What are the main types of gray genital warts. How are gray genital warts diagnosed and treated. What are the most common symptoms of gray genital warts. How can you prevent contracting gray genital warts. What causes gray genital warts to develop.

Understanding Gray Genital Warts: An Overview

Gray genital warts are a specific type of sexually transmitted infection (STI) caused by certain strains of the human papillomavirus (HPV). Unlike typical genital warts that appear flesh-colored or whitish, gray genital warts have a distinct grayish hue. These warts can develop on the genitals, anus, and surrounding areas in both men and women.

Are gray genital warts different from other types of genital warts. While they share the same viral origin, gray genital warts have some unique characteristics:

• Color: As the name suggests, they appear gray or grayish-white
• Texture: Often smoother than typical cauliflower-like genital warts
• Size: Can vary from tiny spots to larger clusters
• Location: May appear in both external and internal genital areas

Common Symptoms and Appearance of Gray Genital Warts

Recognizing the symptoms of gray genital warts is crucial for early detection and treatment. While some individuals may remain asymptomatic, others may experience various signs:

• Gray or grayish-white growths in the genital or anal area
• Flat or slightly raised lesions
• Itching or mild discomfort in affected areas
• Clusters of warts that may grow and spread over time
• Occasional bleeding, especially after sexual intercourse

Can gray genital warts appear in locations other than the genitals. Yes, they can also develop in the following areas:

• Around the anus
• On the upper thighs
• In the mouth or throat (in rare cases)

Causes and Risk Factors for Gray Genital Warts

Gray genital warts are caused by specific types of HPV, primarily types 6 and 11. These strains are considered low-risk HPV types, meaning they are less likely to cause cancer compared to high-risk HPV strains. However, they are highly contagious and can spread easily through sexual contact.

What factors increase the risk of contracting gray genital warts. Several factors can contribute to a higher likelihood of infection:

• Multiple sexual partners
• Unprotected sexual intercourse
• Weakened immune system
• Previous STI infections
• Early onset of sexual activity
• Smoking

Diagnosis and Medical Assessment of Gray Genital Warts

Proper diagnosis of gray genital warts is essential for effective treatment. Healthcare providers typically use the following methods to confirm the presence of these warts:

1. Visual examination: A thorough inspection of the genital and anal areas
2. Biopsy: In some cases, a small tissue sample may be taken for further analysis
3. Acetic acid test: Application of a vinegar solution to make warts more visible
4. HPV DNA test: To identify the specific HPV strain causing the warts

How accurate are these diagnostic methods. While visual examination is often sufficient, combining multiple techniques can provide a more definitive diagnosis, especially in cases where warts are not clearly visible or when there’s uncertainty about the nature of the lesions.

Treatment Options for Gray Genital Warts

Treatment for gray genital warts aims to remove visible warts and alleviate symptoms. The choice of treatment depends on factors such as the size, number, and location of warts, as well as the patient’s overall health. Common treatment options include:

Topical Medications

• Imiquimod cream: Boosts the immune system to fight HPV
• Podofilox solution: Destroys wart tissue
• Trichloroacetic acid (TCA): Chemically burns off warts

Surgical Procedures

• Cryotherapy: Freezing warts with liquid nitrogen
• Electrocautery: Burning warts with an electric current
• Laser therapy: Using laser light to remove warts
• Surgical excision: Cutting out warts under local anesthesia

Is there a cure for gray genital warts. While treatments can remove visible warts, they do not eliminate the underlying HPV infection. The virus may remain dormant in the body, potentially leading to recurrences. However, many people’s immune systems eventually clear the virus over time.

Prevention Strategies for Gray Genital Warts

Preventing gray genital warts involves a combination of safe sexual practices and vaccination. Here are some effective prevention strategies:

• HPV vaccination: Recommended for both males and females, ideally before becoming sexually active
• Consistent condom use: Reduces but doesn’t eliminate the risk of transmission
• Limiting sexual partners: Fewer partners lower the risk of exposure
• Regular STI screenings: Early detection can prevent transmission to others
• Abstinence or monogamy: The most effective ways to avoid HPV infection

How effective is the HPV vaccine in preventing gray genital warts. The HPV vaccine is highly effective, providing protection against the most common HPV types that cause genital warts, including those responsible for gray genital warts. However, it’s important to note that the vaccine doesn’t protect against all HPV strains.

Living with Gray Genital Warts: Emotional and Social Aspects

Coping with gray genital warts can have significant emotional and social impacts. Many individuals experience feelings of shame, anxiety, or depression following a diagnosis. It’s important to address these aspects of living with the condition:

• Seek support: Consider joining support groups or seeking counseling
• Educate yourself: Understanding the condition can help reduce anxiety
• Communicate with partners: Open and honest communication is crucial
• Practice self-care: Maintain overall health to support your immune system
• Follow treatment plans: Adhering to prescribed treatments can improve outcomes

How can individuals maintain a healthy sex life with gray genital warts. While it may be challenging, maintaining a healthy sex life is possible:

• Wait until warts are treated before engaging in sexual activity
• Use barrier methods like condoms and dental dams
• Discuss the condition with sexual partners before intimacy
• Explore non-penetrative forms of sexual expression
• Regular check-ups and open communication with healthcare providers

Complications and Long-term Health Implications

While gray genital warts are generally benign, there are potential complications and long-term health implications to consider:

Potential Complications

• Increased risk of other STIs: Warts can create entry points for other infections
• Psychological distress: Anxiety, depression, and low self-esteem
• Sexual dysfunction: Pain or discomfort during intercourse
• Pregnancy complications: Rarely, warts may complicate childbirth

Long-term Health Implications

• Recurrence: Warts may return even after treatment
• Persistent HPV infection: May increase the risk of certain cancers
• Transmission to partners: Ongoing risk of spreading the virus

Do gray genital warts increase the risk of cancer. While the HPV types causing gray genital warts are considered low-risk for cancer, persistent HPV infection with any strain may slightly increase the risk of certain cancers. Regular screenings and check-ups are essential for early detection of any potential issues.

Research and Future Developments in Gray Genital Wart Treatment

The field of HPV research is continually evolving, with ongoing efforts to improve prevention, diagnosis, and treatment of gray genital warts. Some promising areas of research include:

• New vaccine formulations: Targeting a broader range of HPV types
• Immunotherapy: Enhancing the body’s natural ability to fight HPV
• Topical treatments: Developing more effective and less invasive options
• Genetic therapies: Targeting the virus at the molecular level
• Improved diagnostic tools: For faster and more accurate detection

What potential breakthroughs can we expect in the near future. While specific predictions are challenging, researchers are optimistic about developing more targeted therapies that could potentially eliminate the virus entirely, rather than just treating visible warts. Additionally, advancements in personalized medicine may lead to more tailored treatment approaches based on individual genetic profiles.

In conclusion, understanding gray genital warts is crucial for effective prevention, early detection, and appropriate treatment. By staying informed about the latest developments and maintaining open communication with healthcare providers, individuals can better manage this condition and minimize its impact on their overall health and well-being. Remember, while gray genital warts can be concerning, they are manageable with proper care and treatment.

What You Need To Know About Female Genital Warts

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What You Need To Know About Female Genital Warts

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It is important to know about female genital warts because they are a common sexually transmitted infection. Female genital warts are caused by the human papillomavirus or HPV, which is a virus that can be passed through skin contact with an infected person. It is possible to have the virus without realizing it, as not everyone who is exposed will develop symptoms. Genital warts are a sexually transmitted disease, also known as condyloma acuminatum. Learn how to prevent them and what to do if you have them.

What Are Female Genital Warts And How Are They Transmitted

Wart is a common term that is used to describe a small growth or bump on the skin. These growths are typically benign and can be found in several different areas of the body, including around the mouth, fingers, and feet. Genital warts look like whitish or skin-colored bumps. These warts have a rough surface texture and usually take on the look of cauliflower in appearance. In most cases, they are harmless but may become uncomfortable or painful if they are irritated or subjected to friction. Sometimes, warts may develop on the labia minora of the vagina in women.

Genital warts are caused by a virus called human papillomavirus or HPV, a sexually transmitted virus. This virus can be passed through skin contact with a person who has them. You can get genital warts even if you use condoms or engage in skin-to-skin foreplay because condoms don’t cover all of the genital skin.

Genital warts can cause one or more small bumps on the genitals. Some people will not develop symptoms even after they have contracted HPV; this makes it possible to spread the virus without knowing that you have it. About 70% of sexually active men and women are exposed to HPV during their lives, but very few experience symptoms.

Learn about other STDs with our Ultimate Guide to STDs

What Are The Symptoms Of Female Genital Warts

The symptoms of female genital warts can vary depending on the individual. The most well-known symptom is their appearance. Genital warts often present as a single growth and sometimes as a cluster of multiple growths. Most of the time, genital warts are painless. In some cases, warts will cause some degree of itching, burning during urination, and vaginal pain, especially if there is friction.

These symptoms of genital warts are usually mild to moderate in nature and may come and go over time. However, there are other potential symptoms that can occur as a result of this infection. For example, genital warts may cause bleeding after sex. This symptom is less common than others but is still a possibility.

If you are experiencing these symptoms, you may have genital warts:

• Flesh-colored or grey growths around your vagina, anus, or upper thighs
• Cauliflower-like growths
• Growths may be internal
• Itching or bleeding from your vagina or anus
• Changes to the flow of urine

Some people will carry the HPV virus and never develop symptoms. They may never know they even have the genital warts virus without a screening from an OBGYN. Symptoms may not appear for weeks, even years after coming in contact with the virus.

How Are Female Genital Warts Treated

There are several different ways that female genital warts can be treated. Treatment options include topical medications, cryotherapy (freezing), laser surgery, and electrosurgery. Some methods may be more effective than others depending on the size and location of the warts. Visible warts on the outside of your body are easier to treat.

In most cases, treatment is not necessary if your genital warts are small and you don’t have any severe symptoms. That being said, genital warts are easier to treat if you begin from the start of noticing them. You also may want to treat genital warts for cosmetic reasons, as they may be embarrassing.

During treatment, avoid irritating soaps and lotions. Having intercourse may also irritate the skin, and it is best to avoid that as well until treatment is finished. It may take several weeks for a genital wart treatment to be effective, depending on the type of treatment.

Remember, genital warts are different than warts on the hand or feet. Do not try an over-the-counter remedy made for these areas as it could damage the delicate skin in the genital region. Dr. Lodge, an experienced OBGYN in Cool Springs, can prescribe the best course of treatment that won’t damage your skin.

How To Prevent Female Genital Warts

As genital warts are a sexually transmitted infection that can be passed from person to person through skin contact, they can be hard to prevent. There is no sure way to prevent genital warts and sexually active people are at risk, but there are several steps you can take to reduce your risk of exposure:

• If you are sexually active, it is important to be aware of the risk of genital warts.
• Use condoms every time you have sex or oral sex. You can use male or female condoms to help with this.
• If sharing sex toys, make sure they too are covered in a condom and washed between use.
• Avoid skin-to-skin contact with someone who has genital warts. Sexual contact of the genital area can result in warts even without full penetration.
• If you are your partner has warts, make sure that the infected skin area is covered. Remember that even after treatment, the virus can still be passed up to 3 months after warts have been removed.
• Get vaccinated against HPV. The HPV vaccine is a very effective way to protect yourself against the virus that causes genital warts. This vaccine has been found to prevent 90% of genital warts in young women.
• Get regular screenings for HPV and other sexually transmitted infections.
• Talk about your sexual health with your partner.
• If you are pregnant, there is a chance you could pass them to your baby. Seek guidance from your obstetrician.

Can Female Genital Warts Be Cured

The good news is that warts themselves can be treated and removed. Some genital warts cases will resolve on their own over time, but they cannot be guaranteed to go away entirely without treatment. Unfortunately, there is no medical cure for the human papillomavirus (HPV) itself. Some people’s bodies are able to clear the virus naturally over time. You will need screenings to confirm if the virus is still active in your body.

There is no such thing as a mild case of genital warts in men or women. If you see the wart or have tested positive for the virus, you have the STI and may be able to transmit it.

Cervical Cancer Caused by HPV

Some strains of HPV can cause cancer. There are low and high-risk strains of HPV that might cause cervical cancer. The highest-risk HPV strains to cause cancer are HPV 16 and 18. These two strains are responsible for about 70% of cervical cancers. Not all types of HPV infections cause cancer, but you should still get a full check-up.

Having HPV and other sexually transmitted infections can make it easier to contract HIV. This is why it’s important for women to get screened regularly as part of a preventative health care routine.

Learn more about HPV>>

Testing For Female Genital Warts

To check for warts themselves, your gynecologist can identify them visually on the exterior and interior of the genitals. They will check for hidden warts inside the vagina. This process should not be painful, and your doctor deals with screenings like this all the time. To test for the HPV virus, Dr. Lodge will perform a Pap smear. A Pap test checks for abnormalities of cancer in cells collected from your cervix, and an HPV test will be done at the same time.

Schedule a Screening for Genital Warts in Cool Springs, Tennessee

If you are experiencing any of the symptoms associated with female genital warts, it is important to seek medical treatment as soon as possible. It is also important for women who are sexually active to be screened for HPV on a regular basis especially if they have multiple sexual partners.

Please give the staff at Cool Springs OBGYN in Brentwood, Tennessee a call to make an appointment. Call us at 615.690.6600, Monday through Thursday for women’s health care with all the latest advances in gynecology.

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Genital warts – MyDr.com.au

What are genital warts?

Genital warts are are small, soft lumps in the genital area that are caused by certain types of the human papillomavirus (HPV). They are spread from person to person through intimate skin-to-skin contact, and are among the most common sexually transmitted infections (STIs).

Genital warts (also called condylomata acuminata) can affect both males and females and are most often seen between the ages of 15 to 28 years. Genital warts do clear up on their own over time, but this may take months or sometimes even years. Most people prefer to use available treatments to remove visible genital warts.

Symptoms

Genital warts are small, soft, skin-coloured, white or grey bumps that appear in the genital area. The warts can be different sizes, and there can be just one or several in a clump. When several warts clump or cluster together they sometimes resemble a cauliflower-like shape. They can be found on any part of the female or male genital area, including the vulva, walls of the vagina, cervix, penis, scrotum, and the skin between the genitals and anus. They are referred to as anogenital warts when they affect the genitals and the anus.

Some people may experience itching, discomfort or pain associated with genital warts. This pain may be aggravated by intercourse or contact. In some cases, the warts may bleed after sex.

How do you get genital warts?

Genital warts are caused by an infection with certain types of human papillomavirus (HPV). The virus is passed on through having sex or very intimate skin-to-skin contact with someone who is infected. It’s possible to be infected with several different types of HPV at the same time.

HPV can pass through small tears in the skin (micro-abrasions) of your genitals or through contact with genital secretions. Condoms do not offer 100 per cent protection against HPV, as they don’t necessarily cover all of the infected skin.

Most people infected with human papillomavirus (HPV) have no recognisable symptoms and are unaware that they have the virus. So they can pass on the virus without even realising. And for those who develop visible genital warts, it can be difficult to know when you caught the virus because symptoms do not always appear straight after becoming infected.

What is the risk of catching HPV?

HPV infection is extremely common in Australia, and it’s likely that most sexually active people will be infected with one type of the virus at some time in their lives. Your risk of HPV infection may be increased if you’ve had other STIs or unprotected sex with multiple partners.

It also seems that removing some or all of your pubic hair may increase your risk of getting genital warts. That’s because hair removal through waxing or shaving can cause tiny tears in the skin that may allow the virus to enter the skin more easily. Having a Brazilian wax (where all pubic hair is removed) seems to put you at more risk than a bikini wax because more skin is involved. Other hair removal techniques may increase the risk in a similar way. So to reduce your risk of infection, wait at least a day after waxing or shaving before having intimate contact with someone.

What makes genital warts worse?

If you already have genital warts, shaving and waxing your pubic hair can lead to more widespread infection. That’s because these hair removal techniques can cause tiny cuts and abrasions or irritation of the skin, which can allow the virus to enter and infect a larger area of skin. So if you have genital warts, it’s best to avoid shaving or waxing your pubic hair.

Pregnancy can sometimes trigger genital warts if you have a dormant HPV infection, or it can make an active infection worse, meaning that the warts grow more quickly than usual.

HPV, genital warts and cancer

There are more than 40 different types of HPV that can infect the genital area, and these viruses are very common in the community. The types of HPV that cause genital (or anogenital) warts are usually different to the types that can lead to the development of genital cancers or oropharyngeal (back of the throat) cancer in men and women. The types that are linked with cancers are called high-risk genotypes, while the types that cause genital warts are low-risk genotypes.

About 95 per cent of genital warts are caused by HPV types 6 and 11 – these are low-risk types of HPV, which means that they rarely cause cancer.

Persistent infection with a high-risk type of HPV can lead to the development of cell abnormalities that may eventually turn into cancer. Most cervical cancers are caused by infection with types 16 and 18, but there are 13 other high-risk types than can also cause cervical cancer. Type 16 is the most common cause of cancers involving the vulva, vagina, penis and skin around the anus.

Women found to have high-risk types of HPV may need to have more frequent cervical cancer screening tests. Women with genital warts do not usually need more frequent screening tests unless they have also been infected with a high-risk type of HPV.

Tests and diagnosis

The diagnosis of genital warts can usually be made by examining the affected area. During the examination, your doctor may apply a weak acetic acid (vinegar) solution to the lumps, which should turn white if they are warts.

In some cases, women with genital warts may be referred to a sexual health specialist, dermatologist (skin specialist) or gynaecologist (specialist in conditions affecting the female reproductive organs) for further tests or treatment. If there are warts on your cervix, your doctor may recommend colposcopy. This involves examining the cervix using a colposcope, which magnifies the area and allows close inspection.

A biopsy (small sample of the suspected wart(s) that is examined under a microscope) is generally not needed to diagnose genital warts. However, biopsy may be recommended if:

• the appearance of the warts is unusual;
• new warts occur in older people; or
• genital warts are not responding to treatment.

Treatment

Genital warts usually get better on their own without treatment, and the HPV infection is eventually cleared by the immune system. However, this can take several years, so many people choose to have genital warts treated for cosmetic reasons. Treatment can also reduce symptoms of itching and discomfort. Current treatments can remove the visible warts but as yet there is no treatment to cure HPV infection.

Your doctor may recommend applying medicine to the warts, freezing them, or or having the warts surgically removed. The extent and size of the warts, their location, and your preferences will help determine the best treatment choice.

You may need several treatments to get rid of the warts. Bear in mind that genital warts can come back after treatment while you still have the HPV infection. If this happens (usually it happens in the first 3 months after treatment), you may need to be treated again.

Medicines to treat genital warts

A cream called imiquimod (brand names Aldara, Aldiq) can be used to treat external genital warts and anogenital warts. It works by improving the immune system’s response to HPV, and you can apply the cream yourself.

The cream is applied at bedtime and then washed off after 6 to 10 hours. You apply the cream 3 nights per week until the warts are gone (up to 16 weeks). Imiquimod may not be suitable for people with dermatitis or eczema and should not be used during pregnancy or breast feeding. Imiquimod is not suitable for warts inside the vagina or on the cervix in women. You should avoid all sexual contact while the cream is on your skin. Imiquimod can weaken condoms and diaphragms, so you may need to use an alternative form of contraception if you do have sex. Possible side effects of imiquimod include redness, swelling and skin irritation.

Alternatively, a medicine called podophyllotoxin can be applied to external anogenital warts. It comes as a cream (brand name Wartec cream) or solution that can be painted on the warts (Condyline Paint, Wartec topical solution).

These medicines are applied 3 days a week for a maximum of 4 or 5 weeks. The paint is best used on external skin, while the cream may be preferable for warts around the anus, under the foreskin in men and around the opening of the vagina in women. Podophyllotoxin is not suitable for warts inside the vagina or on the cervix in women. It should not be used by women who are pregnant or breast feeding.

You should avoid having sex while using podophyllotoxin. Side effects can include redness, burning, itching and irritation of the skin.

For all wart medicines applied to the skin (known as topical medicines), take care not to get the medicine on normal skin to avoid irritation.

Cryotherapy

Cryotherapy, or cryosurgery, is where liquid nitrogen is applied to the warts to freeze them. Cryotherapy may be recommended for warts that are not responding to topical medicines.

Cryotherapy may be done once a week or once every 2 weeks until the warts disappear. It can be painful, so your doctor may suggest taking a painkiller such as paracetamol before or after the procedure. Following cryotherapy, a blister will usually form – don’t touch or break the blister; it will heal in a few days.

Surgical removal of genital warts

Genital warts can be removed surgically or using laser ablation or electrosurgery (which uses an electrical current to remove warts). These procedures are usually done under general anaesthetic and may be offered to people with anogenital warts over a relatively large area. Some warts may be surgically removed under local anaesthetic.

Treating genital warts during pregnancy and childbirth

Pregnancy can sometimes trigger genital warts if you have a dormant HPV infection, or it can make an active infection worse, meaning that the warts grow more quickly than usual. Warts often clear up on their own after the baby is born, but if treatment is needed during pregnancy, cryotherapy or surgical removal is usually recommended because topical wart medicines are not recommended for pregnant women.

Some women with genital warts are concerned about passing the virus to their baby while giving birth vaginally. However, this is generally rare. Ask your doctor, obstetrician or midwife for advice if you have genital warts while you are pregnant.

HPV vaccination

Australian research has led to the development of vaccines that immunise against the some of the HPV types that can cause genital warts and/or cervical cancer.

Gardasil protects against HPV types 16, 18, 6 and 11, so it can help protect against genital warts as well as cervical cancer. From early 2018 a new 9-valent vaccine (Gardasil 9) will be available that protects against 9 different types of HPV. It is possible to be vaccinated with this newer vaccine even if you have already been immunised – talk to your doctor. Cervarix vaccine protects against 2 high-risk HPV types that are linked with cervical cancer (types 16 and 18), but not the types responsible for genital warts.

HPV vaccination with Gardasil 9 (from 2018) is recommended for all adolescents aged 12-13 years as part of the National Immunisation Program Schedule. The Commonwealth Government currently funds a school-based HPV programme where vaccination is offered for free to girls and boys in year 7 or 8 of high school.

It’s important to remember that none of the current vaccines protect against all types of HPV associated with cervical cancer. So you still need to have cervical cancer screening tests even if you’ve been vaccinated. HPV tests have replaced Pap smears as the primary cervical cancer screening tests in Australia. These tests check for the presence of infection with high-risk types of HPV in the cervix, and cell changes in the cervix if needed.

Protecting yourself and others from genital warts

You can lower your risk of getting genital warts and protect others from infection by practising safe sex using condoms (they offer some protection against genital warts, but not 100 per cent).  Remember, vaccination doesn’t protect against all types of HPV that can cause genital warts, and using condoms also helps prevent infection with other STIs.

If you remove your pubic hair by waxing or shaving, wait at least a day before having intimate contact with someone. This gives your skin a chance to repair itself and will help reduce your risk of infection. If your skin is irritated, wait until it returns to normal before having sex.

Genital warts – Humanitas

Genital warts is one of the most common sexually transmitted infections. At least half of sexually active people become infected with the human papillomavirus (HPV) at some stage in their lives, which leads to the formation of genital warts. Women are more likely to develop genital warts than men.

Genital warts form on moist tissues in the genital area. Genital warts are small, flesh-colored bumps, but may resemble cauliflower. In many cases, warts are almost invisible due to their small size.

Like warts that appear elsewhere on the body, genital warts are caused by the human papillomavirus (HPV). Some strains of genital HPV can cause genital warts, while others can cause cancer. Vaccination helps protect against some strains of genital HPV.

Symptoms

In women, genital warts can appear on the vulva, vaginal walls, between the vulva and anus, in the anus and on the cervix. In men, genital warts can appear on the head and shaft of the penis, as well as in the anus. Genital warts can also form in the mouth and throat after oral sex with an infected person.

Signs and symptoms of genital warts:

• Small flesh-colored or gray lesions in the genital area
• Several genital warts closely spaced, resembling cauliflower in appearance
• Itching or discomfort in the genital area
• Bleeding during sexual intercourse
• Often, genital warts are so small and flat that they cannot be detected without special equipment. However, sometimes genital warts are combined into large clusters.

Conditions that require medical attention

If you or your partner develops bumps or warts in the genital area, you should consult a physician.

Complications

Complications of genital warts:

Malignant neoplasms. Cervical cancer is closely associated with genital HPV infection. Some types of HPV have also been associated with vulvar cancer, anal cancer, penile cancer, oral cancer, and throat cancer. The human papillomavirus does not always lead to the development of malignant neoplasms, however, women are advised to regularly take a cytological smear, especially if they are infected with a high oncogenic risk human papillomavirus.
Disorders during pregnancy. Genital warts can cause problems during pregnancy. Warts can grow in size, resulting in difficulty urinating. The presence of genital warts on the walls of the vagina can cause insufficient elasticity of the vaginal tissues during childbirth. Large warts on the vulva or in the vagina may bleed when stretched during childbirth.

Rarely, a baby born to a mother with genital warts may develop warts in the throat. Surgery may be required to secure the child’s airway.

Genital warts (prevention of genital diseases)

(Adapted from Atlas of Sexually transmitted Diseases, Ed. By Stephen A. Morse et al., Mosby, 2003, pp. 261-278) they meet?

MC are warty growths that most often appear in the genital area or anus of a person. They can be both very small and quite voluminous, resembling cauliflower in appearance. OK are by nature a viral disease and in fact one of the manifestations of infection with the human papillomavirus (HPV), which causes them.

Up to 75% of young sexually active women are known to be infected with one or more types of HPV and approximately 15% of these have some form of infection. At the same time, from 50 to 75% of those infected were infected with high oncological risk types of the virus, and 1% of the infected had OK. Among young men, the prevalence of HPV infection is about the same, but lifelong carriage is less common. Currently, about 5 million cases of HPV infection are registered in the United States every year, and the total number of infected people is about 20 million people. Thus, HPV is the second most common sexually transmitted disease (STD) in the United States, behind only genital herpes infection (45 million infected). We do not have data on the prevalence of HPV in Russia.

What are the properties and characteristics of HPV, how does infection and reproduction of the virus occur in the body? What diseases can HPV cause?

Human papillomavirus (HPV) or Human papillomavirus (HPV) belongs to the category of small open DNA viruses, 55 nm in diameter. It belongs to the family of so-called PAPOVA viruses. This name is formed from the first 2 letters of the names of the viruses that make up the family: PApilloma, POlyoma, VAcuolating viruses. These viruses are extremely common among mammals, incl. person. Transmission of the virus from person to person is carried out by contact and mainly through sexual contact. The infection mainly affects the basal (deep) cells of the epidermis (skin), where it penetrates through microtraumas (for example, abrasions, cracks and other damage to the skin or mucous membranes of the genital organs that occurred during sexual intercourse). In these cells, the virus can carry out primary reproduction and exist for many years (chronic carriage).

Chronic persistence or carriage can also occur in the more superficial layer of the skin (stratum spinosum). This layer of the skin under the influence of the virus undergoes hyperplasia (cell proliferation). The most intensive reproduction of the virus occurs in even more differentiated superficial layers of the skin: stratum granulosum and stratum corneum, or the most superficial stratum corneum. It is here that the reproduction of the virus manifests itself, depending on the type of virus and the location of the lesion, either in the form of OK or warts (warts), or in the form of papillomas or intraepithelial lesions. In newborns and young children, the virus can be transmitted from one affected area to another (the occurrence of recurrent respiratory papillomatosis). The incubation period (the time from the moment of infection to the development of symptoms of the disease) is 3-8 months for genital warts and 4-36 months for precancerous squamous lesions of the cervix.

Currently, about 100 types of HPV have been identified, 80 of which are fairly well studied and characterized. Specific types of HPV are responsible for the development of various diseases in different human anatomical regions (Table 1). Approximately 30 types of HPV are responsible for lesions of the mucous membranes of the genital organs. HPV types such as 16, 18, 31, 33, 35, 39, 45, 51, 52 are high oncological risk types, cause squamous epithelial lesions of the genital mucosa and invasive cancer. Other HPV types (6, 11, 42-44) cause genital warts and recurrent respiratory papillomatosis.
Table 1. Human diseases caused by different types of HPV.

Diseases and clinical manifestations	Causal types of HPV
Skin lesions:	.
Warts on the sole of the foot (corns)	1, 2, 4
Common warts	2, 4, 26, 27, 29, 57
Flat warts	3, 10, 28, 49
Warts Butcher	7
Veruciform epidermodysplasia	2, 3, 5, 8, 9, 10, 12, 14, 15, 17, 19, 20 – 25, 36, 37, 46, 47, 50
Lesions of the genital mucosa:	.
Genital warts	6, 11, 42 – 44, 54
Squamous intraepithelial lesions (such high-risk lesions may be precancerous)	6, 11, 16, 18, 30, 31, 33㪻, 39, 40, 42, 43, 51, 52, 55, 57 – 59, 61, 62, 64, 67 – 70
Carcinoma (cervical cancer), much less common cancers of the vulva, vagina, anus and penis)	16, 18, 31, 33, 35, 39, 45, 51, 52, 54, 56, 66, 68
Other (non-genital) mucosal lesions:	.
Oral mucosa (focal epithelial hyperplasia)	13, 32
Recurrent respiratory papillomatosis	6, 11, 30
Carcinoma / cancer of the head, neck, lung	2, 6, 11, 16, 18, 30

What is the relationship between HPV and human cancers?

The clearest causal role of HPV has been demonstrated in cervical cancer. Thus, high-risk HPV types (see Table 1) were found in 93-99% of women with cervical cancer. Prior to this, it was found that women who had an early sexual life, had STIs, had a large number of sexual partners, and also had contact with men whose partners had cervical cancer were most susceptible to cervical cancer. It turned out that high-risk HPVs contain regions with high oncogenic activity (E6 and E7) in their genome. When HPV is introduced into the genome of cervical mucosal cells, the E6 and E7 genome regions stimulate the synthesis of the corresponding proteins, which in turn interact with proteins that regulate cell division and cell death. The E6 protein suppresses the activity of the P53 gene (and the corresponding protein), and the E7 protein of the retinoblastoma gene, which stimulates the process of apoptosis (programmed cell death). This leads to the predominance of cell reproduction over cell death, which stimulates the uncontrolled malignant growth of cervical epithelial cells, the development of cervical cancer. Thus, the International Agency for Research on Cancer has concluded that high-risk HPV types are the main cause of cervical cancer.

However, it is known that the majority of women infected with HPV do not develop cervical cancer and HPV is “necessary” but not “sufficient” to develop the disease. Smoking, long-term use of hormonal contraceptives, and the presence of other STIs such as chlamydia, namely Chlamydia trachomatis, herpes simplex virus type 2, contribute to the development of cervical cancer in HPV-infected people. In addition, vitamin A deficiency, genetic predisposition, and immunodeficiency contribute to the development of cervical cancer in the presence of HPV. In addition to cervical cancer, the causal role of HPV has been established in cancer of the anus (especially in homosexuals), in cancer of the vulva, vagina, and penis. Some cases of cancer of the mouth, larynx, and esophagus are also possibly associated with HPV.

Up to half a million new cases of cervical cancer occur each year worldwide. Most of these cases are in developing countries where preventive annual screening programs for HPV, dysplasia and cervical cancer do not work or work poorly. The introduction of such preventive programs in developed Western countries has reduced the incidence of cervical cancer by 75%. Although the incidence of other HPV-related cancers is much lower, the incidence of anal cancer among gay men is estimated to be 4 times higher than the incidence of cervical cancer in women (35 cases per 100,000 homosexuals per year, versus 8.3 cases per 100,000 female population per year).

What is the natural development (without treatment) of HPV infection and what is its real danger to humans?

In the vast majority of cases, in people with normal immunological resistance, HPV carriage is temporary. The average duration of HPV carriage is 8 months. After 1 year from the moment of infection, no more than 30% of people remain infected, and after 2 years no more than 9%. If HPV, especially types of high oncological risk, exists (persists) in a person for a longer time, this may indicate that it caused the development of dysplasia or precancer. Such cases require closer monitoring. A longer carriage of the virus is observed in older individuals, as well as in those with immunodeficiency. A latent or latent course of HPV infection is also possible, which is not available for analysis in the deep layers of the epithelium.

Spontaneous disappearance of OCs, warts, skin papillomas and intraepithelial lesions is noted to occur quite often. It is known that OK of the genital organs pass independently in every 4th case (25%). The most intensively studied natural development of the so-called cervical intraepithelial neoplasia (CIN) or precancer in relation to cervical cancer. CIN was conditionally divided according to the degree of malignancy into 3 stages (1st least malignant, 3rd most malignant). With CIN 1 stage, the probability of its development into invasive cancer is 1%, the probability of regression to the norm is 60%, with CIN 2 invasive cancer develops in 1.5% of cases, regression to CIN 1 occurs in 40% of cases, with CIN 3 invasive cancer develops in 12% of cases, and reverse development to CIN 2 or CIN 1 is observed in 32% of cases. It has also been shown that when infected with high-risk HPV, CIN 2 and CIN 3 develop quite quickly, often bypassing CIN 1. The natural development of precancerous lesions of other localizations has not been studied enough, but the likelihood of developing cancer in these cases is much lower. Immunocompromised patients (primarily AIDS) are much more likely to develop HPV-induced cancer.

How is HPV infection manifested and diagnosed?

– MC of the genitals, perineum and anus

They are identified as pale gray, sometimes pinkish or pigmented growths on the stalk (reminiscent of cauliflower in appearance). Often these formations cause itching, pain or irritation when touched, sometimes they bleed. In women, OCs are most often found in the area of ​​​​the entrance to the vagina, on the labia minora and less often in the vagina and on the cervix. The external opening of the urethra is more often affected in men, and the area of ​​the perineum and anus in women, which is associated with differences in sexual behavior during intercourse. OK in the perineal area are more common in those who practice anal sex, and OK in the anus zone is almost exclusively in such persons.

Squamous intraepithelial lesions of the cervix

Recognized at screening examinations during colposcopy and biopsy of the cervix. Visually, such lesions, as well as flat OKs, are difficult to determine and they become visible only after treating the affected surface with 3-5% acetic acid.

Diagnosis is made by examining suspicious areas. Treatment with 3-5% acetic acid makes subtle lesions appear white and more visible. However, this test has low specificity and is not suitable for screening. In persons with obvious OCs, with the exception of those localized on the cervix, no additional examination is required. OK are subject to removal, however, with multiple, large, fixed to the skin and poorly amenable to standard treatment, OK, after removal, they are sent for histological examination to exclude malignant lesions. With lesions in the cervix and during screening (preventive) examinations, a more extensive diagnosis is carried out. It includes a cytological examination of Pap smear-stained smears (the so-called Pap smear or Pap smear). A more accurate diagnosis in the case of identified cellular atypia is carried out by histological examination of tissues obtained from a biopsy of the cervix. It allows you to assess the degree of CIN and establish the presence and degree of invasiveness and malignancy of cervical cancer. During preventive examinations of women, the HPV type is determined using the polymerase chain reaction (PCR). The identification of high-risk HPV types in women with CIN often dictates the need for colposcopy and later more aggressive treatment to remove the affected area and reduce the risk of developing cervical cancer. Since the simultaneous presence of STIs such as Chlamydia trachomatis (chlamydia trachomatis) and Herpes simplex virus type 2 (herpes simplex virus type 2) with HPV can significantly increase the oncogenic potential of HPV and increase the likelihood of cervical cancer, these infections can be diagnosed simultaneously .

What are the goals of HPV treatment and how is it done?

Diagnosis, treatment and prevention of diseases of the genital organs caused by HPV in men is carried out by urologists, in women – by gynecologists. Unfortunately, there are currently no methods of systemic exposure to HPV in the human body (antiviral agents), with the help of which it would be possible to completely destroy the virus. The main goal of treating OK is their removal with the help of electro- or laser coagulation, excision, cryodestruction (destruction by cold), as well as with the help of chemical substances of cellular toxins (podophyllin) or immunomodulators applied topically. Removal of OCs solves mainly a cosmetic problem, there is no data confirming that the removal of OCs contributes to the complete removal of HPV from the body or reduces the risk of its sexual transmission or infection of the fetus during childbirth. There is no evidence that OC treatment has any effect on the likelihood of developing cancer. However, from the point of view of common sense, the removal of OK should reduce the risk of development and recurrence of diseases caused by HPV.

The main goal of treatment of squamous epithelial lesions of the cervix is ​​the prevention of cervical cancer. If a Pap smear shows a lesion of unclear significance for the risk of malignancy, follow-up is indicated with Pap smears performed every 4 to 6 months for 2 years until there are 3 consecutive negative (without any pathological changes) smears. Women with high-risk intraepithelial lesions require immediate colposcopy and possibly biopsy of detected lesions for more detailed histological evaluation. If CIN 1 is detected as a result of a histological examination, dynamic observation is indicated, because the vast majority of such lesions undergo spontaneous regression to normal. CIN 2/3 lesions require active treatment, which consists of cryodestruction, laser evaporation or loop electrosurgical excision (conical excision or conization) of the cervix.

Recent randomized clinical trials have shown that all three methods have similar rates of complications (2-8%), persistence (3-5%) and recurrence (13-19%) of lesions. The risk factors for persistence (lack of treatment effect) were a large affected area, relapse – older age, the presence of oncogenic HPV types 16 and 18, as well as previous treatment.

What is HPV prevention?

Examination of sexual partners of patients with diseases caused by HPV has no proven value in terms of preventing their occurrence / relapse. However, theoretically, timely and complete removal of TCs and intraepithelial lesions can reduce the risk of these diseases, including cervical cancer. Condoms have not been proven to protect against the transmission of HPV, but their use reduces the risk of developing OC and cervical cancer. The most promising method for the prevention and treatment of the early stages of diseases caused by HPV are specific polyvalent (for HPV types 6, 11, 16 and 18) vaccines, which are currently in the stage of clinical trials. In summarizing what is known about HPV-related illnesses, the US Centers for Disease Control (CDC) draws attention to the public’s knowledge of the following key points:

• HPV is a very common STD
• Rarely able to identify source of infection due to very variable incubation period
• The natural course of diseases caused by HPV is often benign, and treatment sometimes takes several months. Often there are relapses (up to 50% of cases).
• TCs are most commonly caused by HPV types that do not cause cervical cancer
• Infectivity of sexual partners decreases with time
• The effectiveness of condoms in protecting against HPV has not been proven. However, the use of condoms by HPV patients during new sexual contacts is considered mandatory.
• Tell new sexual partners that you have previously been infected with HPV

Women, especially of sexually active age, need to know that the basis for the prevention of cervical cancer is mandatory annual preventive examinations by a gynecologist with a cytological examination of a Pap smear of the cervical epithelium, as well as, if necessary, HPV typing, colposcopy and biopsy of the cervix.

How to choose the right clinic for the diagnosis and treatment of HPV, adequate prevention of the diseases caused by it?

After reading the above material, you probably realized that the diagnosis and treatment of cervical cancer, ovarian cancer and other diseases caused by HPV is not an easy task, and it cannot be fully solved, for example, by a general practitioner or a small private clinic, where they can only “cauterize warts”. First of all, to solve the most important problems of diagnostics and treatment, urologists and gynecologists are needed, who know all the modern aspects of the problems of HPV infections and have a special education in the field of oncourology and oncogynecology, as well as general oncology. The medical institution you should contact should have an adequate diagnostic base. All types of cytological studies should be available here (standard cytological examinations of smears stained according to Papanicolaou are not widely available even in very reputable medical institutions in large cities of Russia) and histological studies. A specialist pathologist (histologist) should be well versed in all types of HPV epithelial lesions, from the most minor and benign to precancerous (such as CIN) and malignant.

The institution should have access to PCR diagnostics, should have all the necessary tools for high-quality sampling of materials for research (special disposable brushes, spatulas), should have special standard tools for cervical biopsy, should have electrosurgical equipment for cervical conization. A urologist must have a high-quality ureteroscope and master the technique of ureteroscopy, and a gynecologist, accordingly, must have a high-quality colposcope and master the technique and methodology of colposcopy in full. Urologists and gynecologists of a clinic specializing in the treatment of diseases caused by HPV should have and master one of the methods of excision and destruction of OK (electrocoagulation and excision, laser coagulation or evaporation, cryodestruction) in combination with methods of local drug treatment.

If necessary, doctors should also perform surgical excision of the affected tissue with cosmetic sutures. Ideally, the hospital of your choice should have sufficient administrative and computer facilities to track and dynamically monitor high-risk patients. Remember that the widespread introduction in developed Western countries of preventive cytological examinations of Pap-stained cervical smears, as well as other components of the treatment and prevention program for diseases caused by HPV, has reduced the incidence of cervical cancer by 75%. INCLUDING THIS IS THE BASIS OF THE SIGNIFICANT INCREASE (BY 15-20 YEARS) IN THE AVERAGE LIFE EXPENSITY OF WOMEN IN THE COUNTRIES OF WESTERN EUROPE, JAPAN AND THE USA IN RECENT YEARS.