these treatments must be repeated several times, sometimes over several months. All methods of treatment have high failure rates. Therefore, repeated reexaminations are sometimes  recommended, even after the warts seem to go away.

Are there special guidelines for treatment?

Yes. Remember that early diagnosis and treatment offer the best option for thorough elimination of genital warts infection. Other important guidelines include the following: - The sexual partner(s) of an infected person should undergo prompt examination. This will reduce the risks of reinfection or recurrence, as well as the risk of spreading HPV   infection to other people. - Women who are pregnant, or who suspect that they are pregnant, should be particularly careful about prompt treatment of genital warts, as warts can be transmitted to the baby. - Pregnant women should not undergo treatment with podophyllin. - HPV infection often co-exists with other genital infections such as vaginal infections, or with other STD's such as chlamydia, syphilis, or gonorrhea. These infections must be diagnosed and treated as well. - Irritation of genital tissues by tight clothes or by moisture such as vaginal secretions can reduce treatment effectiveness and can encourage recurrence. To speed your recovery, wear loose fitting clothes, bathe regularly, and avoid sexual intercourse.

How can someone reduce the risk of acquiring genital warts?

Genital wart infection is highly contagious. The use of safe sex guidelines will reduce the risk of transmission and acquisition. Use condoms during intercourse. Limit the number of sexual partners, preferably to one monogamous relationship. Discuss STD's with a possible new sexual partner before you embark on an intimate relationship. Avoid intercourse if you or your partner(s) have or suspect you have genital warts or any other STD. To reduce the risk of recurrence or further spread of genital wart infection, the sexual partner(s) of anyone with genital warts should also undergo treatment. Avoid sexual intercourse during treatment and until a follow-up examination confirms cure. Remember, prompt diagnosis and treatment are essential. Genital warts are likely to grow, spread, and recur. Untreated infections will increase one's health risks and make eventual treatment more difficult, more expensive, and more inconvenient.