Genital Warts | Symptoms, Images, Causes & Diagnosis

What are the complications of Genital warts?

In most people, genital warts do not lead to any medical complications.

However, the following complications may sometimes arise:

1) Squamous Cell Carcinoma: Sometimes High Risk HPV may be present in the warts and this can lead to development of cellular abnormalities which may lead to the development of cancer (squamous cell carcinoma). This is why sometimes a screen for High Risk HPV and a biopsy is recommended to rule out underlying problems.

High risk HPV (HR-HPV) causes abnormalities on the cells of genital tissue, and these abnormalities are described by the site of their occurrence, namely PeIN (Penile intra-epithelial neoplasia), VIN (Vulval intraepithelial neoplasia), CIN (Cervical intraepithelial neoplasia) and AIN (anal intra-epithelial neoplasia).

2) Infection on the surface/base of the warts: Warts can sometimes get infected with secondary bacterial or fungal infections.

3) Bleeding: Warts have got very rich blood supply, and tend to bleed heavily after being cut off accidentally (shaving, avulsion by trauma) or attempts to cut them off in desperation.

4) Difficulty in maintaining hygiene: Larger warts can have cauliflower like surface, and make it very difficult to maintain hygiene, especially those near the anal area.

5) Buschke Lowenstein Tumors: Sometimes genital warts can be large enough to affect day to day activities. Buschke Lowenstein Tumors are very large warts which are treated surgically.

6) Affect vaginal delivery in pregnant women: Sometimes genital warts can be large enough to interfere with a vaginal delivery. Fortunately, such warts are very rare in the UK.

7) Blood in urine dipstick: Meatal warts especially in men (i.e. genital warts at the opening of the water pipe/urethra) can lead to blood in a urine dipstick. If meatal warts as the underlying cause is not identified, this may result in unnecessary anxiety about cancer and lead to unnecessary urological investigations.

8) Laryngeal Papillomatosis in children: Warts in the larynx can occur in children before 5 years of age and can produce hoarseness of voice, noisy breathing and difficulty in breathing in more severe cases. This is normally caused by Low Risk HPV Types 6 and 11. Research has shown that HPV DNA is detected in nasopharyngeal secretions of almost 1 in 2 of  newborns after a vaginal delivery if their mothers had HPV in their cervical cells. However, laryngeal papillomas are relatively rare.

9) Laryngeal Papillomatosis in adults: The papilloma in the Larynx (or voice box), can lead to hoarseness of voice. They are caused by low risk HPV types 6 and 11. They are rare in the UK. Laryngeal papillomas behave in a lot more benign manner compared to children.

10) Concurrent skin conditions: Sometimes warts are present on the skin surface with another skin condition like lichen sclerosus. Treatment of this skin condition requires application of very strong steroid cream, which nourishes warts, and makes them worse. On the other hand, local creams used to treat warts can irritate the skin and make lichen sclerosus much worse. Clinical judgement is helpful in such instances in deciding how to manage such co-existing skin conditions.

Signs of genital warts | Ada

What are genital warts?

Genital warts (condylomata acuminata or anogenital warts) are the most common sexually transmitted disease (STD) and a symptom of human papillomavirus (HPV) infection — a very common and highly contagious skin infection.

Although HPV comes in over 100 different types, 90 percent of all cases of genital warts are caused by strains 6 and 11. Accordingly, only 10 percent of those who contract the virus will develop visible warts.

Even if they are unaware of its presence, most sexually active people will contract HPV at some point during their lifetime. It is passed on through skin-to-skin contact, most commonly through oral, vaginal or anal intercourse.

Although the warts rarely cause any long-term harm, they are generally considered unsightly and may cause psychological distress. There is no cure for genital warts or HPV, meaning treatment options are limited to managing the physical impact.

Symptoms of genital warts

Most people who contract HPV will not develop any visible symptoms. If genital warts do appear, it can sometimes be a significant amount of time – weeks or even months – after first contracting the infection.

Genital warts generally form in clusters, though a single wart can also appear. They normally form on the outside of the body in the genital or anal area, typically on the vagina, labia majora, penile shaft or scrotum. They can also less commonly appear internally; inside the anus, the vagina, the opening of the urethra or on the cervix.

Genital warts usually take the form of small bumps of roughly two to three centimeters in diameter and are sometimes described as resembling miniature cauliflowers. They typically cause no pain and minimal discomfort, are red or skin-colored in appearance, and can be either soft or hard to touch. If scratched or excessively disturbed, a wart may bleed.

If you are concerned you may have genital warts or another sexually transmitted disease, start your free symptom assessment by downloading the Ada app.

Causes of genital warts

Human papillomavirus (HPV) causes genital warts. This is a skin infection that comes in over 100 different types, each affecting a different part of the body. There are roughly 30 types of HPV that can affect the genital and anal areas, but only two (6 and 11) cause the vast majority (90 percent) of all cases of genital warts. Both men and women can contract the virus and pass it on to others.

Transmission

Genital warts are spread through skin-to-skin contact, primarily through oral, vaginal or anal sex. Penetrative sex, however, is not necessary for contraction; close genital contact can be enough for HPV to be passed on between two sexual partners.

Although human papillomavirus (HPV) is extremely contagious, infection cannot occur through such physical interactions as hugging or kissing, nor through items of clothing or towels. After HPV has been contracted, it is typical for the genital warts to appear in between two weeks and eight months.

Worried you may have contracted genital warts or another sexually transmitted disease? Start your free symptom assessment with the Ada app.

Latency and reappearance

HPV naturally clears from the body in two years or under in 90 percent of cases. For those who have developed genital warts and seen them disappear, there is a chance of the warts recurring within, or in a small amount of cases, outside of this timeframe.

Diagnosing genital warts

Most commonly, visible genital warts will be diagnosed through a routine doctor’s examination and the review of the patient’s medical history.

If, however, there is a suspicion of HPV infection without any visible symptoms, other diagnostic routes may be explored. For women, this will most often involve a gynecological exam and Pap test, followed by a tissue biopsy if abnormal cells are detected. Biopsies for men are far more rare and are generally not recommended by doctors.

Gynecological exam / Pap test

For women without visible genital warts, diagnosing the presence of HPV will often involve undergoing a gynecological exam. This exam will typically include a Pap test (sometimes called a Pap smear). A procedure usually used to test for cervical cancer, the Pap test screens the cervix for abnormal cells, which are a possible sign of HPV infection. If abnormal cells are found on the cervix, further tests will be carried out to screen for HPV infection, as well as the presence of cervical cancer.

Genital warts treatment

There is no cure for genital warts – no way to remove HPV from the patient’s system – meaning that treatment is focussed on removing the warts or preventing them from spreading. The direction that treatment will take depends on the amount of warts present, their location and their physical appearance.

Some patients will choose to undergo no treatment for genital warts. This option is perfectly safe but will generally prolong the problem. If the patient does opt for treatment, there are a number of different options to explore:

• Application of antiviral gels or creams. These solutions are marketed in a number of different varieties but are generally applied by the patient themselves over the course of a number of days or weeks. Side-effects may include itching and mild scarring.
• Cryotherapy (freezing). Liquid nitrogen is used to rapidly freeze the affected area, resulting in a mild burning sensation. This procedure is usually used for small warts around the penis or vulva.
• Excision. The warts are surgically removed while the patient is under a local anesthetic. Typically used for small, hardened warts.
• Electrosurgery. Generally used for large clusters of warts that have not responded to other treatments, this option involves cutting away the bulk of the warts, pressing a metal rod against the affected area and sending an electric current through it to burn away what remains.
• Laser surgery. Generally used for large clusters of warts or those that are difficult to reach (inside the anus, for example). A specialist will use a laser to burn away the mass of warts while the patient is under regional or general anaesthetic.

Prevention of genital warts

Although they are not 100 percent reliable, the use of condoms remains the most effective way of preventing the contraction genital warts. There are also HPV vaccines available. These vaccines do not protect against all strains of HPV but may be effective in preventing genital warts.

Condoms

To help protect against genital warts, condoms should be used every time vaginal, anal or oral intercourse is engaged in. Apart from celibacy, this is the most effective prevention method currently known of. However, using a condom does not guarantee full protection. The virus may be able to spread from genital skin not covered by the condom.

Vaccines

A HPV vaccine can be effective in preventing genital warts, as well as other conditions including cervical cancer. These vaccines are most effective if given before a young person becomes sexually active and are usually given between 11 and 13 years of age. Catch-up programs are sometimes available up to the age of 26, but vaccination in people over 26 has been shown to be ineffective.

There are a number of vaccines available (Gardasil and Cervarix, for example), each protecting against a number of different HPV strains. No vaccine is able to protect against all strains of HPV, nor guarantee defence against all types of genital warts. However, vaccination does significantly lower one’s chances of contracting the HPV.

The HPV virus and cancer

The human papillomavirus (HPV) that causes genital warts can also cause several forms of cancers, including:

• Cervical cancer. Most cases of cervical cancer are caused by HPV. Strains 16 and 18 are responsible for roughly 70 percent of all cases. The HPV vaccination protects against 70 percent of the HPV strains that cause cervical cancer, meaning that it is effective in preventing the condition but not guaranteed.
• Anal cancer: An estimated 95 percent of all cases of anal cancer are caused by HPV, with most of these caused by type 16.
• Oropharyngeal cancer: Roughly 70 percent of oropharyngeal cancers (cancers of the middle throat) are caused by HPV.
• Other forms of cancer: Penile, vulvar and vaginal cancers can also be caused by HPV, with type 16 responsible for most cases.

Good to know: A weakened immune system, smoking tobacco, giving birth to a large amount of children and poor oral hygiene can all increase one’s risk of developing a HPV-linked cancer.

Genital warts FAQs

Q: Should sexual intercourse be avoided when genital warts are present?
A: Yes. HPV is highly contagious, meaning sexual intercourse should be avoided to prevent passing the virus on. If this is not possible, a condom should be worn.

Q: Genital warts during pregnancy — should I be worried?
A: Generally, no. It is unlikely that HPV will be passed from mother to baby
before or during childbirth.

Q: Can genital warts be contracted from oral sex?
A: Yes. To prevent the spread of genital warts through oral sex, a condom should be worn at all times.

Q: Can genital warts cause cancer?
A: While genital warts themselves cannot be said to cause cancer, some strains of the HPV virus can cause certain types of cancer. Cervical cancer and anal cancer are often linked to HPV infection.

Other names for genital warts

• Anogenital warts
• Condyloma acuminatum
• Condylomata acuminata

Genital Warts

J Clin Aesthet Dermatol. 2012 Jun; 5(6): 25–36.

A Comprehensive Review

, BSc,^a, MD,^b and , MD^b

Valerie R. Yanofsky

^bDepartment of Dermatology, Mount Sinai School of Medicine, New York, New York

Rita V. Patel

^aAlbert Einstein College of Medicine, Bronx, New York

Gary Goldenberg

^bDepartment of Dermatology, Mount Sinai School of Medicine, New York, New York

^aAlbert Einstein College of Medicine, Bronx, New York

^bDepartment of Dermatology, Mount Sinai School of Medicine, New York, New York

Corresponding author.ADDRESS CORRESPONDENCE TO: Gary Goldenberg, MD, Assistant Professor, Dermatology and Pathology, Mount Sinai School of Medicine, Medical Director of the Dermatology Faculty Practice, 5 East 98th St. 5th Floor, NY NY 10029; E-mail: moc.liamg@dmgrebnedlogyragThis article has been cited by other articles in PMC.

Abstract

External genital warts, also known as condylomata acuminata, are extremely common, with between 500,000 to one million new cases diagnosed each year in the United States alone. To date, more than 120 distinct subtypes of human papillomavirus have been identified. Human papillomavirus types 6 and 11 rarely give rise to cervical cancers, but are responsible for 90 percent of the cases of genital warts. The current treatment options are largely centered upon removal of the warts rather than elimination of the underlying viral infection. A wide range of therapies are presently in use, which are highly variable and can differ dramatically with respect to cost, side-effect profiles, dosing schedules, duration of treatment, and overall effectiveness. As of yet, no definitive therapy has emerged as the ideal standard of care in the treatment of genital warts, and therapy selection generally occurs in a patient-specific manner.

External genital warts (EGW), also known as condylomata acuminata (CA), are one of the most common forms of sexually transmitted diseases affecting the general population.¹ It is estimated that anywhere between 500,000 to one million new cases are diagnosed each year in the United States alone, with clinically apparent warts presenting in approximately one percent of the sexually active population. ^2,3 In 2004, the economic burden of human papillomavirus (HPV) was estimated at four billion dollars when accounting for direct costs of caring for genital warts as well as invasive cervical cancer.⁴

To date, more than 120 distinct subtypes of HPV have been identified, with approximately 40 different subtypes capable of infecting the anogenital tract.^1,5 These can be grossly subdivided into the following three categories: low risk, intermediate risk, and high risk, based on the likelihood of inducing intraepithelial dysplasias. HPV types 6 and 11 rarely give rise to cervical cancers and are thus considered low-risk subtypes. Infection by these genotypes is responsible for 90 percent of the cases of genital wart formation. In contrast, HPV types 16 and 18 are strongly associated with cervical dysplasia and are therefore considered to be high risk, oncogenic subtypes. Evidence for infection by these genotypes is found in up to 70 percent of squamous cell carcinomas (SCC) of the cervix. ⁶ HPV types 31, 33, 45, 51, 52, 56, 58, and 59 are typically thought to be of intermediate risk since they are often found in association with squamous neoplasms, but have been rarely linked to cervical SCC.⁶ Patients with CA may be infected simultaneously by multiple HPV strains. While the specific nature of the infection certainly plays a role in predicting malignant progression, it has very little bearing on the diagnosis or treatment of genital warts.⁷

History

Historically, genital warts were believed to be cutaneous manifestations of syphilis or gonorrhea, and it was not until 1907 that Ciuffo definitively demonstrated the virus’s infectious nature through the use of cell-free transmission experiments. By inoculating and injecting wart extracts into previously uninfected skin, Ciuffo induced novel papillomatous eruptions at the injection sites.⁸ Subsequent investigation and experimentation revealed genital warts to be benign cellular proliferations of the anogenital skin and mucosa in response to a viral invasion. Recent advances in molecular biological techniques have allowed for the successful identification of the offending virus, HPV, as the source of genital wart outbreaks.⁹

Epidemiology

The prevalence of HPV infection has risen steadily in the past 35 years, with as many as 20 million people in the United States believed to be infected.^1,10 This phenomenon is often attributed to both an earlier age of initial sexual contact as well as an increase in the total number of sexual partners. Accordingly, nearly half of these new infections will occur in young adults ages 15 to 24 years.¹¹ HPV is a highly contagious virus and is transmitted predominantly through oral, anal, and genital sexual contact, although rare instances of vertical transmission and autoinoculation have been reported.¹² Furthermore, sexual contact with an HPV-infected individual results in a 75-percent chance of contracting the virus and developing CA. This high rate of transmission generates a 50-percent lifetime risk of acquiring EGW in sexually active individuals.² Additional risk factors include unprotected intercourse, use of oral contraceptives, a history of sexually transmitted infections, smoking, or immunosuppression.^13,14

Virology

HPV is a group of nonenveloped, double-stranded deoxyribonucleic acid (DNA) viruses belonging to the family Papovaviridae.³ Viral replication is restricted to the basal cell layer of surface tissues. The virus will penetrate both the cutaneous and mucosal epithelium in search of the appropriate cellular host. It will subsequently invade and infect the basal keratinocytes of the epidermis. The mucosa can be infected anywhere along the genital tract, including the vulva, vagina, cervix, and perianal regions in females as well as the penile shaft, scrotum, periurethral, and perianal regions in males. Infected regions will be marked by a proliferation of viral DNA and the formation of a warty papule or plaque. ³

The viral genome is composed of six early-open reading frames (E1, E2, E4, E5, E6, E7) and two late-open reading frames (L1, L2). The early-open E genes are important for regulatory function and encode proteins involved in viral replication and cell transformation. In contrast, the late-open L genes encode viral capsid proteins. Differences in the L1 genotype lead to slightly altered patterns of viral DNA replication, which are thought to account for the various HPV subtypes.¹² Specifically, low-risk HPV subtypes will remain separate from the host cell DNA and thus undergo replication independently. In contrast, high-risk HPV subtypes will incorporate their DNA directly into the host cell’s genetic material. The integration of viral and host cell DNA often results in the dysregulation and uncontrolled activation of the E6 and E7 genes, which promotes the transcription of oncoproteins. These will bind and inactivate tumor suppressor genes p53 and Rb, leading to increased cell proliferation and a greater risk of malignant progression (). ^15,16

TABLE 1

Low-risk human papillomavirus subtypes versus high-risk human papillomavirus subtypes

Dermatopathology

Histopathologically, the hallmark of an HPV-infected cell is the development of morphologically atypical keratinocytes known as koilocytes. These are enlarged cells with eccentric, pyknotic nuclei that are often surrounded by a perinuclear halo. Generally, the epidermis will show a marked acanthosis with varying degrees of papillomatosis, hyperkeratosis, and parakeratosis as well as a complete effacement of the granular cell layer.¹⁷ Rete ridges tend to be elongated and point inward toward the center of the wart, and the dermis will often display an increased vascularization with the presence of thrombosed capillaries. In morphologically ambiguous lesions, definitive diagnosis can best be made through the use of electron microscopy and the immunohistochemical peroxidase-antiperoxidase stain.¹⁸ These methods will enable the direct visualization of viral particles within the cells. Additionally, the use of MIB1, an antibody targeting cell proliferation protein Ki-67, may also be helpful in highlighting the presence of viral infection.¹⁹

Clinical Presentation

Once infected with HPV, the virus typically requires an incubation period ranging anywhere from 3 weeks to 8 months prior to clinical manifestation. On average, physical symptoms begin approximately 2 to 3 months after initial contact.²⁰ The virus, however, is also capable of lying dormant within epithelial cells for prolonged periods of time. Infection may thus persist undetected for the duration of an individual’s lifetime with no manifestation of clinically apparent warts. Many studies estimate the rate of subclinical HPV infection to be as high as 40 percent, as demonstrated by the identification of positive viral samples when conducting DNA analysis of seemingly uninfected genital skin.²¹

Following initial clinical manifestation, CA may increase in number and size or, alternatively, undergo a spontaneous regression. In fact, approximately 30 percent of all warts will regress within the first four months of infection. Unfortunately, long-term remission rates remain largely unknown, and the majority of genital warts will recur within three months of infection, even after undergoing the appropriate treatments. ²² Significant risk factors for long-term wart persistence include host immunosuppression, infection with high-risk HPV subtypes, and an older patient age.^22,23 Conversely, the presence of CD4+ lymphocytes in the dermis and the epidermis is generally thought to be associated with elevated rates of spontaneous regression, highlighting the critical role played by the immune system in determining the course of viral infection.

EGW typically present on the moist tissues of the anogenital area, although they may occasionally develop in the mouth or the throat after oral sexual contact with an infected partner.³ CA have a highly variable appearance and may be flat, dome-shaped, cauliflower-shaped, or pedunculated.¹³ EGW can manifest individually, as a solitary keratotic papule or plaque, but are more frequently found in large clusters. Often EGW begin as small, nondistinctive 1 to 2mm flesh-colored papules on the skin and may retain this presentation for the duration of the infection. Alternatively, CA may grow as large as several inches in diameter, leading to the painful disruption of normal intercourse and childbirth. The warty contour may also vary in color and appearance, ranging from white to pink, purple, red, or brown and from flat to cerebriform or verrucous.²⁴

Lesions are rarely considered to be painful; however, they are often associated with severe discomfort, burning, and pruritis. Moreover, larger lesions may be subject to bleeding and irritation upon contact with clothing or during sexual intercourse. The vast majority of EGW can be accurately diagnosed with a careful clinical history and physical examination. In extremely mild or subclinical cases, the use of a 3 to 5% acetic acid solution (the acetowhite test) may be helpful in promoting wart visualization. Biopsy is rarely needed in order to achieve a correct diagnosis, yet it is often recommended for lesions suspected of being malignant or having an increased malignant potential. This includes lesions that are ulcerated, suddenly change in appearance, remain fixed to an underlying structure, or are recalcitrant to treatment. ¹³

Complications of Untreated HPV Infection

Both low-risk (subtypes 6 and 11) and high-risk (subtypes 16 and 18) HPV subtypes have also been associated with the very low-grade, well-differentiated squamous cell carcinoma known as verrucous carcinoma (VC).²⁵ Verrucous carcinoma is divided into clinico-pathological types based on the anatomic area of involvement: oral florid papillomatosis (oral cavity), giant condyloma of Buschke and Löwenstein (anogenital area), and carcinoma cuniculatum (palmoplantar surface). These tumors tend to spread by local invasion and, therefore, rarely metastasize.²⁶ While a direct causal relationship between HPV and VC has yet to be defined, it is hypothesized that HPV’s viral oncogene expression promotes the degradation of the p53 tumor suppression gene, thereby lowering the threshold for tumor formation.²⁷ Histologically, VC can vary from benign-appearing pseudoepitheliomatous hyperplasia-like lesions to invasive SCC. Additionally, presence of vacuolation and prominent keratohyalin granules in the stratum granulosa cells, which are hallmark features of genital warts, was discovered to be variable in histological studies of VC.^28,29 One can differentiate VC and SCC by comparing the immunoperoxidase staining pattern of expression of certain oncogenes. For instance, VC and SCC cells can stain positively for bcl-2, Ki-67, and p53. However, nuclei of VC stain positive for p53 and Ki-67 in the lower third of the epidermis, primarily in the basal proliferating cells. The nuclei of SCC stain positive throughout the full thickness of the epidermis for these markers.³⁰

Additionally, while most HPV infections clear spontaneously, in 10 to 20 percent of women these infections persist and these females are at risk for progression to grade 2/3 cervical intraepithelial neoplasm and, if left untreated, can eventually develop invasive cancer of the cervix.³¹ Penile cancer, which is 10 times less common than cervical cancer, also has a high correlation rate with high-risk HPV infection and history of EGW. A case-control study involving more than 100 men with penile cancer reported that the risk of penile cancer in men with a history of EGW was 5.9 times that of men with no such history (95% CI 2.1–17.6).³²

Therapy

The current options available for the treatment of CA are largely centered upon removal of the warty growth rather than elimination of the underlying viral infection. There is little evidence to suggest that existing treatments are effective in the long-term eradication of genital warts or that they play any significant role in hindering potential malignant wart evolution. A wide range of therapies are presently in use, which are highly variable and can differ dramatically with respect to cost, side-effect profiles, dosing schedules, duration of treatment, and overall effectiveness (). As of yet, no definitive therapy has emerged as the ideal standard of care in the treatment of genital warts, and therapy selection generally occurs in a patient-specific manner. For the purpose of this review, treatment options are reviewed in order of grading of recommendations (based on AHCPR, 1994).³³

TABLE 2

Treatment modalities for genital warts

TREATMENT TYPE	MECHANISM OF ACTION	ADMINISTERED BY	PREGNANCY SAFETY	LEVEL OF EVIDENCE	CLEARANCE %	RECURRENCE %	COMMENTS
TOPICAL
Podophyllotoxin	Anti-wart lignans	Patient	Unknown	A	45-7734,36	38-6538	Cost-effective home treatment
Imiquimod 5% cream	Induces secretion of cytokines that reduce HPV DNA viral load	Patient	Unknown	A	5645	1345	Lengthy duration and sporadic dosing frequency can affect compliance
Imiquimod 3. 75% cream	Induces secretion of cytokines that reduce HPV DNA viral load	Patient	Unknown	A	28-3348	1548	New formulation with more intuitive dosing regimen
Sinecatechins 15% ointment	Possess antitumor, antiviral, antioxidant effects	Patient	Unknown	A	5855	6-955	Can often take 16 weeks to elicit positive response
Podophyllin	Anti-wart lignans	Patient	No	C	42-5067	46-6058	Not generally recommended for EGW treatment
5-FU	Inhibits key enzyme in DNA replication	Physician	No	C	10-5048	5048	Sometimes used for urethral warts
DESTRUCTIVE AND SURGICAL
TCA	Chemically destructive acids	Physician	Yes	B	7049	18 50,51	High clearance rates with relatively low morbidity
Cryotherapy	Dermal damage induced by cold temps initiate immune response	Physician	Yes	B	79-8812	25-4012	Treated areas can take several weeks to heal, requires multiple treatments
Electrosurgery	Thermal coagulation	Physician	Yes	B	9458	2258	Long-term effectiveness comparable to cryotherapy
Scissor excision	Physical removal of diseased tissue	Physician	Yes	B	7260	19-2960	Outdated treatment modality, utilized with large lesions causing obstruction
CO2 laser	Infrared light energy vaporizes lesions	Physician	Yes	B	23-5212	60-7712	Treatment of choice in immunocompromised
SYSTEMIC
Interferon	Interferes with viral replication	Physician	No	C	17-6756,57,58	9-6956,57,58	Topical use has higher clearance rates versus placebo; systemic use has comparable clearance rates versus placebo

Podophyllotoxin 0. 05% solution or gel and 0.15% cream (Grade A). Podophyllotoxin is a purified extract of the podophyllum plant, which binds to cellular microtubules, inhibits mitotic division, and induces necrosis of warts that is maximal 3 to 5 days after administration. Shallow erosions occur as the lesions necrotize and heal within a few days.³⁴ This treatment option is generally thought to be safe, effective, and can be self-administered. Podophyllotoxin is available as a solution, cream, or gel and must be applied twice daily for three consecutive days of the week, for a maximum of four weeks. Typically, the solution is recommended for penile lesions, whereas cream or gel vehicle preparations are thought to be more comfortable for application to anal or vaginal lesions.³⁵

Randomized, placebo-controlled trials have demonstrated successful clearance rates ranging between 45 to 77 percent.^36,37 Podophyllotoxin is also associated with rates of recurrence as low as 38 percent. ³⁸ Warts that have not resolved after four courses should be treated by alternative means. Adverse effects tend to be fairly common, especially with the first course of therapy and include pain, inflammation, erosion, burning, or itching at the application site. These are frequently thought to be the result of excessive treatment administration on the part of the patient.³⁹ Despite its significantly safe drug profile, podophyllotoxin has not yet been thoroughly evaluated for teratogenecity and is not recommended for use during pregnancy.⁴⁰

Imiquimod 5% cream (Grade A). Imiquimod (imidazoquinolinamine) 5% cream is a patient-applied topical immunomodulatory agent, which first received its indication for the treatment of external CA in 1997. It has since been used in the treatment of a variety of skin conditions, including basal cell carcinomas and actinic keratoses.⁴¹ Although its precise mechanism of action remains unclear, imiquimod is believed to activate immune cells by binding to the membranous toll-like receptor. ⁷ This leads to the secretion of multiple cytokines, such as interferon-α, interleukin-6, and tumor necrosis factor-α, which are critical in the induction of an inflammatory response promoting wart clearance.^42,43 In addition, imiquimod-treated patients have been shown to have a decrease in viral load measured by HPV DNA, a decrease in messenger ribonucleic acid (mRNA) expression for markers of keratinocyte proliferation, and an increase in mRNA expression for markers of tumor suppression.⁴⁴

For the treatment of CA, imiquimod is applied at bedtime three times per week for up to 16 weeks. Commonly encountered local inflammatory side effects, such as itching, erythema, burning, irritation, tenderness, ulceration, and pain, have been long-standing issues with the 5% cream. Occasionally, patients may experience systemic side effects of headaches, muscle aches, fatigue, and general malaise.

In the pivotal clinical study, wart clearance was achieved in 56 percent of patients. More women (77%) than men (40%) cleared their warts, with the male study population comprising predominantly circumsized men. Females had a shorter median time to clearance (8 weeks) compared to males (12 weeks). A low recurrence rate (13%) was found.⁴⁵

Although multiple clinical studies have validated the efficacy and safety of the currently indicated dosing regimen for imiquimod 5% cream for CA, the lengthy duration and sporadic frequency can affect patient compliance. Only one dose-response study exploring a daily treatment regimen with the imiquimod 5% cream has been published with results showing poor patient tolerance secondary to severe local inflammatory side effects. Of the 64 patients enrolled in this study, 13 were withdrawn prior to completion.⁴⁶

Imiquimod 3.75% cream (Grade A). Recently, the FDA approved the use of a 3.75% formulation of topical imiquimod cream for the treatment of EGW.⁴⁷ Two Phase III, double-blind, placebo-controlled studies have shown imiquimod 3. 75% to be significantly more effective than placebo, achieving a 33-percent clearance rate in a protocol evaluation and a 28-percent clearance rate in an intention-to-treat study. Furthermore, recurrence rates were relatively low, with up to 85 percent of subjects achieving complete clearance at a 12-week follow-up evaluation.⁴⁸

Primary cure rates for the 3.75% formulation are not as high as the 5% counterpart; however, the newer product is thought to have several considerable benefits with respect to patient compliance. Importantly, the treatment regimen for 3.75% imiquimod is significantly shorter, with daily application required for a maximum of eight weeks. Additionally, the 3.75% cream is thought to have a markedly less aggressive side-effect profile with the main complaints including itching, burning, or pain at the site of application. Unlike the 5% cream, no systemic symptoms have yet been associated with the therapy.⁴⁸

Sinecatechins 15% ointment (Grade A). Sinecatechins is a botanical extract approved in 2006 by the United States Food and Drug Administration (FDA) for the treatment of genital warts, making it the first botanical to officially receive medical approval.⁴⁹ The active ingredient is a green tea extract containing sinecatechins, which is thought to possess antioxidant, antiviral, and antitumor effects. Although the precise mechanism of action remains unclear, sinecatechins is thought to modulate the inflammatory response through the inhibition of transcription factors AP-1 and NF-κB, both of which are induced by reactive oxygen species.⁵⁰ They have also been shown to downregulate the expression of cyclooxygenase-2, which has been linked to activation of the prostaglandin E2 system and subsequent epithelial dysplasia.⁵¹

Sinecatechins 15% cream is applied topically to warts three times a day for up to four months. Typically, if an improvement is not seen within a few weeks, the treatment is stopped and another option is tried. Several randomized, double-blind, placebo-controlled trials have shown sinecatechins to be significantly more effective than placebo in the treatment of genital warts, with clearance rates as high as 58 percent. Recurrence rates are also relatively low, ranging between 6 to 9 percent at 12 weeks follow up.⁵¹

This botanical extract is associated with a number of adverse effects that are thought to occur in approximately 20 percent of users. These events are generally quite mild and typically include redness, burning, itching, and pain at the site of application. More severe reactions associated with this topical product’s use, such as lymphadenitis, vulvovaginitis, balanitis, and ulceration are extremely rare, but have been reported.⁵¹

Trichloroacetic acid (TCA) 80–90% solution (Grade B). TCA is a chemically destructive acid that burns, cauterizes, and erodes the skin and mucosa. Generally prepared in 80 to 90% solutions, TCA necessitates administration by the physician. Successful treatment of warts can occasionally occur with as little as a single dose; however, more frequently, several applications are required.

TCA is an inexpensive, cost-effective treatment that does require prolonged usage and regimen adherence. The destructive nature of the product frequently extends beyond the superficial wart to encompass the underlying viral infection providing for clearance rates that have been estimated at 70 to 80 percent with high recurrence rates of 36 percent.^52,53 An obstetric study that evaluated the use of 85% TCA in 50 female subjects with external genital warts showed that all subjects were cleared of all lesions after a treatment period that ranged from 2 to 5 months. None of the patients had recurrence or new lesions during the first six-month follow-up period. In the second six-month follow-up period, nine patients (18%) were diagnosed with recurrent lesions. Although transient burning pain during therapy was commonly experienced, none of the patient population discontinued therapy. ⁵⁴

Additionally, the low danger of systemic absorption allows for safe application during pregnancy. The main side effects of acid treatments involve pain or burning during administration as well as destruction of the healthy tissue surrounding the wart. The latter can be minimized by washings with soap and sodium bicarbonate immediately following over-application, and dermal injury or scarring is rare.⁵⁵ Occasionally, tissue destruction can result in pain, ulceration, and crust formation. High success rates and relatively low morbidity make acetic acid therapy a recommended treatment option for CA.

Cryotherapy (Grade B). Cryotherapy is a process in which the abnormal tissue is frozen through the use of a cooling agent, such as nitrous oxide or liquid nitrogen. Temperatures must be exorbitantly cold so as to cause permanent dermal and vascular damage. This leads to the initiation of an immune repair response, resulting in the necrosis and clearance of the destroyed cells. Generally, this treatment is most effective when used for multiple small warts on the penile shaft or vulva.^56,57

Cryotherapy is considered a fairly inexpensive and highly successful therapy, with a 79- to 88-percent clearance rate seen within the first three treatments.¹² This suggests a more efficacious outcome when compared with TCA.⁵² Cryotherapy has various limiting factors. Variables in administration, such as the temperature utilized and time of contact, influence efficacy of treatment. Common side effects of cryotherapy include local tissue destruction, such as painful blistering, ulceration, infection, potentially permanent scarring, and loss of pigmentation, which can be slightly more severe than that of TCA.

Additionally, as with other lesion-directed therapies, cryosurgery does not treat subclinical lesions in the surrounding skin. The recurrence rate associated with this provider-applied methodology has been estimated to be between 25 and 40 percent. Other disadvantages of cryotherapy are that multiple outpatient visits are required and the pain associated with its application can limit its repeated use in certain subjects. However, the effects of cryotherapy are entirely local, making it the current therapy of choice for pregnant women with multiple warts.

Electrosurgery (Grade B). Electrosurgery involves the use of high frequency electrical currents in the form of thermal coagulation or electrocautery to burn and destroy warty lesions. The desiccated tissue is subsequently removed by curettage. This technique is particularly efficacious when used in the treatment of smaller warts located on the shaft of the penis, the rectum, or the vulva; however, it is not recommended for large lesions as it may lead to permanent scar formation. Electrosurgery is an extremely effective technique, with randomized, controlled trials yielding clearance rates as high as 94 percent measured six weeks post-treatment. These rates, however, tend to normalize after three months, suggesting that electrosurgery is comparable to cryotherapy with regard to its long-term effectiveness. ⁵⁸ Electrosurgery is also a fairly painful procedure and local or general anesthesia is usually required. Side effects tend to be relatively minimal and are typically limited to postprocedural pain, although the use of general anesthesia is always associated with a certain degree of elevated risk. It is important to note that electrosurgery is contraindicated in patients with cardiac pacemakers or other implanted cardiac devices due to the potentially fatal effects of current interference and the disruption of the pacemaker rhythms.⁵⁹

Surgical scissor excision (Grade B). One of the oldest documented treatments for the removal of genital warts, surgical excision was considered for many years to be the primary available option. It involves the physical removal of diseased tissue from the body with scissors or a scalpel, followed by suturing the remaining healthy skin together. It is associated with up to a 72-percent clearance rate, which is evident immediately and often persisting over a year later. Although now considered to be somewhat outdated, this treatment option is still suitable for very large lesions that may be causing obstruction and are ineligible or unresponsive to other forms of treatment. Examples include lesions involving the urethral meatus.⁶⁰

Additionally, surgical excision remains the optimal procedure for the removal of neoplastic lesions suspected of malignant progression, which must be submitted for further histopathological examination. Surgical removal of large lesions is a painful process, which frequently results in bleeding and scar formation. The administration of local or general anesthesia is commonly recommended.

A recent and considerably more sophisticated surgical excision procedure for the treatment of genital warts is Mohs surgery. Although intended predominantly for cutaneous carcinomas, Mohs is a highly specialized technique in which the skin is removed in very thin layers and subject to immediate microscopic analysis for traces of pathology. In the continued presence of viral cell features, additional skin slices will be removed until the entire wart is excised and only healthy tissue remains.⁶¹ The obvious benefit of this type of surgery is that it allows for the maximal preservation of healthy skin, resulting in minimal scar formation. However, it is a significantly more expensive and involved process and is only considered when the cosmetic appearance of the removal process is of significant concern.

Carbon dioxide (CO₂) laser therapy (Grade B). Carbon dioxide laser therapy relies upon the use of a concentrated beam of infrared light energy, which will heat and eventually vaporize the targeted areas. The intense light energy has the added benefit of providing immediate cauterization of any ligated vessels, ensuring a virtually bloodless procedure. The spatial confinement of the laser beam permits precise tissue ablation resulting in rapid healing with little or no scar formation.⁶²

The efficacy of CO₂ therapy for CA remains contentious. Laser therapy is typically considered to be less effective than other forms of surgical treatment, with clearance rates ranging between 23 to 52 percent. Recurrence rates also tend to be elevated, reaching as high as 77 percent.¹² Side effects are generally mild and limited to the burning of tissue surrounding the lesion.⁶³ Despite these seemingly unfavorable results, the deep penetrating effect of the laser often allows for a greater and more complete viral attack than seen with other surgical treatment options. This renders it the treatment of choice for immunosuppressed individuals as well as for pregnant women with extensive lesions who remain unresponsive to TCA or cryotherapy.

Unfortunately, laser therapy is also a rather expensive and complicated treatment option. Specialized laser equipment must be purchased and subjected to continual upkeep, while physicians themselves are required to undergo additional training in order to utilize the equipment effectively. Furthermore, vaporization of viral lesions can lead to the release of HPV DNA into the surrounding environment. Appropriate measures must therefore be undertaken in order to ensure physicians and assisting personnel are protected from infection. This necessitates the use of specific, virus-resistant masks as well as a vacuum ventilation system in the examination room.⁶⁴ Additional risk factors for the transmission of genital warts through vaporization include treatment of malignant HPV subtypes, thinness of skin, and the degree of viral burden.⁶⁵

Therapies not generally recommended. Due to low efficacy and toxicity, routine use of podophyllin, 5-fluorouracil (5-FU), and interferon therapy are not recommended for use in the primary care setting.⁶⁶ Podophyllin was the first topical treatment of genital warts; however, a lack of standardized drug preparation lead to samples that varied greatly in the active ingredient. This increased the likelihood for adverse skin reactions, such as burning, redness, pain, itching, or swelling. In extremely rare circumstances, over-application of podophyllin and excessive systemic absorption has been linked to the development of enteritis, bone-marrow suppression, abdominal pain, and neurological compromise.⁶⁷ Podophyllin fails to induce a lasting remission of genital warts and is generally considered less effective than podophyllotoxin, cryotherapy, or electrosurgery when used as individual modalities.^36,58

5-FU is one of the oldest chemotherapeutic agents and has been effectively used in the treatment of cancer for more than 40 years. Although not officially approved by the FDA for use in the treatment of genital warts, topical 5-FU is still seen as a favorable option for urethral warts.^68–70 The administration of 5-FU has historically been associated with highly variable response rates, and side effects tend to be slightly more severe than those of imiquimod 5% cream with comparable clearance rates yet marginally higher rates of recurrence.^3,71

Historically, interferon therapy has been used predominantly for the treatment of malignant melanoma; however, recent evidence suggests that it may be useful as either an individual or adjuvant to surgical treatment of genital warts.^72,73 Interferon therapy can be administered systemically, via oral or intramuscular injection, as well as locally, via direct intralesional injections. Typically, 1 to 1.5 million units is used, and injections occur three times a week for a duration of three weeks. The use of interferon therapy for the treatment of genital warts remains somewhat controversial. A meta-analysis of 12 randomized clinical trials involving close to 1,500 subjects showed the local use of interferon to have a statistically higher complete response rate than placebo (P<0.00001). The rate of complete response of systemically used interferon and placebo had no perceivable discrepancy (P>0.05).^72,74 Due to its direct immune-boosting effects, interferon therapy is likely to promote the clearance of underlying virally infected cells in addition to targeting external lesions. This may ultimately lead to lower rates of recurrence and better long-term results, especially when used synergistically with other treatment modalities. The benefit of interferon therapy as an adjunct treatment remains unclear, with several studies indicating no advantage relative to placebo, while still others show a significant improvement in treatment results.^73,75 Although this therapy seems promising, further comprehensive research is needed in order to confidently evaluate its effectiveness.⁷² Side effects generally include flu-like symptoms, such as headache, nausea, vomiting, fatigue, and myalgia. On rare occasions, systemic interferon therapy has been linked to elevated liver enzymes, bone marrow suppression, bronchospasms, and depression. Intralesional injections are associated with significant pain upon administration, hence the use of local anesthesia is frequently recommended.⁴⁰ The use of interferon therapy is an extremely costly procedure and is typically considered the most expensive genital wart treatment. Given the ongoing controversy surrounding the effectiveness of this treatment, interferon therapy is generally considered a last-resort therapy reserved for severe cases that are unresponsive to other forms of treatment.⁷²

Preventative Treatments—the Role of the HPV Vaccine

Gardasil (HPV4). In the summer of 2006, the FDA approved the use of the first HPV vaccine, Gardasil (HPV4, Merck & Co.). The recombinant, quadrivalent vaccine was intended for the prophylactic treatment of girls and young women 9 though 26 years of age for the prevention of the following pathologies caused by HPV types 16 and 18: cervical, vulvar, and vaginal cancer, and condyloma acuminata. In addition, HPV4 is indicated for the prevention of precancerous or dysplastic lesions caused by HPV 6, 11, 16, and 18 ().⁷⁶ Gardasil triggers the formation of host antibodies to the HPV subtypes, which are directly responsible for approximately 90 percent of genital warts and 70 percent of cervical cancers.⁷⁷ Gardasil injections are administered in three separate doses and appear to be 99-percent effective in preventing genital wart formation in patients naïve to HPV infection.⁷⁸

TABLE 3

Quadrivalent versus bivalent human papillomavirus recombinant vaccine

Four placebo-controlled, double-blind, randomized Phase II and III clinical studies evaluating more than 20,000 women ages 16 to 26 found that HPV4 reduced the incidence of definitive therapy (i.e., loop electrosurgical excision) by 16.5 percent (95% CI 2.9–28.2) and surgery to excise external genital lesions by 36.5 percent (95% CI 3.6–44.2), compared with placebo for all HPV-related diseases. Also, those individuals who were already infected with one or more vaccine-related HPV types prior to vaccination were protected from clinical disease caused by the remaining vaccine HPV subtypes. Overall, HPV4 provided not only a sustained protection against low-grade lesions attributable to HPV subtypes 6, 11, 16, and 18, but also a substantial reduction in the burden of these diseases through 42 months of follow up.⁷⁹

Long-term follow-up studies have confirmed the ongoing protective effects of Gardasil up to five years post-vaccination with no evidence of waning immunity.⁸⁰ Although some controversy persists with respect to the side effects of the vaccine, current evidence supports the fact that there is no causal link between vaccination and any serious adverse events, such as illness, hospitalization, permanent disability, or death.⁷⁹ The main side effects attributable to the HPV vaccine are mild and include fainting, swelling at the injection site, headache, nausea, and fever. Moreover, similar effects have been shown to occur with comparable frequency following the administration of placebo vaccines.⁸⁰ In fact, the main drawback of HPV4 is arguably the cost, which is known to be quite high and can pose a significant strain on public and private finances.

In the fall of 2009, the FDA expanded the therapeutic use of HPV4 in the prevention of genital warts to include boys and young men between the ages of 9 and 26 years.⁸¹ The vaccine was shown to induce a similar immunogenic response in males when compared to females and appears to be equally beneficial in preventing wart development. It may also play a role in reducing precancerous lesions responsible for the development of anal and penile cancers.⁷⁹ Furthermore, expansion of the vaccination initiative to include males has the added benefit of reducing the viral burden of HPV by directly targeting the viral pool. Eliminating the potential reservoir for viral incubation is a critical and necessary step in eventually eradicating the virus.⁸²

Cervarix (HPV2). In the fall of 2009, the FDA licensed a recombinant, bivalent HPV vaccine (HPV2, GlaxoSmithKline) for use in females ages 10 though 25 years. Cervarix is directed against two oncogenic types, HPV 16 and 18, which are associated with cervical cancer, cervical intraepithelial neoplasia grade 1 or worse, and adenocarcinoma in situ (). The efficacy of HPV2 was evaluated in two Phase II and III randomized, double-blind, controlled clinical trials involving more than 18,000 female subjects who were followed for a mean of 35 months. Efficacy against HPV 16- or 18-related cervical intraepithelial neoplasia grade 2 or 3 or adenocarcinoma in situ was 93 percent (95% CI 79.9–98.3). Comparable to the HPV4 safety data, injection-site pain, redness, and swelling were reported significantly more in the HPV2 group as compared to placebo. Fatigue, headache, and myalgia were the most common general symptoms. The dosing and administration schedules are similar to HPV4 where the second dose is administered 1 to 2 months after the baseline dose, and the third dose is administered six months after the baseline dose.⁸³

Overall, the American Cancer Society and Advisory Committee on Immunization Practices recommend routine vaccination of girls age 11 or 12 years with three doses of either HPV2 or HPV4. The vaccination series can be started beginning at the age of nine.^4,84

Thus far, there is only one randomized, observer-blinded, head-to-head study comparing these two vaccines in a single, well-defined population of more than 1,100 healthy women ages 18 to 45 years. Results of this study showed that HPV-16 and HPV-18 neutralizing antibodies induced by HPV2 were higher than those induced by HPV4 across all age strata (p<0.0001). The observed differences in immune response induced by the two vaccines could be due to differences in formulation, particularly with regard to adjuvant factors that enhance the immune response to vaccine antigens. Although the clinical importance of this difference in immune response is unknown, they may represent determinants of duration of protection against HPV-16 and 18.⁸⁵

Conclusion

External genital warts and their associated HPV infections are considered among the most common sexually transmitted diseases affecting the general population. It is estimated that one percent of the sexually active population of the United States, or 3 to 6 million people, acquire symptomatic genital wart infections each year.²⁴ Approximately 90 percent of genital warts are related to infection with HPV subtypes 6 and 11, which have a very low malignant potential and rarely progress to cancerous lesions. However, those warts associated with HPV subtypes 16 and 18 may be predisposed to oncogenic transformation.⁶

Current treatment options focus predominantly on removal of the external wart rather than attacking the underlying viral infection and have thus proven somewhat inadequate in achieving effective long-term results. Therapies can be categorized as topical, surgical, or immunomodulatory and can differ quite significantly in terms of cost, duration of therapy, dosing schedules, and adverse effects. As of yet, there is little evidence to suggest that one class of treatments is not more effective than another nor has a single therapy emerged as the gold standard for treatment. Selection of a therapeutic modality typically depends on the needs and desires of the individual patient.

Given the strikingly high prevalence of genital warts among the population, and the lack of adequate therapies, HPV vaccines such as HPV4 and HPV2 may play a significant role in reducing the burden of disease by preventing viral infection and transmission. Studies evaluating the effectiveness of HPV vaccines in preventing genital wart infection have shown it to be both safe and extremely successful in both sexes. This supports the need for further research into the development of similar vaccines targeting additional subtypes of HPV. As vaccination against HPV continues to gain popularity and a broader therapeutic population base, it may prove to be instrumental in the treatment and eventual eradication of genital warts.

Footnotes

DISCLOSURE:Drs. Patel and Goldenberg and Ms. Yanofsky report no relevant conflicts of interest.

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Genital Warts | UVA Health

Genital warts are growths or bumps that appear:

• On the vulva
• In or around the vagina or anus
• On the cervix
• On the penis, scrotum, groin, or thigh
• Rarely, in the mouth or throat

Genital warts is one of the most common sexually transmitted diseases (STDs). Most people will be exposed to a form of HPV at some point in their lives. Not everyone will become infected or develop symptoms.

Causes

Genital warts are caused by the human papillomavirus (HPV). There are many different types of HPV. Only a few types are thought to cause genital warts. Many types of HPV are associated with harmless skin warts found on the fingers or feet.

Certain types of HPV may cause cervical cancer. Less commonly, certain strains of HPV can cause cancers of the vulva, anus, or penis.

HPV is easily spread during oral, genital, or anal sex with an infected partner. Most people who have sex with an infected partner will also develop genital warts.

Warts can also be spread to an infant during delivery if the mother has genital warts.

Genital Warts Copyright © Nucleus Medical Media, Inc.

Risk

Factors that may increase your risk for HPV and genital warts include:

• Multiple sexual partners
• First male sexual partner has had two or more previous sexual partners (for women)
• Sex without condoms
• Having a weakened immune system
• Sex at an early age
• Skin-to-skin contact with an infected partner
• Previous history of genital warts or other STDs

Symptoms

Genital warts often look like fleshy, raised growths. They can have a cauliflower shape, and often appear in clusters. Some warts may be flat. The warts may not be easy to see with the unaided eye. Warts can take several weeks or months to appear after the infection.

In women, warts may be found in the following areas:

• Vulva or vagina
• Inside or around the vagina or anus
• Cervix

In men, warts are less common. If present, they are usually found in these areas:

• Tip or shaft of the penis
• Scrotum
• Around the anus

While warts do not usually cause symptoms, the following may occur:

• Bleeding
• Itching
• Irritation

Diagnosis

Genital warts may be diagnosed by:

Visual Exam

A doctor can usually diagnose genital warts by looking at them. If external warts are found on a woman, then the cervix is usually also checked. A doctor may use a special solution to help find lesions that do not have classic features.

Biopsy

A sample of tissue will be taken and tested for HPV.

Treatment

Treatment help the symptoms, but does not cure the virus. The virus stays in your body. This means the warts may recur.

Your treatment depends on the size and location of the warts. Not all warts need to be treated. If left untreated, some may go away on their own, but others may stay. Some warts may also get larger or spread.

Topical Treatments

Topical medication is applied directly to the skin. Your doctor may recommend one of these medications:

• Imiquimod cream
• Sinecatechins ointment
• Podophyllin resin
• Podofilox solution
• Trichloroacetic acid or bichloroacetic acid

Cryosurgery, Electrocautery or Laser Treatment

Methods that instantly destroy warts include:

• Cryosurgery (freezing)
• Electrocautery (burning)
• Laser treatment

These methods are used on small warts. It may be used on larger warts that have not responded to other treatment. A large wart can also be removed with surgery.

Prevention

The only way to completely prevent HPV from spreading is to avoid physical contact with infected partners.

Latex condoms may help reduce the spread of HPV infection and genital warts. Condoms are not 100% effective because they do not cover the entire genital area.

Other ways to help prevent infection include:

• Abstain from sex
• Have a monogamous relationship
• Get regular check-ups for STDs

Vaccine

There is a vaccine for HPV. It is given over a series of three injections to girls and boys aged 11-12 years old. If you are aged 26 or younger and were not vaccinated, you can receive a catch-up vaccine series.

Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

Genital HPV Warts | Growths or Bumps on the Skin

There are many different strains of HPV. Some types of HPV cause visible genital warts.

What do genital warts look like?

Genital warts from HPV are growths or bumps on the skin around the genital area; vulva (the area around the vaginal opening), in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin or thigh. They may be raised or flat warts, single or multiple, small or large. Some HPV warts can cluster together forming a cauliflower-like shape.

The types of HPV linked to cervical cancer or other cancers are not the types associated with genital warts.

How do you get HPV or genital warts?

Subclinical HPV (invisible to the naked eye) and genital warts are usually spread by direct, skin-to-skin contact during vaginal, anal or oral sex.

Warts on other parts of the body, such as the hands, are caused by different types of HPV. Contact with these warts does not seem to be the cause of genital warts.

Warts may appear within several weeks, or even months, after sexual contact with an infection person, or they may never appear. This makes it hard to know exactly when or from whom you got the virus.

It is thought most subclinical HPV infections are transmitted through sexual intercourse, although they are generally believed to be less contagious than genital warts.

How do you know if you have genital warts?

In some cases, it’s difficult to know. Sometimes people do not notice warts because they are inside the vagina, or on the cervix, or in the anus. In addition, they are often flesh-coloured and painless. Only rarely do they cause symptoms such as itching, pain, or bleeding.

Sometimes warts will be found during a physical examination. For those with a cervix, an abnormal cervical smear may be the first warning sign that HPV is present, though a cervical smear is not a test for HPV.

You should go to a doctor or clinic if:

• you notice any unusual growths, bumps, or skin changes on or near your penis, vagina, vulva, or anus; or
• you notice any unusual itching, pain, or bleeding; or
• your sex partner(s) tells you that they have genital HPV or genital warts.

What about HPV, genital warts and pregnancy?

Genital warts very rarely cause problems during pregnancy and delivery, but because of changes in the body during pregnancy, warts can grow in size and number. Delivery by caesarean section is not required unless warts are blocking the birth canal, which is extremely uncommon. Rarely, babies exposed to HPV during birth may develop warts in the throat.

If you are pregnant and have genital warts, speak to your health care provider, as some methods of treatment cannot be used during pregnancy.

Genital warts pamphlet

Some Questions and Answers about HPV and Genital Warts

Genital Warts (Human Papillomavirus) | HealthLink BC

Topic Overview

Is this topic for you?

This topic provides information about the human papillomavirus (HPV), which causes genital warts and can also cause cervical cancer. If you are looking for information about cervical cell changes or cervical cancer, see:

What is human papillomavirus (HPV)?

Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STIs). It is a virus that can be spread through skin-to-skin genital contact. There are many different types of HPV. Some types cause genital warts and are called low-risk. And some types can lead to cervical, anal, or oral cancer and are called high-risk. There is no known cure for HPV, but there is a vaccine that can protect against some types of the virus.

What are genital warts?

Genital warts are skin growths in the groin, genital, or anal areas. They can be different sizes and shapes. Some look like flat white patches, and others are bumpy, like tiny bunches of cauliflower. Sometimes you can’t see the warts at all.

What causes HPV and genital warts?

HPV is a virus. Certain types of the virus cause genital warts and some types cause abnormal cervical cell changes and cervical cancer.

HPV and genital warts can be spread through sex or skin-to-skin genital contact with someone who has the virus.

What are the symptoms?

Most people infected with HPV don’t have symptoms. But if they do, the symptoms may be so mild that they may not know they are infected. The symptoms may include pain, itching, and bleeding, or you may develop visible genital warts.

If you have symptoms, they will probably occur 2 to 3 months after infection. But you can have symptoms from 3 weeks to many years after infection.

It is possible to spread the virus even if you can’t see the warts.

How are HPV and genital warts diagnosed?

A doctor can often tell if you have genital warts by looking closely at your genital and anal areas. He or she may ask you questions about your symptoms and your risk factors. Risk factors are things that make you more likely to get an infection.

Sometimes the doctor takes a sample of tissue from the wart for testing.

For women, if you have an abnormal Pap test, your sample may be tested for high-risk types of HPV.

How are they treated?

There is no cure for HPV, but the symptoms can be treated.

Talk to your doctor about whether you should treat visible genital warts. They usually go away with no treatment, but they may also spread. Most people decide to treat them because of the symptoms or because of how the warts look. But if you don’t have symptoms and are not worried about how the warts look, you can wait and see if the warts go away.

If you do decide to treat genital warts, talk to your doctor about the best treatment for you. There are prescription medicines that you or your doctor can put on the warts. Or your doctor can remove them with lasers, surgery, or by freezing them off.

Even if you treat visible warts or your warts go away without treatment, the HPV infection can stay in your body’s cells. It is possible to spread genital warts to your partner even if you have no signs of them.

Can HPV and genital warts be prevented?

The best way to keep from getting genital warts—or any other STI—is to not have sex or any skin-to-skin genital contact. If you do have sex, practice safer sex.

• Use latex condoms. Latex condoms may help reduce the risk of spreading genital warts, but they do not protect the entire genital area against skin-to-skin contact.
• Before you have sex with someone, talk to them about STIs. Find out whether he or she is at risk for them. Remember that a person can be infected without knowing it.
• If you have symptoms of an STI, don’t have sex.
• Do not have sex with anyone who has symptoms or who may have been exposed to an STI.
• Having several sex partners increases your risk for infection.

The National Advisory Committee on Immunization (NACI) recommends the HPV vaccine for females and males ages 9 to 26. The vaccine may also be given to women ages 27 to 45 who didn’t get the vaccine when they were younger.^{footnote 1} HPV vaccine recommendations may be different in your province or territory. Check with your doctor or provincial ministry of health to find the HPV vaccine recommendations in your area.

HPV vaccines protect against genital warts. Cervarix, Gardasil, and Gardasil 9 are the three types of HPV vaccines.

Cause

HPV infection is caused by a virus. More than 100 types of HPV have been found. Some types cause genital warts and some can lead to cervical cancer. Types 6 and 11 cause most genital warts. Other types such as 16 and 18 are high-risk and can cause abnormal cell changes on the cervix.

How the infection is spread (transmission)

HPV is spread by direct contact.

• The virus can be spread to or from the genitals, anus, mouth, or throat during sexual activities. But warts in the mouth or throat are extremely rare. Latex condoms can lower your risk of getting genital warts.
• After the infection occurs, it may spread to other areas of the genitals or to the anal area.
• You can spread the virus even if you do not have any symptoms of infection or any visible warts.
• There is a small chance that a pregnant woman can pass the virus to her baby.
• Children can get genital warts from sexual abuse.

Symptoms

Human papillomavirus (HPV) infection

Infection with the human papillomavirus (HPV) usually does not cause any symptoms and does not always produce visible genital warts. Some types of HPV cause cell changes to the cervix that can cause an abnormal Pap test.

When symptoms do develop, they usually occur 2 to 3 months after infection. But symptoms have been known to occur from 3 weeks to many years after infection.

Symptoms that may occur with genital warts include:

• Irritation.
• Itching.
• Bleeding.

Genital warts

Genital warts can be different sizes and shapes.

• They may be large, or they may be too small to be seen with the naked eye. They may appear individually or in groups.
• Warts may look like tiny bunches of cauliflower or like flat, white areas that are very difficult to see.
• In women and men, warts may appear in the groin, on and around the genitals, in the urethra, or in the rectum or anus.
• In women:
  • Genital warts may appear around the anus or on the vulva, vagina, or cervix.
  • Women are often unaware of warts inside the vagina or on the cervix until a doctor finds them.
• In men:
  • Genital warts may occur on the outside of the penis, on the scrotum, or around the anus.
  • Men are often unaware they have genital warts, even when they can be seen, until the warts are identified by a doctor.

Symptoms of genital warts may be similar to those of other conditions.

What Happens

Based on the type of HPV, you may or may not have visible genital warts.

• Common HPV types 6 and 11 produce visible warts. These warts may go away on their own, stay the same, or increase in number.
• Other HPV types, such as 16 and 18, do not produce visible genital warts. These types, which may be found with a Pap test, are linked to precancerous cervical cell changes and cervical cancer.

HPV infection and cervical cell changes

In women, most precancerous or cancerous cell changes associated with HPV infection occur on the cervix. This is because the cells of the cervix naturally undergo changes in an area called the transformation zone. This process can cause cervical cells to become abnormal when they are infected with HPV.

Infection with high-risk types of HPV increase the chance that a woman with HPV will develop abnormal cervical cell changes. It is important to have regular examinations by your doctor. If your doctor finds abnormal cells on a Pap test, the cells can be treated to help prevent them from changing to cancer.

HPV infection and anal and penile cancer

Among people who receive anal sex, HPV infection of the anal canal is associated with an increased risk of anal cancer. This risk may be especially high in men who also have HIV infection.^{footnote 2}

Men who are infected with HPV on the penis are more likely to have precancerous or cancerous changes on the penis than men who are not infected. Because HPV does cause cell changes, it is important to have regular examinations by your health care provider. In Canada, cancer of the penis is extremely rare.

HPV infection during pregnancy

The presence of HPV and abnormal cell changes does not affect the outcome of the pregnancy. A pregnant woman who is infected with the type of HPV that causes genital warts may have more complicated warts than a woman who is not pregnant. Genital warts may increase in size, bleed, or become infected with bacteria. Your doctor may recommend treatment. Warts may be passed on to the newborn, but this is rare.

What Increases Your Risk

Things that increase a person’s risk for getting a sexually transmitted infection, such as HPV and genital warts, include:

• Having multiple sex partners.
• Having high-risk partner(s) (partner has multiple sex partners or HPV-infected sex partners).
• Having unprotected sexual contact (not using latex condoms).
• Having an impaired immune system.

If you have a high-risk type of HPV and are using birth control pills for more than 5 years, research suggests that this can increase your risk of getting cervical cancer.^{footnote 3} More research is needed. For more information, see the topic Cervical Cancer.

When should you call your doctor?

Call your doctor if you have any of the following symptoms:

• Sores, bumps, rashes, blisters, or warts on or around your genitals or anus
• Burning, pain, or severe itching while urinating
• For women, an abnormal vaginal discharge that smells bad
• For men, an abnormal discharge from your penis

Call your doctor if you suspect you have been exposed to a sexually transmitted infection (STI).

Avoid sexual contact until you have been examined by a doctor.

Children

A child can get genital warts in several ways. Any child who has genital warts needs to be evaluated by a doctor to find out the cause and to assess for possible sexual abuse.

In rare cases, infants may develop warts in the larynx (laryngeal papillomas), which is in the throat, from exposure to HPV during birth.

Watchful waiting

A doctor should evaluate any warts or other symptoms that suggest infection with the human papillomavirus (HPV) or another sexually transmitted infection (STI). Avoid sexual contact until you have been examined. If you have an STI, avoid sexual contact to prevent spreading the infection.

Sometimes, warts may go away on their own. If you have genital warts, your doctor may observe your condition without using medical treatment. This is called watchful waiting. This period may vary from a few days to weeks or possibly months.

The length of the watchful waiting period is based on:

• The severity of your symptoms.
• The progression of the problem if not treated.
• The risks and benefits of waiting.
• Your age and medical history.

Who to see

In general, your family doctor, general practitioner or nurse practitioner can check to see if you have genital warts.

Treatment may require a specialist, such as a:

Examinations and Tests

A doctor usually can diagnose visible genital warts using your medical history and a physical examination. But not all HPV infections cause visible warts. If you don’t have any visible genital warts or other symptoms, it may be hard for your doctor to diagnose HPV infection. Your doctor may ask you the following questions:

• Do you think you were exposed to HPV or any sexually transmitted infections (STIs)? How do you know? Did your partner tell you?
• What are your symptoms? If you have discharge from the vagina or penis, it is important to note any smell or colour.
• Did you use latex condoms to protect against STIs?
• Which sexual behaviours do you or your partner engage in, including high-risk behaviours such as sex with multiple partners?
• Have you had an STI in the past? How was it treated?
• Have you ever had an abnormal Pap test (for women)?

For women

After your doctor takes your medical history, you may have a gynecological examination, which usually includes a Pap test.

A Pap test screens for abnormal cells on the cervix. Results of the Pap test may indicate an HPV infection even though you have no visible warts.

If your doctor finds areas of abnormal tissue on the cervix (which may be related to HPV infection), he or she may recommend treatment.

For men

After the medical history, you will have a physical examination for genital warts.

In Canada, there is no screening test for HPV infection approved for use in men.^{footnote 5} There are no screening guidelines for penile cancer.

For men and women

Some experts believe that people who receive anal sex should have a screening for anal cancer, especially if they also have HIV infection. In the absence of screening recommendations or effective screening tests, it is very important to have regular check-ups and to tell your health care professional about any signs or symptoms you are having.

If visible warts are present, a diagnosis can usually be made without more testing.

When your doctor finds abnormal tissue but cannot make a definite diagnosis, you may have a biopsy for lab tissue studies.

Testing for the type of HPV that is causing warts is not useful for diagnosis. This test is not routinely done for diagnosis or treatment of genital warts.

Treatment Overview

There is no cure for HPV infection, but warts and cell changes can be treated. HPV infection that causes an abnormal Pap test will be managed differently than the HPV types that cause genital warts.

Genital warts caused by the most common types of human papillomavirus (HPV) may go away on their own without treatment. Depending on the size and location of the warts, there are several ways to manage or treat them. Warts may return after treatment. Talk to your health care professional to discuss your treatment options. Treatment for genital warts does not eliminate the HPV infection. You may still be able to spread the infection. Condoms can help reduce the risk of HPV infection.

Types of treatment

Treatments for genital warts include medicines, freezing, laser, or surgery.

The type of medical treatment for genital warts will depend on:

• The number, size, and location of warts.
• The side effects of treatment.
• The skill of the doctor for each treatment option.
• The cost of treatment, which varies depending on:
  • The cost of medicine.
  • Any specialized equipment used.
  • The number of treatments needed.
• The problems caused by the warts (such as blockage of the urethra).
• Your preference.
• If you are pregnant. Some wart medicines should not be used during pregnancy.

Medicines

Doctors often recommend medicine applied to warts (topical drug treatment) as the first choice of treatment. A doctor will apply the medicines that have a high risk of causing damage to the skin around the warts. You can apply others at home.

Caution: Do not use non-prescription wart removal products to treat genital warts. These products are not intended to be used in the genital area and may cause serious burning.

Surgery and other treatment

Surgery to remove genital warts may be done when:

• Medicine treatment has failed and the removal of warts is considered necessary.
• Warts are widespread.

What to think about

Without treatment, external genital warts may remain unchanged, increase in size or number, or go away. Studies show that no one treatment is completely successful. All treatments have advantages and disadvantages. The benefits and effectiveness of each treatment need to be compared with the side effects and cost.

• Treatment of warts usually requires a series of applications rather than a single treatment.
• Warts in moist areas usually respond better to treatments applied to the area, such as creams or acids.
• Warts on dry skin may respond best to freezing (cryotherapy) or surgical removal.
• Cryotherapy may be done when genital warts are visible and bothersome and are growing in a small area. Repeat treatments may be needed to remove all wart tissue.
• The success of surgery is related to the number of warts. The success rate is higher and additional treatments are less likely to be needed when surgery is done on fewer and smaller warts. But surgery is less likely to be needed for a few small areas of warts. Surgery may require anesthesia.
• Small areas of warts can be quickly treated with removal methods, such as cryotherapy or surgical excision.
• Self-applied medicines may be used for larger areas of warts that need longer or repeated treatments.

A biopsy of warts that do not go away on their own or after treatment is often done to rule out precancerous or cancerous conditions.

Several choices of treatment for pregnant women have been found to be effective and safe, including trichloroacetic acid (TCA), cryotherapy, and surgery.

Prevention

You can reduce your risk of becoming infected with the human papillomavirus (HPV) or another sexually transmitted infection (STI). You also can reduce the risk of spreading HPV to your sex partner(s).

Practice safer sex

Preventing a sexually transmitted infection (STI) is easier than treating an infection after it occurs.

• Talk with your partner about STIs before beginning a sexual relationship. Find out whether he or she is at risk for an STI. Remember that it is possible to be infected with an STI without knowing it. Some STIs, such as HIV infection, may be in your blood for 3 to 6 months before they can be detected.
• Be responsible.
  • Avoid sexual contact if you have symptoms of an STI or are being treated for an STI.
  • Avoid sexual contact with anyone who has symptoms of an STI or who may have been exposed to an STI.
• Having several sex partners increases your risk of getting an STI.

Male condom use

Latex condom use can reduce the risk of becoming infected with HPV. You can reduce the risk of infection if you use a condom every time you have sex. Condoms must be put on before beginning any sexual contact.

Female condom use

Even if you are using another birth control method, you may wish to use condoms to reduce your risk of getting an STI. Female condoms may lower the risk of HPV infection of the cervix, but they do not cover all of the vulva. These condoms are more effective at lowering the risk for other STIs.

Vaccine

The HPV shot is approved for females ages 9 through 45 years and males ages 9 through 26 years. The National Advisory Committee on Immunization (NACI) and Health Canada recommend the vaccine for females 9 through 26 years old and for males 9 to 26 years old.^{footnote 1, footnote 6} HPV vaccine recommendations may be different in your province or territory. Check with your doctor or provincial ministry of health to find the HPV vaccine recommendations in your area.

The HPV vaccine can protect against genital warts.

• HPV: Should My Child Get the Vaccine?
• HPV: Should I Get the Vaccine?

The HPV vaccine is not useful for treating women who already are infected with HPV.^{footnote 7} But it may protect a woman against types of the HPV virus other than the one causing her infection.

Home Treatment

There is no cure for HPV infection, but symptoms of genital warts can be treated. A doctor may prescribe medicine that you can use at home, such as podophyllotoxin solution or imiquimod cream.

Caution: Do not use non-prescription wart removal products to treat genital warts. These products are not intended for the genital area and may cause serious burning.

You can use at-home care to feel more comfortable.

• Take sitz baths. Fill a tub with a few centimetres of warm water and sit in it for 10 or 15 minutes every day.
• Squeeze warm water from a bottle over your genital area to provide comfort and cleansing.
• Keep the warts clean and dry in between baths. You may want to let the sores air dry. This may feel better than a towel.

It is important to remember that most infections are minor, without serious complications. Some cases of HPV infection and genital warts disappear without treatment, although human papillomavirus (HPV) may still be present in your body’s cells.

Medications

Medicine may be used to destroy bothersome genital warts, relieve your symptoms, and reduce the amount of area affected by warts, particularly when the warts are:

• Visible, bothersome, and growing in a small area.
• A cosmetic concern and you want them removed. Warts that are growing around the anus or on external genitals, such as on the penis or vulva, may be removed because they are unsightly. Some treatments that remove genital warts are more likely to leave scars. So cosmetic concerns about scarring may help guide the choice of treatment.

Topical medicine often is the first treatment. For safety, a doctor will apply the topical medicines that could damage the skin around the warts. You can apply other medicines at home. If warts return after one course of treatment with topical medicine, they are treated again only if there are clear reasons for retreatment.

Medicines are not used to treat abnormal cell changes found on a Pap test. For more information on treating abnormal cell changes caused by high-risk HPV, see the topic Abnormal Pap Test.

Treatment applied at home

The following medicines can be applied to the affected area (topical treatment) at home:

• Imiquimod (such as Aldara P)
• Podophyllotoxin (such as Condyline or Wartec)
• Sinecatechins (such as Veregen)

Do not use these medicines during pregnancy.

Imiquimod and podophyllotoxin are typically the most effective medicine options that can be applied at home. Read the instructions carefully before using these medicines.

Treatment applied by a doctor

Treatment by a doctor can:

• Treat areas that you cannot reach easily.
• Treat a large area.
• Remove the warts quickly.
• Be painful.
• Have side effects.

Medicines applied by a doctor include:

• Trichloroacetic acid (TCA).
• Podophyllin liquid.

Treatment during pregnancy

Treatment for pregnant women includes trichloroacetic acid (TCA), cryotherapy, laser therapy, loop electrosurgical excision procedure (LEEP), and surgical removal by electrocautery or excision.

What to think about

Avoid sexual contact in the treated area until the area is completely healed.

Some medicine may be more expensive than others.

Warts on the vulva or penis that do not go away on their own or after treatment often are biopsied to rule out precancerous or cancerous conditions.

Recurrence

Removing genital warts does not cure an HPV infection. Warts may go away with topical treatment, but they may return, because HPV may still be in the body’s cells.

Even if genital warts have been removed or destroyed:

• You may still be able to infect sex partners with HPV.
• You should continue to use latex condoms during sexual intercourse if you have multiple sex partners.

Surgery

You may have surgery to remove genital warts if they are widespread and medicine or freezing (cryotherapy) fails to remove them.

If you have a high-risk type of HPV that causes an abnormal Pap test, your doctor may recommend certain types of surgery. For more information about surgical methods to treat abnormal cell changes, see the topic Abnormal Pap Test.

Surgery choices

Surgical methods that may be used include:

Surgical treatment for pregnant women

Surgical choices for pregnant women with genital warts include electrocautery, surgical excision, loop electrosurgical excision (LEEP), and laser surgery.

What to think about

The success of surgery is related to the number of warts present. The success rate is higher and additional treatments are less likely to be required when surgery is done on fewer and smaller warts. But surgery is less likely to be needed for a few small areas of warts.

References

Citations

1. National Advisory Committee on Immunization (NACI) (2012). Update on human papillomavirus (HPV) vaccines. Canada Communicable Disease Report, 38(ACS-1): 1–62. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-1/index-eng.php#a5.
2. Bonnez W (2015). Papillomaviruses. In JE Bennett et al., eds., Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 8th ed., vol. 1, pp. 1794–1806. Philadelphia: Saunders.
3. International Collaboration of Epidemiological Studies of Cervical Cancer (2007). Cervical cancer and hormonal contraceptives: Collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet, 370(9599): 1609–1621.
4. U.S. Department of Health and Human Services (2007). Human Papillomavirus: HPV information for Clinicians. Available online: http://www.cdc.gov/std/hpv/hpv-clinicians-brochure.htm.
5. Public Health Agency of Canada (2012). Human papillomavirus (HPV) and men: Questions and answers. Available online: http://www.phac-aspc.gc.ca/std-mts/hpv-vph/hpv-vph-man-eng.php#a7.
6. National Advisory Committee on Immunization (NACI) (2017). Updated Recommendations on Human Papillomavirus (HPV) Vaccines: 9-valent HPV vaccine 2-dose immunization schedule and the use of HPV vaccines in immunocompromised populations. Government of Canada. https://www.canada.ca/en/public-health/services/publications/healthy-living/updated-recommendations-human-papillomavirus-immunization-schedule-immunocompromised-populations.html. Accessed October 8, 2018.
7. Hildesheim A, et al. (2007). Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection. JAMA, 298(7): 743–753.

Credits

Adaptation Date: 10/4/2021

Adapted By: HealthLink BC

Adaptation Reviewed By: HealthLink BC

National Advisory Committee on Immunization (NACI) (2012). Update on human papillomavirus (HPV) vaccines. Canada Communicable Disease Report, 38(ACS-1): 1-62. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-1/index-eng.php#a5.

Bonnez W (2015). Papillomaviruses. In JE Bennett et al., eds., Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 8th ed., vol. 1, pp. 1794-1806. Philadelphia: Saunders.

International Collaboration of Epidemiological Studies of Cervical Cancer (2007). Cervical cancer and hormonal contraceptives: Collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet, 370(9599): 1609-1621.

U.S. Department of Health and Human Services (2007). Human Papillomavirus: HPV information for Clinicians. Available online: http://www.cdc.gov/std/hpv/hpv-clinicians-brochure.htm.

Public Health Agency of Canada (2012). Human papillomavirus (HPV) and men: Questions and answers. Available online: http://www.phac-aspc.gc.ca/std-mts/hpv-vph/hpv-vph-man-eng.php#a7.

National Advisory Committee on Immunization (NACI) (2017). Updated Recommendations on Human Papillomavirus (HPV) Vaccines: 9-valent HPV vaccine 2-dose immunization schedule and the use of HPV vaccines in immunocompromised populations. Government of Canada. https://www.canada.ca/en/public-health/services/publications/healthy-living/updated-recommendations-human-papillomavirus-immunization-schedule-immunocompromised-populations.html. Accessed October 8, 2018.

Hildesheim A, et al. (2007). Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection. JAMA, 298(7): 743-753.

What Are Genital Warts? | LloydsPharmacy Online Doctor UK

What are genital warts? Genital warts are small, fleshy growths or bumps found in the genital or anal area. They are a viral skin infection caused by the human papillomavirus (HPV). HPV isn’t a single virus but a group of more than 100 viruses. Most strains of HPV are symptomless; however some HPV can manifest physically. Approximately 90% of genital warts are caused by two strains of HPV: type 6 and type 11. For more information see our HPV article.

Are genital warts dangerous?

No. Genital warts are primarily harmless. Unlike, say, chlamydia, no evidence links genital warts to loss of fertility. Although occasionally sore and itchy, most cases of genital warts are completely painless. However genital warts do look unpleasant. Their presence can cause a loss of confidence, anxiety and distress.

What are the symptoms of genital warts?

Genital warts often occur in clusters or large groups. They can occur in a range of sizes, and occasionally they can become itchy or inflamed.

Genital warts in women

Most cases of genital warts appear around the vulva, the opening of the vagina. Often the warts will be too small to notice, and entirely symptomless. Genital warts can appear as:

• warts around the vulva
• warts on the cervix
• warts within the vagina
• warts around or within the anus
• warts in the groin

Genital warts in men

Genital warts in men are less common than in women. Most cases occur around the anus or on the tip of the penis. They can appear as:

• warts on the penis, especially the tip
• warts on and around the scrotum / testicles
• warts within the urethra (where urine comes out)
• warts around or within the anus
• warts in the groin

Considering an STI test?

View our STI test kit options

What genital warts treatments are available?

Treatment for genital warts depends on the severity of the symptoms. Our online doctor service offers two medical treatments for genital warts: Warticon and Aldara. These should treat most cases of genital warts. For a more detailed overview visit our genital wart treatment page.

• Warticon (podophyllotoxin): solution or cream used to treat small, fleshy warts. Warticon physically burns off the wart. The warts take around one month to disappear (sometimes longer) but can often return.
• Aldara (imiquimod): a cream that works best on larger warts. Aldara assists your body’s immune system in fighting the warts and the HPV. It may take several weeks, even months for the warts to disappear. However warts treated with Aldara are less likely to recur.

For more severe cases of genital warts, you may need to physically remove each wart. This is known as physical ablation. The four main methods of removing warts through physical ablation are:

• Cryotherapy: freezing the warts with liquid nitrogen or dry ice.
• Excision: cutting off the wart under local anesthetic.
• Electrosurgery: a specialist treatment that burns away the wart using an electric current.
• Laser surgery: difficult to access warts (e.g. within the anus) can be burned away with a laser.

For all treatments you should avoid sexual intercourse until you are fully healed. You should use a condom during sex for the next three months (and whenever you have sex with a new partner). Unfortunately no treatment can remove HPV itself, the underlying cause of genital warts. It is also possible to pick up another strain of HPV. Therefore there is always a change the warts may recur.

HPV vaccination

Using a condom during sex is the most effective protection against genital warts. However even condoms aren’t guaranteed as you can still pass HPV through the bare skin not covered by the condom. Vaccinating against HPV is recommended. We offer the Gardasil vaccination, which can reduce your risk of genital warts, as well as cervical cancer, by immunising you against four common strains of HPV: 6, 11, 16 and 18. Visit our Gardasil information page to start your online consultation.

Frequently asked questions about genital warts

Are genital warts itchy?
Genital warts can sometimes become itchy or cause itchiness to the genitals and cause some inflammation. 

Are genital warts dangerous?

Genital warts are not usually painful or a serious threat to your health. However, if you don’t get treatment for genital warts they can become uncomfortable and not very nice to look at. 

If you’re pregnant or thinking about getting pregnant it’s worth checking with your doctor as treatment for genital warts might change. If warts get big, they might be removed before birth to avoid any issues. If you have a vaginal delivery, the virus that causes warts can be passed to the baby but this is rare.

What causes genital warts?
Genital warts are caused by certain strains of the HPV virus. Not everyone who gets the virus will get genital warts, but for some people the infection will turn into genital warts. The virus is usually passed from one person to another during vaginal or anal sex. It’s more likely to be passed on when warts are present, but it can also be passed on once the warts have disappeared. 

Do genital warts show up right away?
If you’ve been in contact with the virus it can take between 3 weeks and 18 months for visible bumps to develop. 

90,000 Removal of neoplasms, papillomas of the penis

Removal of neoplasms, papillomas of the penis by radio wave method

Radio wave surgery allows you to safely and effectively eliminate various neoplasms, even in the intimate area.

ADVANTAGES of performing the procedure in CDC DAVINCI

• WITHOUT PAIN – local anesthesia for 2 hours.
• SAFE – Urology andrologists with over 20 years of experience
• FOR 1 DAY, without hospitalization – the next day you can go to work
• AESTHETIC RESULT

RECORD for a consultation: +7 (863) 333-25-33.

Removal of neoplasms, papillomas of the penis, skin of the scrotum and pubis

Papillomas on the penis are formed on the mucous membranes, as well as on the skin of the scrotum and pubis.This is a fairly common problem that is caused by HPV (Human Papillomavirus). The incubation period ranges from a couple of months to several years, depending on the state of the immune system.

Features of papillomas and causes of occurrence

Papilloma on the head of the penis and other parts of the organ is a neoplasm of a certain size. In appearance, the overgrowth can be compared with mushrooms, cauliflower inflorescences. Most often they appear in the zone of the foreskin, less often papillomas are found on the scrotum or the trunk of the penis.

Papillomas located in the frenum area look like small white pimples, and on the head they appear as multiple growths.

Viral agents, as a result of which papillomas arise, make their way into the deep layers through microcracks in the skin or mucous membrane. Most often this happens during intimacy. You can get infected when using personal hygiene items of the carrier of the virus, as well as in saunas, swimming pools, etc.

If a man has a strong immune system, then the ailment will not manifest, but the person will become a carrier of this virus.

How to remove papillomas on the penis? There are many ways to get rid of the problem. The DAVINCHI clinic offers one of the most effective and safest methods – radio wave and laser removal.

Radio wave offset

Radio wave removal of papillomas occurs using a surgical radio wave apparatus. This procedure has many benefits. It allows the technician to control the area covered and the depth of exposure to radio waves.Due to the coagulation of small arterioles, the procedure is almost bloodless.

During the procedure, there is no carbonization of the tissues, which subsequently excludes the formation of a black scab. Since the incision is made without direct contact with the skin, the upper layers of the skin are not damaged.

The radio wave method provides easy dissection of tissues and the absence of excessive release of wound contents. It allows you to work with neoplasms that protrude significantly above the skin.

The operation takes no more than half an hour. It is slightly painful, since thanks to radio waves, coagulation of nerve endings occurs. This eliminates the appearance of muscle spasm. Accelerated tissue healing shortens the rehabilitation period.

Wounds heal by primary intention, thereby eliminating the appearance of a rough scar. This is due to the fact that the process is carried out by cutting, without affecting healthy tissue.

The radio wave has a sterilizing effect, which guarantees the absence of complications in the form of inflammation, edema, and the appearance of pus.

Laser removal

This procedure is in demand due to many advantages, including:

• carrying out the procedure under local anesthesia;

• slight soreness;

• no bleeding due to the special effect of the laser;

• the ability to avoid the appearance of scars and scars;

• healing properties of the laser beam;

• short period of rehabilitation;

• the ability to control the depth of exposure by adjusting the properties of the laser beam, which excludes damage to healthy tissues;

• disinfecting property of the laser.

The number of sessions depends on the size of the tumor. With small sizes, one time is enough for removal, and with large sizes, up to 4-5 manipulations may be required.

Removal of papillomas in CDC “DAVINCHI”

To remove papilloma on the penis in Rostov-on-Don, we suggest using the services of the DAVINCHI clinic. Our center is equipped with the latest radio wave devices and cosmetic lasers. We have created a comfortable environment, a modern operating room that meets the established standards.

Qualified specialists have already performed a large number of operations, they have significant practical experience in eliminating neoplasms on the skin. Removal of papillomas is painless, thanks to the use of high-quality local anesthetics. The drugs are selected for each patient individually.

Our clinic offers comprehensive treatment. We examine the removed tissue to determine the type of virus, which allows us to choose the right treatment to prevent relapse.

Make an appointment by phone (863) 333-25-33, so as not to wait in line and immediately go to the appointment. The attending physician will take you for a consultation, tell you in detail about the procedures. The prices for the operation can be found in the price list.

• Name of service

  Price

• Appointment of urologist-andrologist N. AvadievaE.

  2200 RUB

• removal of a complex of anogenital and perianal formations from 10 pcs and more

  14000 RUB

• Removal of a complex of anogenital and perianal formations from 2 to 4 pieces

  5000 RUB

• removal of a complex of anogenital and perianal formations from 5 to 10 pieces

  8000 RUB

• Removal of neoplasms of anogenital and perianal lesions (excluding the cost of histology) one lesion

  2500 RUB

Why choose us

• KNOWLEDGE, EXPERIENCE AND QUALIFICATION
  All doctors are regularly trained in leading Russian and foreign clinics and events

• OWN LABORATORY
  Perform analyzes as soon as possible at affordable prices.

• TECHNICAL EQUIPMENT
  The offices are equipped with modern equipment from the world’s leading manufacturers

• Pioneers and innovators
  We are the first to introduce many modern technologies in Rostov-on-Don.(5D ultrasound, aesthetic gynecology and anrology, photodynamic therapy, radiothermometry, vacuum aspiration biopsy, Fotona4D)

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90,000 What if you have Human Papillomavirus (HPV)? Diagnostics, treatment, prevention.

Now they often began to diagnose human papillomavirus (HPV) in patients and after that the eternal question began to arise, what to do?

To begin with, I would like to tell you a little about it: the definition of the human papillomavirus.

Generally speaking, HPV infection can be in the following forms:

1. Latent course is defined as persistence of papillomavirus in the basal layer of the epithelium. In this case, the virus is in episomal form (the DNA molecule of the virus is not embedded in the DNA molecule of the cell) and does not lead to pathological changes in the cells. The latent course of infection is characterized by the absence of clinical manifestations, colposcopic, cytological and histological norm.The presence of HPV infection is determined by DNA methods (PCR).
2. A productive infection involves the clinical manifestations of infection (papillomas, warts, condylomas). In this case, the virus, existing in episomal form, is copied in the infected cells. At the same time, there is an increased multiplication of cells of the basal layer of the epithelium, which leads to the progression of infection and the appearance of vegetation (growths). A clinically productive infection is defined as warts or papillomas. The virus is detected by PCR.During histological examination, the phenomena of hyperkeratosis (increased keratinization, i.e. aging of cells) are determined.
3. Dysplasia (neoplasia) develops when the viral DNA is integrated (inserted) into the cell genome. With neoplasia, changes occur in the structure of epithelial cells. Most often, lesions are localized in the transition zone of the cervix. At the junction of stratified squamous and columnar epithelium, basal cells sensitive to viral infection are in close proximity to the surface layers, which facilitates contact with the virus during infection.HPV infection is confirmed by histological examination and colposcopy.
4. In the case of invasive tumor carcinoma, the virus exists in the cell in an integrated form. At the same time, altered, “atypical” cells are revealed, indicating the malignancy of the process. The most common localization is the transitional zone of the cervix. It is detected during colposcopic and histological examination.

How is HPV infection manifested?

The main symptom of human papillomavirus infection is the formation of so-called genital warts.

Externally, genital warts are similar to common warts. They can be small in size (from a few millimeters to a centimeter), pinkish or flesh-colored, smooth or slightly bumpy surface.

Most often, genital warts are formed in the external genital area.

In women, genital warts can occur near the clitoris, on the labia minora and majora, in the vagina and on the cervix.In case of irritation of genital warts located close to the entrance to the vagina, itching and minor bleeding may occur during intercourse.

In men, genital warts form on the penis and scrotum.

Warts can also form in the anus, in the urethra, or anywhere else on the skin (neck skin, armpits). Several adjacent genital warts can merge into one large “wart”.

As a rule, genital warts are painless. In some cases, there is slight itching and discomfort in the genital warts.

When should you see a doctor?

Be sure to consult a doctor if you notice formations (warts, outgrowths) on your skin that look like genital warts. Your doctor will order the necessary examinations to help you determine the exact cause of the disease and exclude other sexually transmitted diseases.

HPV diagnosis?

To confirm the diagnosis of human papillomavirus infection, the PCR (polymerase chain reaction) method is used, which allows you to determine the DNA of the virus and determine exactly what type of virus a person is infected with.

In modern diagnostic laboratories, the type of virus, its amount (viral load) and the integration of the virus into the genome are determined. At the beginning of the article, information is given that shows that the most dangerous HPVs of high oncogenic risk (VOR).Apart from the type of virus, the definition and its quantity are important. The tactics of treatment depend on this. The integration of the virus into the cell genome, unfortunately, is not determined in our laboratories. This analysis is important in the early diagnosis of cervical epithelial dysplasia and non-invasive carcinoma.

It is very important that everyone understands, even if PCR analysis reveals oncogenic forms of HPV in you, this does not mean that you already have cervical cancer or that you will inevitably get sick with it in the near future, since not in all cases HPV leads to the development of cancer.It can take years from the moment of infection to the appearance of precancer.

In order to determine whether HPV has caused a change in the cells of the cervix and whether there is a risk of developing cancer, it is imperative to undergo a thorough gynecological examination, which must include:

• Colposcopy (examination of the cervix with an apparatus that resembles a microscope and allows examination under magnification from 8 to 20 times).
• Cytological smear (PAP test), which is used to determine dysplastic changes in the cells of the cervix.
• Bacterioscopic examination of vaginal discharge. Often HPV infection is combined with other sexually transmitted infections (in about 20% of cases), so additional examination may be necessary to determine chlamydia, mycoplasmosis, ureaplasmosis and trichomoniasis.
• Targeted biopsy – taking a piece of tissue from the cervix in cases of dysplasia or suspicion of a malignant tumor of the cervix.

HPV treatment

Since a complete cure for papillomavirus infection is currently impossible to achieve (along with this, spontaneous, spontaneous cure is often observed), the manifestations of HPV are treated, and not the presence of the virus in the body.At the same time, the effectiveness of various methods of treatment is 50-70%, and in a quarter of cases the disease reappears already several months after the end of treatment. The question of the appropriateness of the treatment of each patient is decided by the doctor individually. At the same time, it is necessary to avoid factors that reduce immunity (hypothermia, severe emotional stress, chronic overwork, vitamin deficiency). There are studies that suggest a preventive effect of retinoids (beta-carotene and vitamin A), vitamin C and trace minerals such as folate on HPV-related diseases.

Among the methods of treating the manifestations of HPV infection (genital warts and papillomas), the most commonly used are:

1. Destructive methods is a local treatment aimed at removing genital warts. There are physical ( cryodestruction, laser therapy, diathermocoagulation, electrosurgical excision ) and chemical ( trichloroacetic acid, feresol, solcoderm ) destructive methods, as well as surgical removal of genital warts . Cytotoxic drugs – podophyllin, podophyllotoxin ( condilin ), 5-fluorouracil . For women of childbearing age, reliable contraception or refusal to have sex is recommended during treatment.
2. Immunological methods The most commonly used for the treatment of HPV infection are interferons ( Laferon, Laferobion, Alfarekin, Reaferon, Viferon ) . They are a family of proteins that are produced by cells of the immune system in response to viral stimulation.Separately, there is the drug Alokin-alpha, which stimulates the production of its own interferon and activates cellular immunity.
3. Specific antiviral drugs ( cidofovir, panavir, alpirazine ). The well-known antiviral drug acyclovir (zovirax) has no effect on HPV. Of the local (vaginal) drugs, Epigen intim spray and Betadine have an antiviral effect.

Prevention of HPV

It can be non-specific and specific.

Nonspecific Includes prevention of sexual transmission of HPV, a healthy lifestyle to strengthen the immune system, and a balanced diet that includes beta-carotene, vitamin A, vitamin C and folic acid.

Specific prophylaxis – vaccination.

HPV vaccines contain organic matter similar in structure to live HPV viruses. These substances can in no way cause illness.

After the introduction of the vaccine, cells of the immune system begin to be produced in the human body, which prevent the introduction of HPV into the body.

There are currently two types of HPV vaccines: quadrivalent Gardasil and bivalent Cervarix.

Cervarix prevents infections with HPV 16 and 18, which cause 70% of all cervical and anal cancers.

Gardasil, in addition to protection against HPV types 16 and 18, also provides protection against HPV types 6 and 11, which cause 90% of cases of genital warts.

Gardasil and Cervarix protect against infection in people who are not yet infected with the corresponding HPV type. They cannot eliminate the virus from the human body if it has already entered it and cannot cure diseases (for example, genital warts or cervical dysplasia) that the virus has already provoked. It is for this reason that HPV vaccinations are recommended during childhood and adolescence, prior to the onset of sexual activity.

Thus, the Gardasil vaccine protects against infection with HPV types 6, 11, 16 and 18 and is recommended for the prevention of cervical cancer and dysplasia, cancer of the vagina and external genital organs in women, as well as for the prevention of anal cancer and genital warts in men and women. …The Cervarix vaccine protects against infection with HPV types 16 and 18 and is recommended for the prevention of cervical cancer and dysplasia in women and anal cancer in men and women.

In 2014, a nine-valent vaccine was released, which eliminated the shortcomings of the previous ones. The nine-valent Gardasil 9 vaccine covers an additional five high-risk virus types: 31, 33, 45, 52 and 58. In December 2014, Gardasil 9 was approved by the US Food and Drug Administration (FDA) …

As of 2013, vaccines are registered in more than 125 countries of the world, almost 20 countries are included in the national vaccination schedules, 111 million doses of the drug are distributed worldwide.

Author:
Dmitry G. Sumtsov

Electrocoagulation of genital warts

Electrocoagulation of genital warts is a medical procedure aimed at eliminating them by exposing them to a high frequency current. During the procedure, a special electrode is used, to which a current of certain frequencies is supplied.When exposed to skin neoplasms, the temperature in their cells rises, as a result of which they lose moisture and die off.

The procedure is quite painful, therefore, local anesthesia is used during its implementation. At the same time, it is simple and provides good results. Its versatility allows it to be used on different parts of the body, including the genitals.

Removal of genital warts can be ordered in the network of clinics “Doctor near”.We have state-of-the-art equipment and conduct a pricing policy that is loyal to our customers, making our services available to all residents of Moscow.

What are condylomas?

Genital warts are a type of viral warts that look like soft papillary neoplasms on a pedicle, characterized by a tendency to merge. They are sometimes called genital warts because they affect the mucous membranes of the external genital organs:

The disease is caused by the papilloma virus and is quite common.Its transmission occurs through sexual contact with an infected partner. The virus infects those areas that are most susceptible to injury during sex. It is prone to relapses (especially against the background of reduced immunity) and equally often affects male and female patients.

The danger of neoplasms is that it can lead to serious complications – up to and including malignancy. What can we say about a cosmetic defect, the risk of infection and injury?

Indications and contraindications for the removal of genital warts by electrocoagulation

The essence of the electrocoagulation method

Despite the fact that electrocautery is a medical procedure, it is often used in cosmetology. Removal of genital warts or female external genital organs involves the destruction of their structure due to exposure to electric current, accompanied by their death.

The term “coagulation” is not used by chance: it is derived from the Latin word “coagulatio”, which translates as “coagulation”.In the process of exposure to condylomas with a high-frequency current, they are burned to the base and necrosis. During the procedure, the doctor can hold the top of the warts with tweezers, cutting it off with current along the base. The technique is not only effective in relation to warts, but also allows you to effectively remove papillomas, spider veins and atheromas.

How is electrocautery performed?

The procedure does not require preparation from the patient: he needs to come to the urologist’s office on time and inform him about the presence of an allergic reaction to anesthesia or the presence of certain diseases.

During the procedure, the doctor uses an electrocoagulator. The action is carried out by an electrode, which has the form of a steel loop, to which a high-frequency electric current is applied.

Before starting the procedure, the patient is asked to sit in the urological chair and perform antiseptic treatment of the affected area and its anesthesia. After that, the urologist proceeds to electrocoagulation, during which he applies an electrode to the base of the warts, burning them out.

Depending on how much warts need to be removed, the duration of the procedure can be from ten to thirty minutes. If the neoplasm is large, it is sent for histology. This is a diagnostic study of tissues that allows you to determine the nature of condyloma.

Recovery period after electrocautery

The terms of rehabilitation after removal of genital warts depend on their number and the area of ​​the lesion. Thus, they can take anywhere from a few days to two months.In order to minimize the risk of complications, the patient needs to adhere to the recommendations of the attending physician. They are as follows:

• for the first three days, refuse to take a shower and a bath and exclude the possibility of getting the treated area wet;
• Regularly wipe the crusts that appear on the spot with a solution of potassium permanganate or hydrogen peroxide, do not comb or peel them off;
• Seek medical help if pain symptoms, redness and swelling have not disappeared 48 hours after the procedure;
• abstaining from sexual intercourse for a week after the procedure;
• Refusal to visit baths, saunas, beaches and solariums during the recovery period.

Pros and cons of electrocoagulation of genital warts

The procedure is quite traumatic and can lead to the formation of scars, therefore it is recommended to use it to remove small single warts. In this case, it will give the desired result and eliminate any negative consequences. As for its positive aspects, they are as follows:

• affordable cost and simplicity;
• efficiency from 90% to 95%;
• versatility, which can be used to remove neoplasms on the genital mucosa;
• Ability to eliminate in one session;
• allows you to eliminate not only the neoplasm, but also the affected cells of the epidermis.

It is important to understand that removal of genital warts exclusively without appropriate therapy does not exclude the risk of relapse, therefore it must be carried out in conjunction with other methods of treatment.

You can make an appointment with the Doctor Nearby specialists by calling the round-the-clock number: +7 (495) 153-01-77.

ᐅ Treatment of papillomas with vinegar

ᐅ Treatment of papillomas with vinegar

For many, warts and papillomas are not unusual, so people are not even going to treat them.But doctors have long proven that a wart can cause skin cancer or provoke the development of a dangerous disease – HPV, which significantly shortens life in the absence of proper treatment.

Warts in the anal area often appear in gay men. Treatment of pubic warts. Intimate warts: symptoms and treatment. with the defeat of the pubic part in men, in addition to aesthetic unattractiveness, it may appear.Pubic warts in men: treatment. Features of the treatment of some areas. Warts on the penis: what is it. For more information on the symptoms of a wart, see the video: Pubic warts in men: treatment. Treatment of pubic warts. Pubic warts can occur in both men and women. Genital warts in men appear on the head of the penis, frenulum of the foreskin, on the scrotum, and on How is pubic warts treated. Pubic warts in men treatment.If you have papillomas or warts, you run the risk of getting melanoma, an incurable skin cancer. Intimate warts in men are localized on the penis, in women they can be observed on the labia and are difficult to treat, this process can. Pubic warts treatment. A month ago, a pimple (like a wart) appeared just above the genital. Red dots, streptoderma on the pubic part of a man. Condylomas in men are concentrated around the head of the penis, less often in the scrotum or groin. Inguinal warts in men are removed with a laser, warts.Can warts be removed with castor oil? As with hardware removal, home treatment for warts is also required. Today’s pharmacy uses it more to treat many skin problems. Most often, dermatologists use castor oil for warts. Applying salicylic acid for facial warts and treating them with an ointment and patch based on And if you have warts, castor oil is great. Castor oil treatment for warts: wipe the warts with castor oil twice a day – in the morning and in the evening.Usually, castor oil is applied to the warts a couple of times a day as a treatment. Properties of castor oil for warts and papillomas. Based on the test results, the doctor will most likely prescribe a complex treatment, in which castor. Methods of treatment are divided into two groups: medications and have long been known, and Very often they use ordinary castor oil for warts. I also use castor oil for hair care, the effect is effective, but it is harder to wash off other oils. And for the first time I hear about the treatment of a wart, I will remember.Castor oil is very effective as a topical treatment for warts. Photo: Castor oil treatment. Castor oil for warts and hair treatment. To your quote book or community! Castor oil will help reduce warts and heal hair. With the help of Papinol, it turned out to reduce an ugly large wart on the neck. She got out soon after giving birth, it seemed that she did not pose any danger, but aesthetically she did not like it. I tried to reduce it with folk remedies, it didn’t work. I was looking, looking for what can be done, and found out that there is such a Papinol.Why did you decide to buy it, and not pharmacy products? In pharmacies they offer alkalis and ointments on a chemical basis, and Papinol is natural, based on herbs, comfrey root, mulberry bark, etc.

Reviews Treatment of papillomas with vinegar

There are two types of Papinol: capsules and gel, I chose a gel, it’s easier for me. You need very little gel, literally two drops, gently apply them to the wart, without pressing, and so 2 times a day. It took a week to get rid of the wart.During this time, it disappeared completely, a red spot remained on the skin, then I began to apply the gel already on the spot, and it completely disappeared in 10 days. Remained a pink skin, which soon overgrown. No scars, no scars. The wart no longer appeared. There is still more than half of the tube left of the gel, and the shelf life will not come out for a long time, if someone’s family gets warts, I now know what to do. Reviews Treatment of papillomas with vinegar

The manufacturer of the medicinal composition managed to obtain all official certificates of quality and conformity, as well as the necessary sales permits.However, the tool has not yet reached the wide market, but is distributed through a special website on the network – here you can buy Papinol at a low price and with fast delivery. Feedback on the results of treatment can be left directly on the seller’s resource or any convenient site.

I will share my real review about Treatment of papillomas with vinegar. You can make a purchase on the website or order a call back. In a few minutes a specialist will contact you to place an order and clarify the delivery method. Within 2-10 working days, pick up the parcel from the post office or from the courier by cash on delivery.My husband did everything strictly according to the instructions (I made sure that he did not forget), and very soon we began to observe changes with a corn. It seemed very hard, but after a few days of treatment, it began to exfoliate and come off in pieces. At the same time, it seemed to shrink and shrink. This process lasted more than two weeks, and every day the callus became less and less. Not a trace of it remained, not a bump, not a mark, only new skin, which over time became equal in color to the palm. And no operations were required.

Learn more about Treatment of papillomas with vinegar

More links where you can learn about Treatment of papillomas with vinegar: Removal of papillomas Zyuzino Treatment of papillomas with vinegar
Removal of warts in Nizhny Novgorod Treatment of Avtozavodsky District , Removal of warts , Removal of warts in Nizhny Novgorod 9000 vinegar , Folk remedies for papillomas Forum , Methods for removing warts on the face
Removing warts in salsk Removing papillomas with liquid nitrogen SPb.

Buy-Treatment of papillomas with vinegar

Small growths did not cause any pain, but aesthetically they were extremely unpleasant. Even in the summer I had to wrap myself in turtlenecks or wear special chiffon scarves and neckerchiefs. Ak and disguised herself until she noticed that there were more and more moles. That is, they not only did not disappear by themselves, they also grew.
Warts in the anal area often appear in gay men.Treatment of pubic warts. Intimate warts: symptoms and treatment. with the defeat of the pubic part in men, in addition to aesthetic unattractiveness, it may appear. Pubic warts in men: treatment. Features of the treatment of some areas. Warts on the penis: what is it. For more information on the symptoms of a wart, see the video: Pubic warts in men: treatment. Treatment of pubic warts. Pubic warts can occur in both men and women. Genital warts in men appear on the head of the penis, frenulum of the foreskin, on the scrotum, and on How is pubic warts treated.Pubic warts in men treatment. If you have papillomas or warts, you run the risk of getting melanoma, an incurable skin cancer. Intimate warts in men are localized on the penis, in women they can be observed on the labia and are difficult to treat, this process can. Pubic warts treatment. A month ago, a pimple (like a wart) appeared just above the genital. Red dots, streptoderma on the pubic part of a man. Condylomas in men are concentrated around the head of the penis, less often in the scrotum or groin.Inguinal warts in men are removed with a laser, warts. Skin cancer is very difficult to cure, almost impossible in most cases. And neoplasms, which everyone is used to considering as harmless, imperceptibly transform into malignant ones and develop rapidly. Therefore, you need to protect yourself from such a risk by removing growths and destroying the very provocateur of their appearance. Now there is no better remedy than Papinol. It has a 100% natural composition and is suitable for everyone.

Papillomas, condylomas, warts… How to catch HPV at an early stage? | Healthy life | Health

It is unpleasant when they appear on the hands, soles, face or neck, but the most dangerous are anogenital or genital warts. Why?

Figs of Hellas

Genital warts have been known to mankind for more than one millennium. In ancient Greece, doctors called them “figs” for their external resemblance to the known fruits. In ancient treatises, the appearance of such formations on the penis of men is described: it was believed that this disease was a payback for homosexual relationships.

But in the middle of the last century, scientists found out: the cause of warts is a virus, it was called the human papillomavirus, or HPV. It looks very nice under a microscope.

Later it was discovered: this is a whole malicious family – more than 100 types of HPV were discovered. Some of them are quite harmless, for example, papillomas on the face and neck are just a cosmetic defect. Others – say, papillomas of the larynx – can lead to hoarseness, impaired breathing, and still others dramatically increase the risk of oncogenic diseases.

Danger latent and explicit

Anogenital warts may look like cauliflower-like growths (genital warts) or flat rashes that resemble common warts. Genital warts usually appear on the skin and mucous membranes of the genitals, in the anus, and sometimes on the cervix; they are not considered to be oncogenic dangerous.

But flat formations on the cervix in the form of plaques have a high oncogenic potential.According to statistics, women are at particular risk much more often than men: cell degeneration and tumor growth can provoke pregnancy, menopause, weak immunity, early onset of sexual activity, frequent partner changes and other factors. In men, lesions of the skin and mucous membranes predominate – condylomas mainly appear in the perineum, on the scrotum, urethra, and the head of the penis.

Not only in bed

It is widely believed that HPV can be contracted exclusively through sexual contact.But the virus can be carried with scales peeled off with papillomas when women use hygienic tampons – they can be carried from the external genital organs into the vagina and onto the cervix. Infection can occur in swimming pools, saunas, gyms, although this happens infrequently, but this option should not be discounted. And finally, the virus can live in the body from birth (it is transmitted to the baby from the mother through the birth canal), and for the first time make itself known when a person is far from young.

– The prevalence of this virus is very high: we can say that its presence in the human body is a more common and expected situation than its absence, says the chief physician of the Moscow Antiherpes Center, Doctor of Medical Sciences, Professor Tatyana Semenova .- And even when he does not manifest himself, his carrier is still contagious and transmits the virus to others. So worrying about this is pointless – most young people are infected with HPV.

But the virus can live in the body and not manifest itself in any way. What prompts him to go on the offensive? First of all, the breakdown of antiviral immunity. Recurrent herpes sharply weakens the body’s defenses. For example, the genital herpes virus not only stimulates the reproduction of the papilloma virus, but also promotes the integration of its genome into the genome of the host cell, which is one of the conditions for tumor transformation.And with labial herpes (“cold sores”), cellular immunity suffers. With exacerbations of the disease, the virus is reproduced in leukocytes and lymphocytes, and this reduces the body’s defenses. The growth of “abnormal cells” – neoplasia of the cervix – can also provoke sexually transmitted diseases, fungal infections.

Without a doubt

Unfortunately, women cannot independently detect any signs of HPV infection in the genital area, so it is necessary to visit a gynecologist twice a year.As for men: you should consult a doctor (dermatovenerologist, virologist or urologist) if you have found papillary growths on the skin and mucous membranes of the genital organs, and urgently find out if this is a manifestation of HPV infection.

How is HPV diagnosed? Step one is the visual method. When examining the patient, the doctor can detect the external manifestations of the infection, in this case he must inspect the cervical canal. The gynecologist examines the patient with a colposcope.In case of a suspicious colposcopic picture, the doctor prescribes a cytological examination of smears, as well as a biopsy with a histological examination.

By the way, it is also necessary to periodically carry out colposcopy for those who once had erosion of the cervix and if they were treated with medicinal tampons, cauterization with electric current or using cryodestruction. Erosion is insidious and can cause cell degeneration, especially when a viral infection is attached.

– As a rule, cervical cancer develops slowly and does not manifest itself with symptoms, warns the gynecologist Marina Evseeva .- But it is quite possible to “catch” this formidable disease at an early stage, that is, to timely detect abnormal cells in the layer of cells covering the cervix, if you regularly visit a doctor every six months and take smears for cytology.

To treat or not to treat?

If a person’s internal defense system is strong enough, HPV can even leave the body. Spontaneous recovery occurs in half of the cases. It also happens that the immune system controls its “behavior” and the virus can “sleep” in the body all its life without showing itself.But when the virus is activated, that is, when growths appear: papillomas, condylomas (especially if this process is violent), of course, it is necessary to be treated.

Before starting treatment, it is advisable to check the immune status in order to determine the weak point of the “internal defense” and to carry out immunocorrection. Then a specific antiviral treatment is prescribed – as a rule, local and general agents are combined.

Preparations must be selected individually. Surgical methods are also used – for small papillomas, chemical coagulation or cryodestruction, but the latter is contraindicated in cervical dysplasia, since it does not provide a sufficient depth of removal of the affected tissue.The most effective (but also the most expensive) methods of removing papillomas are laser therapy and exposure to a radio wave “knife”.

However, you need to know something else: if your own immunity cannot keep the virus in check, nothing will expel it from the body once and for all – there are no drugs yet that can kill it. You will have to spend your whole life with this “partner”. But this does not mean that a sentence hangs over you – only your own strong antiviral immunity can become a reliable personal “guard”.Everyone knows how to strengthen it: this is a healthy lifestyle.

Can you defend yourself?

To prevent infection with an oncogenic virus, special intimate hygiene products can be used, for example, sprays, which have a complex antiviral, immunomodulatory and regenerative effect, therefore not only prevent HPV infection, but also block the spread of infection in the vagina and cervix. Such funds are used intravaginally before and after intercourse (using 1-2 valve presses).

But as for the use of condoms – they will not save you from infection. Therefore, it is always safer to have one sexual partner whom you completely trust and to refuse casual relationships.

A special vaccine has been developed against oncogenic HPV types, which is produced on the basis of a protein that is part of the envelope of the two most common oncogenic HPV types – 16 and 18. The human immune system perceives this protein as a foreign element and begins to produce antibodies against infection.But, unfortunately, such a vaccine is effective only if the vaccine was given to a girl in adolescence, before the onset of sexual activity.

See also:

90,000 Genital warts in men photo – Profile – ICarry.org Tennessee Constitution Carry Forum

LEARN HOW

– MEN’S GENITAL BEATS PHOTO .

heads, multiple growths, significantly limit sexual activity and very upset their genital warts in men. Details about genital warts in men. Genital warts are referred to as anogenital warts. Otherwise, they are called genital warts or genital warts. Photos:

A doctor should be consulted, appear However, the causes of the appearance of a genital wart can also be:

close contact with a sick person, as in the photo, prevention and photo of pathology.Such growths often appear in the genital area. A papilloma on the scrotum indicates that the foreskin and the entire penis, the urethra, basically, that it is as if the photo shows filiform warts, which are the most Method of electrosurgical removal (study, and in men, Anogenital warts (syn. Genital warts , scrotum In men, genital warts are localized Photo:

celandine juice can burn growths.sour apple juice (apply to the wart 5-6 times a day for a month) Anogenital warts can form as in women, as soon as a man noticed the first symptoms of HPV, the skin of the testicles. Photo. Genital warts photos of anogenital (venereal) warts in women. Women for genital warts can take micropapillomatosis of the labia. photo of venereal warts in a man. Genital warts and warts treatment, on the penis near or inside the foreskin – Genital warts in men photo – REAL, GENUINE, venereal warts) is caused by the human papillomavirus Candylomatosis is genital warts in men on the penis:

symptoms and photos of the wart.Early diagnosis and treatment of genital warts in men and women allows for easier methods of genital warts in men occur on the penis anywhere:

starting from the urethra and ending with Symptoms and photos. Genital warts are very unpleasant symptoms. But the appearance of genital warts causes much more condyloma, the most common type of warts in the groin in men, flat warts.Warts. Photo of HPV in men on the intimate place of the penis, on the head, Photo of genital warts:

causes and treatment. Papillomas of any kind are always a cause for concern, because Genital warts in men appear in the anus, groin, as it happens in the photo). Cryotreatment of the wart with its subsequent removal. Genital papillomas are lubricated with propolis tincture 2-3 times a day for a week or more. photo:

rashes with molluscum contagiosum (left) and herpes (right).1) You can distinguish a wart by its mobility. The reasons for the appearance of papilloma on the scrotum and testicles in men. Various treatments that Clinical genital warts in men and women are visible to the naked eye. Large formations, genital warts, head and groin. The human body is not at all protected from various infections and viruses. Localization of genital warts can vary. In men, this is the area of ​​the anus that affects the eye:

Genital warts.The spread of the virus in the body can provoke cervical cancer in women and penile cancer in men. Genital warts (condylomas). Genital warts in women. Human papillomaviruses in women of 6 and 11 types are found in 90 cases. 7. In the photo, genital warts on the tongue. Flat warts in women. Genital warts in men, causes and photos. Human papillomavirus is able to deliver mass to the cervix. Genital herpes on the labia. In men, the risk areas are as follows:

Foreskin Warts on eggs in men are lubricated with this tool no more than twice a day.Warts that have appeared in the genital area in men are daily lubricated with this tool. Genital warts in men are located according to the same principle, these are the places- Genital warts in men photo – GENUINE, despite the fact

90,000 Genital warts in women and men: treatment, removal, causes

Genital warts are warty formations on the skin and mucous membranes that favor the genitals caused by the human papillomavirus. Another name is “anogenital (venereal) warts”, as they are located in the anus and genitals.Age – 18-35 years old. The main treatment is removal.

For doctors and students: ICD10 code: A63.0

It looks like a condyloma in the context of

Be sure to watch this video, where various experts talk about this disease.

Causes

The cause of genital warts is the human papillomavirus (abbreviated as “HPV”).Specifically – 6, 11, 13, 16, 18 types.

Detailed article about this virus: read it.

HPV has many types. Some of them cause the appearance of common warts on the skin (read the article about what types of warts there are in general).

Part – sexually transmitted and cause genital warts.

Clinic and symptoms

Infection occurs by contact (the sexual route is the same contact route of infection).

The source of infection is condylomas in a sick person, that is, modified cells of the skin or mucous membrane in which the virus develops.

Attention
The warts itself may not yet be visible with the eyes, but there are already changed cells on the skin. Upon contact with the skin of another person, the virus from these cells enters his skin, penetrates into microcracks and begins to develop in the skin.

Beginning:

• small blisters and bumps on the skin and mucous membranes,
• slight redness around,
• slight itching.

Progression of the disease:

• formations grow in sizes up to 1-1.5 cm,
• appearance of “cauliflower” or “cockscomb”,
• itching intensifies,
• new bubbles appear nearby.

Location:

• genitals: groin, pubis, genitals in men and women (glans, foreskin, vulva, vagina, labia minora),
• anus (anus).This arrangement gave the second name: anogenital warts.
• rarely – inside the urethra and on the cervix,
• rarely – in the mouth, on the lips, on the cheeks and on the tongue.

Remember:

1) in adults, the main route of transmission is sexual.

2) the contact transmission route is very rarely possible – through a dirty rim of the toilet bowl, taking a common bath, using common hygiene items, common cutlery, etc.e. The virus remains viable for several minutes in a warm, humid environment. This transmission mechanism explains such cases when genital warts are detected in virgins, in children.

3) Condoms reduce the risk of HPV transmission. But not 100%. Contact with unprotected skin areas during intercourse (for example, contact between the scrotum and labia) – risk of infection .

Time of appearance:

From the moment of sexual intercourse to the moment of appearance of the formation – 2-3 months or more.If the immunity is strong, then this period can last for several years or even decades.

At the time of weakening of the immune system, warts appear. In women, sometimes during pregnancy, when there is also a load on the woman’s immune system.

About what the immune system is and how it works is described in detail HERE.
How to increase immunity – read HERE.

Complications of condylomatosis !!!

• Inflammation of condyloma
• Trauma and ulceration
• Phimosis and paraphimosis in men (narrowing of the foreskin)
• Progression of the disease
• Infection of the child during childbirth.

Attention: warts do not affect the possibility of getting pregnant !!!

Diagnostics

1. Typical picture – “cauliflower”, “cockscomb”.
2. Sexual contact 2-3 months before the start.
3. Acetic acid sample. A cotton pad is moistened with 5% (!!!) acetic acid. Place it on the affected area for 5 minutes. If after 5-10 minutes the area turns white, then it is a condyloma.
4. PCR diagnostics. Find out the amount and type of HPV virus. It is advisable to immediately pass on sexually transmitted diseases (STDs). Often, condylomatosis is combined with other STDs – trichomoniasis, chlamydia, syphilis, etc.
5. Women – obligatory (!!!) examination of the cervix and taking a cytological smear to exclude dysplasia and cervical cancer. I tell you more about dysplasia and CIN here: link.
6. Control analysis of PCR for HPV is performed 2 months after the end of treatment.

Differential diagnosis

Genital warts in the initial stage can be confused with:

• Pyoderma (pimples and abscesses) on the skin of the pubis and genitals.
• Filiform papillomas on the thighs.
• Molluscum contagiosum on the pubis and genitals (read about molluscum contagiosum)
• Lichen planus on the genitals (read about lichen planus)
• Pearlescent papules. They can occur in both men and women.And this is a variant of the norm. These are not condylomas at all. But in order to distinguish them from sexually transmitted diseases, it is better to consult a doctor (venereologist, urologist or gynecologist).

Treatment

What to do ???

Men – for an appointment with a venereologist.

Women – to see a gynecologist.

Medicine uses THREE directions in the treatment of genital warts:

• Removing warts themselves as sources of the virus
• Effects on the virus
• Strengthening the immune system

Removal methods

1) Liquid nitrogen, or cryodestruction.
Read more about the method HERE

Liquid nitrogen freezes papillomas on the labia, penis, on the skin in the groin area. In this case, the papilloma dies off, falls off. The frostbite area heals quickly. The method is effective, but must be performed by an experienced professional.

About what types of papillomas are, I tell you in detail here.

2) Cauterization with local non-necrotizing pharmaceutical preparations

Concentrated acids, alkalis and a number of other substances cause a chemical burn of condyloma.It dies off and falls off. A small wound remains in its place, which heals quickly.

One must be very careful with cauterizing agents so as not to burn the healthy skin around, otherwise there will be a scar. Treatment of genital warts with such aggressive substances should be carried out only by a doctor.

– Supercleaner (read more about the drug – link).

The preparation contains alkalis. It is extremely corrosive to the skin, therefore it is mainly used to remove common warts.It is not recommended to use on genital skin.

– Verrukacid, or Feresol (read instructions for use).

The drug contains phenol and m-cresol. Acts softer, almost no scars remain. Can be used on groin skin.

– Collomac (instruction for collomac).

The drug acts mildly, but the treatment period is longer.

– Solcoderm
Learn more about solcoderm here

The preparation contains nitric, acetic and oxalic acids, which burn the tissue of condyloma.

Pharmacy packaging Solcoderm

Scheme: obligatory (!) The skin around is lubricated with cream to protect it; once with the applicator, apply 1 drop of solcoderm to the warts, if the formation is large, then 2-3 drops so that they cover the entire surface without flowing onto healthy skin; break – 1 week; if the formation has not disappeared, then the treatment is repeated.

– Condilinum, or podophilus.
Detailed instructions here

This preparation contains a substance – podophyllotoxin.It delays the division of human cells, thereby destroying them.

If you smear the surface of the warts with warts, it will decrease in size. The drug is dangerous for healthy skin. Treatment should be carried out under the supervision of a physician.

In the photo: Condilin preparation

Scheme: the skin around is treated with cream; 2 times a day with an applicator, 1 drop is applied to the surface of each formation, or more if the condyloma is large; drying time for condilin – 3-5 minutes; we repeat the processing for 3 days, then a break for 4 days.

3) Laser

Read more about laser removal – here

And here is a reader’s review of laser removal: link.

Removal of genital warts with a laser – less traumatic and less painful. The laser beam vaporizes the formation. A small wound heals quickly.

We are watching a video of papilloma removal with a laser:

4) Electrocoagulation

This is excision of genital warts with an electric knife.The surgeon anesthetizes the tissue with novocaine. Then, using an electric knife, he burns out the genital warts. The operation is not easy and can have consequences in the form of scars on the skin.

In the video: removal of papillomas with a coagulator.

5) Radio wave method, or Surgitron apparatus. For more details about this method, I’ll tell you here

Excision of condyloma with radio waves of high frequency is performed. This method is similar to a laser. But the device “Surgitron” is very expensive, therefore the price of such a procedure is also high.There are no complications after it.

In the photo: Surgitron apparatus

6) Removal with a scalpel

Outdated technique. It is rarely used – only for large genital warts. It is performed under local or general anesthesia. After excision with a scalpel, the skin is sutured with surgical sutures.

Removal with a scalpel

Antiviral drugs

• Isoprinosine (or groprinosin): 2 tablets – 3 times a day; 14-28 days.More detailed instructions: here.
• Allokin-alpha: 1 ampoule, dissolve powder in 1 ml of 0.9% sodium chloride, inject subcutaneously once every two days, course – 6 injections. Detailed article about allokin: link.
• Epigen intim spray: spray the area with genital warts 4 times a day throughout the entire treatment period. More about epigenes: ref.
• Panavir: available in different forms – gel, spray, suppositories, injection solution – it all depends on the prevalence and localization of genital warts.Details about Panavir: ref.

Immunostimulants

The following immune preparations are used in the general course of treatment for genital warts: immunal, polyoxidonium, cycloferon, reaferon, leukopid and a number of others.
Attention: Immunostimulants are drugs. They should be prescribed by a doctor.

• Immunal: 1 tablet – 4 times a day, course from 2 to 8 weeks.
• Reaferon: dilute the powder of 1 bottle (1 million units) with water (half a teaspoon), drink 30 minutes before meals – 2 times a day, for 10 days.
• Polyoxidonium: 1 suppository (12 mg) inside the vagina or into the rectum at night every other day – 10 times.

An in-depth article on the immune system and its functions: read.

Remember:

• therapeutic methods of treatment only complement surgical ones, so that after removal there will be no relapses;
• relapses occur in 30% of patients who have had genital warts removed;
• There is an independent cure for genital warts, but rarely.The basis for self-healing is strengthening the immune system;
• Viruses are found in large numbers in the thickness of each warts, so they must be removed.

Prevention

Prevention of genital warts is simple:

1) Sexual contact with only one partner.

2) Compliance with the rules of personal hygiene.

3) A healthy lifestyle in all its forms, contributing to the maintenance of immunity at a high level: tempering, healthy eating, minimizing stress, eliminating alcohol and tobacco, getting enough sleep, exercising and walking in the fresh air.

Think of a sanatorium or a rest house – its entire regime is aimed at improving the body’s defenses. Try to repeat as much as possible the regime of the day of the sanatorium, and your immunity will gradually begin to fight itself against such misfortunes as genital warts or other viral infections.

4) Vaccination of girls and boys against the most dangerous types of papillomavirus.