Article: Genital wart

Genital warts (or condyloma, or condylomata acuminata) is a highly contagious sexually transmitted infection. Caused by some variants of the Human papillomavirus, typically HPV 6 and HPV 11, it is spread during oral, genital, or anal sex with an infected partner. Genital warts (condylomata acuminata or venereal warts) are the most easily recognised sign of genital HPV infection. Of the multiple strains of genital HPV, strains 6, 11, 30, 42, 43, 44, 45, 51, 52, and 54 can cause genital warts (Gearhart et al, 2004). Most people who acquire those strains never develop warts or any other symptoms.

Genital warts often occur in clusters and can be very tiny or can spread into large masses in the genital or anal area. In women the warts occur on the outside and inside of the vagina, on the opening (cervix) to the womb (uterus), or around the anus. While genital warts are approximately as prevalent in men, the symptoms of the disease may be less obvious. When present, they usually are seen on the tip of the penis. They also may be found on the shaft of the penis, on the scrotum, or around the anus. Rarely, genital warts also can develop in the mouth or throat of a person who has had oral sex with an infected person.

Treatment

Genital warts often disappear even without treatment. In other cases, they eventually may develop a fleshy, small raised growth. There is no way to predict whether the warts will grow or disappear. Therefore, if you suspect you have genital warts, you should be examined and treated, if necessary.

Depending on factors such as the size and location of the genital warts, a doctor will offer you one of several ways to treat them.

• Imiquimod, (Aldara®) a topical immune response cream which you can apply to the affected area
• A 20% podophyllin anti-mitotic solution, which you can apply to the affected area and later wash off
• A 0.5% podofilox solution, applied to the affected area but shouldn’t be washed off
• A 5% 5-fluorouracil (5-FU) cream
• Trichloroacetic acid (TCA)
• Pulsed dye laser
• Liquid nitrogen cryosurgery

If you are pregnant, you should not use podophyllin or podofilox because they are absorbed by the skin and may cause birth defects in your baby. In addition, you should not use 5-fluorouracil cream if you are trying to become pregnant or if there is a possibility that you could be pregnant.

If you have small warts, the doctor can remove them by freezing (cryosurgery), burning (electrocautery), or laser treatment. Occasionally, the doctor will have to use surgery to remove large warts that have not responded to other treatment.

Some doctors use the antiviral drug interferon-alpha, which they inject directly into the warts, to treat warts that have returned after removal by traditional means. The drug is expensive, however, and does not reduce the rate that the genital warts return.

Although treatments can get rid of the warts, they do not get rid of the HPV virus, so warts can recur after treatment. The body's immune system typically clears the virus anywhere from 6 months to two years, but it occasionally remains in the body for a lifetime.[1] The state of the immune system determines the chances of ridding the virus entirely, and can be affected by factors such as HIV infection, certain medications, stress, or illness.[2] There is even some suggestion that effective treatment of the wart may aid the body's immune response.

Prevention

The virus that causes genital warts is spread by skin-skin contact. Condoms do not adequately protect against genital warts, because the infected spot may not be covered by a condom. The only reliable prevention is to have no skin contact with potentially infected tissue.

Gardasil, an HPV vaccine, is nearly 100% effective against the most common types has been approved by the Food and Drug Administration (FDA) [3]. The license allows prescription to females between the ages of 9-26. Results indicate that the vaccine is only effective if given prior to infection.

Hirsuties papillaris genitalis

Front and side view of glans with pearly penile papules.

It is a common misconception among men that hirsuties papillaris genitalis are in fact genital warts. Pictured right is an example of this condition. Hirsuties papillaris genitalis is not contagious and no treatment for the condition is necessary. Some may deem it unsightly and there are various methods of ridding the penis of the condition such as carbon dioxide laser treatment.

Fordyce's spots

Genital warts should not be confused with Fordyce's spots, which are considered benign.

Pregnancy and childbirth

Genital warts may cause a number of problems during pregnancy. Sometimes they get larger during pregnancy, making it difficult to urinate. If the warts are in the vagina, they can make the vagina less elastic and cause obstruction during child birth.

Rarely, infants born to women with genital warts develop warts in their throats (laryngeal papillomatosis). Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent obstruction of the breathing passages. Research on the use of interferon therapy in combination with laser surgery indicates that this drug may show promise in slowing the course of the disease.