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Is there a treatment for genital warts: Genital warts – Diagnosis and treatment

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Where Can I Get Treated For Genital Warts?

Genital warts may go away on their own, but sometimes they stick around, get larger or grow in number. Talk with a nurse or doctor about treatment options to have them removed.

Should I get treatment for genital warts?

That’s totally up to you to decide with your nurse or doctor. Your body’s immune system may fight off the virus that causes genital warts, and they’ll go away without any further treatment. But they may not, and can be uncomfortable and be passed to other people. If you’re pregnant, your doctor or nurse may want to remove the warts so they don’t cause problems during a vaginal delivery. Getting treatment also lowers your chances of passing warts on to anyone you have sex with.

What’s the treatment for genital warts?

There are several different ways to treat genital warts, depending on where the warts are and how much of your skin they cover. Like all medicines and procedures, these treatments can have different side effects, costs, and benefits. Talk with your doctor or nurse to decide which genital warts treatment option is best for you.

Your doctor or nurse can:

  • Put chemicals on the warts to make them go away or stop growing. Usually you get this done once a week for a few weeks at a clinic.

  • Give you a prescription for a cream that you put on the warts yourself for several weeks.

  • Freeze the warts off (cryotherapy).

  • Burn off the warts using an electric current.

  • Remove the warts with a knife or wire and electricity (LEEP).

Some of these treatments might sound kind of scary, but they all work by removing the warts, which removes any symptoms and lowers your chances of passing the HPV infection that caused them to anyone else. Your doctor or nurse can give you a numbing medicine to make you more comfortable.

By the way, over-the-counter wart medicines to treat warts that are on your hands or feet should NOT be used to treat genital warts.

Although there’s no cure for the types of HPV that cause genital warts, there is a vaccine that can prevent most kinds of genital warts and certain types of cancer.

What can I do after treatment to make sure I don’t get anymore warts?

Genital warts can be treated, but they can’t be cured. You’re removing the warts, but you’ll still have the HPV that causes them. The HPV may go away at some point on its own, but there’s no way to know for sure. Some people will get warts again and others won’t.

After you get your warts removed:

  • Keep the area clean and don’t scratch it.

  • Wash your hands after touching the area where the warts were.

  • Don’t have sex if it’s uncomfortable.

  • A cold pack may make you feel better if the area hurts or is swollen. You can also take over-the-counter pain medicine to help.

What do I do if my genital warts come back after treatment?

If your genital warts come back after treatment, you can talk with your nurse or doctor about treatment options to have them removed again. There are several different ways to treat genital warts, and your nurse or doctor may suggest a different method this time.

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Genital Warts & HPV (Human Papillomavirus) Treatment

What Are the Treatment Options for Genital Warts?

Generally, genital warts don’t cause symptoms, but they might be painful, itchy, and unsightly. Luckily, there are a number of treatments that can help. For external warts, these treatments include:

  • Creams, gels, and ointments
  • Cryotherapy (freezing off the warts)
  • Surgery
  • Acid solutions

Which treatment your doctor recommends depends on things like how many warts you have, where they are, how big they are, and your own treatment preference.

Creams, Gels, and Ointments

Options for gels, creams, and ointments are imiquimod cream, podofilox gel, and sinecatechins ointment.

Imiquimod is a cream you apply yourself to external warts to boost your immune system. You use imiquimod 5% cream at bedtime, three times a week for 16 weeks. You put on imiquimod 3.75% cream every night. With either strength, you should wash the treated area with soap and water 6 to 10 hours after you put it on. Avoid sex while imiquimod is on your skin because it can weaken condoms and diaphragms.

Podofilox and podophyllin resin are gels designed to kill the warts. After you apply them to an external wart, let the area air dry before you put on clothing. Podofilox isn’t recommended for warts on the cervix, vagina, or anal canal. It isn’t meant for large areas, either. If you use too much or don’t let it air dry, you could spread the gel to other body parts and irritate your skin.

Sinecatechins ointment is made from green tea extract. You apply sinecatechins 15% ointment to warts three times a day for up to 16 weeks. Avoid all sexual contact while the ointment is on your skin.

If the warts are in a moist area or in a spot where skin rubs together, talk to your doctor before using a medicine that goes on your skin.

Do not use these medications If you’re pregnant.

Cryotherapy

Your doctor can also freeze the warts off using liquid nitrogen and a cotton-tipped applicator or a special device called a cryoprobe. The cold is applied for 10-20 seconds. If you have a lot of warts or if they’re large, your doctor may numb the area first with a local anesthetic.

Surgery

This can get rid of all your warts in a single visit. After giving you a local anesthetic, the doctor can remove your warts using different methods. These include:

  • Cutting them off with scissors
  • Shaving them off with a sharp blade (this is called shave excision)
  • Using a laser to remove them (curettage laser)
  • Burning them off using electrocautery, a process that uses a low-voltage electrical probe

In most cases, you won’t need stitches after surgery.

Acid Solutions

Your doctor can use trichloroacetic or bichloroacetic acid to treat the warts. They’ll apply a small amount to the warts once a week and let it dry. This works best on small, moist warts and can be used to treat vaginal, cervical, and anal warts.

Treatments for Internal Warts

If you have vaginal or cervical warts, the recommended treatments are:

  • Cryotherapy or liquid nitrogen
  • Surgical removal
  • Acid solution

If you have warts in your urethra (the tube that carries urine from the kidneys to your bladder), your best treatment options are cryotherapy or surgical removal.

What If I Don’t Get Treated?

Genital warts may go away on their own or stay the same. If you aren’t treated, you could also get more or larger genital warts.

Genital Warts Treatment Side Effects

These are rare. They can include discoloring of the skin or scarring, especially if you haven’t had enough time to heal between treatments.

Rarer still is severe, chronic pain. If you have anal warts, having a bowel movement might become painful. You could also get a condition called a fistula, a tunnel in your skin that leads from your anus to the outside. You’ll need surgery to fix it.

HPV, STD, Symptoms, Causes, Treatment

Overview

What are genital warts?

Genital warts are a type of sexually transmitted disease (STD). The disease causes warts (small bumps or growth ) to form in and around the genitals and rectum. Certain types of human papillomavirus (HPV) cause genital warts.

Some warts are very small. Still, you can usually feel or see them. Healthcare providers may call genital warts condyloma; STDs are also called sexually transmitted infections (STIs). You can give genital warts to other people.

Where do you get genital warts?

Genital warts can infect the:

  • Groin (area between the stomach and thigh).
  • Inside and outside of the anus.
  • Lips, mouth, tongue or throat.
  • Penis and scrotum (the sac that contains the testicles).
  • Vagina (including inside the vagina), vulva, vaginal lips (labia minora and labia majora) and cervix (tissue that connects the vagina and uterus).

How common are genital warts?

An estimated 400,000 people — most of them in their late teens and twenties — get genital warts every year. The virus that causes these warts, HPV, is the most common STD. Approximately 79 million Americans have HPV. There are many different types of HPV. Not all cause genital warts.

Who might get genital warts?

Genital warts affect all genders. It’s most common in teenagers and young adults. Men are slightly more at risk. Your chances of getting genital warts increase if you:

  • Don’t use condoms while having sex.
  • Have multiple sexual partners.

Are genital warts contagious?

Yes, genital warts and the virus that causes them are both highly contagious. There isn’t a cure for HPV. Once you have the virus, you’re always infectious. Even if you don’t have symptoms like genital warts, or you have the warts treated and removed, you can still infect another person with HPV and genital warts.

Symptoms and Causes

What causes genital warts?

Certain types of HPV cause this STD. Genital warts spread through skin-to-skin contact during sex. A different virus causes warts on your hands and feet. You can’t get genital warts by touching yourself or someone else with a hand or foot that has warts.

Genital warts spread through:

  • Intercourse, including anal, vaginal-penile and vaginal-vaginal.
  • Genital touching (skin-to-skin contact without ejaculation).
  • Giving oral sex to someone who has HPV or genital warts.
  • Receiving oral sex from someone who has HPV or who has genital warts on the mouth, lips or tongue.

How soon do genital warts appear after infection?

Some people develop genital warts within weeks after infection. Often, though, it can take months or years for warts to appear. For this reason, it can be difficult to pinpoint when you got infected.

It’s also possible to have the virus and not get genital warts. You might not know if you have warts inside the anus or elsewhere in the body. If you don’t have symptoms, you may unknowingly infect others with the virus.

What are the symptoms of genital warts?

Warts look like rough, skin-colored growths. Genital warts often have a bumpy cauliflower look, but some are flat. Genital warts aren’t usually painful. Occasionally, they cause:

  • Mild bleeding.
  • Burning sensation.
  • Discomfort.
  • Genital itching or irritation.

Diagnosis and Tests

How are genital warts diagnosed?

Your healthcare provider can diagnose external genital warts by looking at them. Internal warts are more challenging to diagnose. You may get these tests:

  • Pelvic exam: A woman may get a Pap test as part of a pelvic exam to check for cervical changes caused by genital warts. Your provider may also perform a colposcopy to examine and biopsy the vagina and cervix.
  • Blood tests: Your provider may test for other STDs often associated with genital warts. These STDs include gonorrhea, syphilis and chlamydia.
  • Anal exam: Your provider uses a device called an anoscope to look inside the anus for warts.
  • Biopsy: Your provider may perform a biopsy (cutting out and removing a tiny piece, about the size of the tip of a pencil) when in doubt about diagnosis.

Management and Treatment

How are genital warts managed or treated?

Genital warts can go away on their own. Or they may get larger or multiply. There are different ways to remove genital warts. You may need several treatments to get rid of warts. For most of them, you’ll receive an anesthetic first to numb the treatment area. During treatment, you should abstain from sexual contact.

Your healthcare provider may use one of these methods to treat genital warts:

  • Electrocautery: An electric current burns away warts.
  • Freezing: During cryotherapy, your provider applies liquid nitrogen to freeze and destroy warts.
  • Laser treatment: A laser light destroys tiny blood vessels inside warts, cutting off their blood supply.
  • Loop electrosurgical excision procedure (LEEP): With LEEP, your provider uses an electrically charged wire loop to remove warts. A provider may use this method to remove warts on a woman’s cervix.
  • Topical (skin) medicine: Once a week for several weeks, you apply a prescription chemical solution to the warts. The chemical causes blisters to form under the warts, stopping blood flow. In some cases, your provider may apply the solution.
  • Your provider applies the topical TCA solution in the office. Your provider may also provide a prescription for a topical medical when appropriate eg. Imiquimod ( Aldara) that patient self-administers at home for some weeks as directed.
  • Surgery: Your provider may surgically cut out warts that are large or don’t respond to other treatments.

Can I get genital warts more than once?

Yes. There’s no cure for HPV, the virus that causes warts. As a result, you can get genital warts over and over again.

What are the complications of genital warts?

Genital warts on the cervix or inside the vagina can cause cervical changes (dysplasia) that can lead to cervical cancer. The warts cause these changes, not HPV.

There are other types of HPV that increase cancer risk. The HPV strains that cause cancer are not the same ones that cause genital warts.

How do genital warts affect pregnancy?

If you have an active outbreak of genital warts while pregnant, your increased hormone levels may cause the warts to bleed, get larger or multiply. Rarely, these complications happen:

  • A large wart or mass of warts blocks the birth canal. You may need to deliver via cesarean section.
  • HPV passes from mother to baby, causing warts to form inside a baby’s airways. This condition, called recurrent respiratory papillomatosis, is very rare.

Prevention

Is there a vaccine for genital warts?

The HPV vaccine can protect against certain types of HPV, including the ones that cause genital warts and certain cancers. There are more than 100 different types of HPV . Even if you already have the type of HPV that causes genital warts, the vaccine could still protect you from other strains.

Recent CDC and FDA guidance recommends that men and women up to 45 years of age get vaccinated to protect against HPV. HPV is the most common STD and can cause certain cancers and genital warts. More than 14 million new HPV infections occur in the US each year. Vaccination starts as early as age 9 ( most people initiate between age 11-12 years)

How can I prevent genital warts?

If you’re sexually active, you can take these steps to protect yourself from getting or spreading HPV, genital warts and other STDs:

  • Use condoms.
  • Get the HPV vaccine.
  • Get routine testing and any needed treatment for STDs.
  • Tell your sexual partners if you have HPV or genital warts so they can get tested and treated.
  • Be monogamous with one sexual partner or limit your number of partners.

Outlook / Prognosis

What is the prognosis (outlook) for people with genital warts?

Genital warts and HPV are common STDs. These types of warts, and the HPV types that cause them, don’t increase cancer risk. Some people have genital warts just once, while others have recurring outbreaks. Treatment can get rid of the warts, but it can’t cure them or HPV. You’ll always be infectious and need to practice safe sex with your partners.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Genital irritation or itching.
  • Painful intercourse.
  • Painful urination (dysuria).
  • Unusual or foul-smelling penile or vaginal discharge.
  • Vaginal or penile redness, soreness or swelling.

What questions should I ask my doctor?

If you have genital warts, you may want to ask your healthcare provider:

  • What is the best treatment for me?
  • Will warts come back after treatment?
  • What’s the best way to avoid getting another STD?
  • How can I protect my partner from getting HPV or genital warts?
  • Am I at risk for cervical cancer? If so, what steps can I take to protect my health?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Thousands of people get genital warts every year, and thousands more have the virus that causes them. Genital warts may not appear until months — sometimes years — after infection. Once you know you have genital warts and HPV, you should share this information with your sexual partners. Your healthcare provider can offer suggestions for preventing the spread of this STD. You can also take steps to lower your risk of getting other STDs.

Genital warts symptoms & treatment

FAST FACTS

  • Genital warts are caused by a virus that can be passed on through close genital contact, including sex without a condom.
  • They look like small lumps or growths and are usually found around the penis, vagina, anus or upper thighs.
  • If you think you might have genital warts, it’s important to have them checked by a healthcare professional.
  • The warts themselves can be treated and removed, but the virus that causes them can’t be cured.
  • The best way to prevent genital warts is to use condoms and dental dams for sex.

What are genital warts?

Genital warts are small, raised, usually painless growths. They are caused by the human papilloma virus (HPV) which can be passed on through sex without a condom. There are over 100 different strains of HPV. The strain of HPV that causes genital warts is different from the strain that causes genital cancers, such as cervical cancer. The HPV that causes warts isn’t linked to cancer and doesn’t cause any more serious health problems. The warts themselves can be treated and will clear.

What are the symptoms of genital warts?

Genital warts can appear as a single wart or as multiple warts in a cluster.

Symptoms include:

  • one or more small, flesh-coloured or grey painless growths or lumps around your vagina, penis, anus or upper thighs
  • itching or bleeding from your genitals or anus
  • a change to your normal flow of pee (for example, sideways), that doesn’t go away.

Be aware that the warts may be difficult to notice if they are internal (inside the vagina or anus) and that many people with the strain of HPV that causes genital warts will not develop any symptoms or know that they have it.

Symptoms of genital warts can appear weeks, months or years after you were in contact with the virus that causes them.

If you have symptoms of genital warts it’s important to visit a health clinic to have them checked.

How do you get genital warts?

Genital warts can be passed on through vaginal or anal sex without a condom and by sharing sex toys. The virus is transmitted through close genital contact, which means that you can get and pass on warts if you touch genitals with someone, even if you don’t have penetrative sex or ejaculate (cum).

Although it’s rare, genital warts can also be passed on through oral sex and affect the mouth and throat.

You can only get genital warts from someone else who has the virus, but be aware that not everyone will know if they have it. If the warts are internal someone may not notice them and people can pass on the virus even if they don’t have any symptoms.

You can’t get genital warts from kissing, hugging, swimming pools, sharing towels or cutlery.

If a woman has genital warts while pregnant, there is a risk that she could pass them on to her baby at birth. This isn’t very common, but it’s important that pregnant women seek advice from a healthcare worker if they notice any symptoms.

How do you prevent genital warts?

The best way to prevent genital warts is to use a condom for vaginal, anal and oral sex. If you’re sharing sex toys these should be covered with a new condom for each partner and washed between use.

If you have symptoms that could be genital warts you should go to a health clinic to have these checked. If you have genital warts, you may be advised to avoid sex while they’re being treated. If you do have sex, make sure that the warts are covered with a condom. This area of skin should be covered with a condom even after the warts have gone. You can still pass the virus on for up to three months after the warts have disappeared. Avoid rubbing or touching your warts, in case you spread the infection to the surrounding area. If you find out that you have genital warts your partner should also get checked.

Talking about your sexual health with your partners, and letting each other know about any symptoms or infections, will help you decide how to have safer sex together.

Reducing your number of sexual partners can also help you reduce your risk of getting sexually transmitted infections, like genital warts. If you are having sex with multiple partners, it’s even more important to use condoms and to have regular STI tests.

Condoms are the best form of protection against STIs and pregnancy. Other contraceptives including the contraceptive pill will not prevent genital warts, neither will PrEP.

Get vaccinated

The HPV vaccine, developed to protect against more serious forms of HPV, can also prevent genital warts. The vaccine does not guarantee that you will not develop genital warts in the future, but it will reduce your risk. It’s best to have the vaccine before you start having sex.

Ask a healthcare worker to find out if you can get the HPV vaccine where you are.

Can I get tested for genital warts?

Yes – a healthcare professional will usually diagnose warts by looking at them. They may check for hidden warts, by looking inside the vagina and or anus. If you have a problem urinating, a specialist may look at the urethra (the tube that carries pee from your bladder).

This examination shouldn’t be painful and you are welcome to have someone with you for the appointment if it would make you feel more comfortable. It’s not something that you should feel embarrassed about, remember that the healthcare professional will do this all the time.

How are genital warts treated?

The sooner genital warts are treated, the easier they are to get rid of. There are two main types of treatment for genital warts. The type of treatment you receive will depend on the type of warts you have and where the warts are. Treatments include:

  • applying a cream, lotion or chemicals to the warts
  • destroying the warts by freezing, heating or removing them.

It may take several weeks for the treatment to work. During this time, you may be advised to avoid soaps, or creams and lotions that could irritate the skin. You might also be advised not to have sex until you or your partner have finished your treatment, and the warts have gone.

Although these treatments can remove the warts themselves, there’s no cure for the virus that causes the warts. Some people’s bodies, however, are able to clear the virus over time.

You should always check with a healthcare worker before using treatments for genital warts. Many wart treatments are designed to be used on hands and feet and should not be used on your genitals.

Genital warts and pregnancy

It’s possible for pregnant women to pass genital warts on to their babies during childbirth, but this is rare. Talk to your healthcare worker if you are pregnant and think you might have genital warts. They will be able to advise you which treatment to use, as not all of the treatments available are suitable for pregnant women.

Genital warts, HIV and sexual health

If you have genital warts you should also test for HIV and other STIs. Having an STI, including genital warts, can increase your risk of getting HIV. This is because having an STI makes it easier for HIV to get into your body and cause an infection.

People living with HIV can also be more likely to get genital warts or have more severe cases of genital warts. This is especially the case for people who aren’t on treatment or who have a lower CD4 count. You’re more vulnerable to infections, like genital warts, if your immune system is weaker.

Speak to your healthcare provider if you are living with HIV and taking treatment for genital warts, to make sure that the medication won’t affect your antiretroviral treatment (ART).

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New approach to managing genital warts

Can Fam Physician. 2013 Jul; 59(7): 731-736.

Assistant Clinical Professor in the Department of Family Medicine of the Faculty of Medicine and Dentistry at the University of Alberta in Edmonton.

Correspondence: Dr Catharine C. Lopaschuk, Department of Family Medicine, University of Alberta, 205 College Plaza, Edmonton, AB T6G 2C8; e-mail [email protected] © the College of Family Physicians of CanadaThis article has been cited by other articles in PMC.

Abstract

Objective

To summarize and determine the appropriate use for the new and old management tools for genital warts.

Sources of information

The following databases were searched: MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ACP Journal Club, and Trip. The bibliographies of retrieved papers were also reviewed. Clinical trials, qualitative review articles, consensus reports, and clinical practice guidelines were retrieved.

Main message

Symptomatic warts are prevalent in at least 1% of the population between the ages of 15 and 49, with estimates of up to 50% of the population being infected with human papillomavirus at some point in their lifetime. Imiquimod and podophyllotoxin are 2 new treatments for external genital warts that are less painful and can be applied by patients at home. In addition, the quadrivalent human papillomavirus vaccine has been shown to be efficacious in preventing genital warts and cervical cancer. There is still a role for the older treatment methods in certain situations, such as intravaginal, urethral, anal, or recalcitrant warts; or for pregnant patients.

Conclusion

The new treatments of external genital warts can reduce the pain of treatment and the number of office visits. Other treatment methods are still useful in certain situations.

Case introduction

A 24-year-old woman presents to the office with a 3-month history of tender, itchy “bumps” on her vulva. She is a competitive cyclist and finds that biking irritates the bumps and causes them to bleed at times. She is not currently sexually active, but has had 4 male sexual partners in the past, with the most recent relationship ending 6 months ago. On examination you find multiple papillomatous lesions on her outer labia that are consistent with the appearance of warts. As you reach for the podophyllin, you remember hearing about some new topical treatments for genital warts that are more convenient and less toxic. You also wonder if you should be discussing the human papillomavirus (HPV) vaccine with your patient.

Sources of information

The databases MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ACP Journal Club, and Trip were searched up to March 2011. Searches were conducted for each treatment individually and were limited to English-language articles. The search terms used were warts or condyloma acuminata or papilloma virus and venereal or genital or vaginal and the specific treatment. The bibliographies of retrieved papers were also scanned for relevant articles. Excluded were articles examining cervical neoplasia and studies done in subjects who were immunocompromised, HIV-positive, or homosexual men.

Seventy-seven relevant articles were retrieved and their abstracts were assessed for inclusion in this evidence-based review, with preference given to high-quality systematic reviews from the Cochrane Collaboration. Of the retrieved papers, 49 were read and 30 were included in this review.

The recommendations and the level of evidence were graded using the Canadian Task Force on Preventive Health Care system ().1

Table 1

Grades of recommendations and levels of evidence from the Canadian Task Force on Preventive Health Care

GRADE OR LEVEL RECOMMENDATION OR EVIDENCE
A There is good evidence to recommend the clinical preventive action
B There is fair evidence to recommend the clinical preventive action
C The existing evidence is conflicting and does not allow a recommendation for or against the use of the clinical preventive action; however, other factors might influence decision making
D There is fair evidence to recommend against the clinical preventive action
E There is good evidence to recommend against the clinical preventive action
F There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors might influence decision making
I At least 1 properly conducted randomized controlled trial, systematic review, or meta-analysis
II Other comparison trials, non-randomized studies, cohort studies, case-control studies, or epidemiologic studies, and preferably more than 1 study
III Expert opinion or consensus statements

Main message

Genital warts are a common cause of morbidity. Symptomatic warts are prevalent in at least 1% of the population between the ages of 15 and 49,2,3 with estimates of up to 50% of the population being infected with HPV at some point in their lifetime.4 New treatments have become available in the past decade that have pushed some of the old treatments, such as podophyllin, into lesser favour. This review presents the new approaches to the treatment and management of genital warts, while including possible roles for some of the old treatments ( and and ).521

Management of genital warts in nonpregnant patients

HPV—human papillomavirus, STI—sexually transmitted infection, TCA—trichloroacetic acid.

Management of genital warts in pregnant patients

HPV—human papillomavirus, STI—sexually transmitted infection, TCA—trichloroacetic acid.

Table 2

Preferred and alternative treatment options:
Ranges in rates of clearance and recurrence reflect the variation of results across studies.

TREATMENT, LEVEL OF EVIDENCE, AND GRADE OF RECOMMENDATION CLEARANCE, % RECURRENCE, % APPLICATION REGIMEN ADVERSE EFFECTS SAFE FOR INTRAVAGINAL OR INTRA-ANAL USE SAFE FOR USE IN PREGNANCY OR LACTATION
Patient-applied treatments
Imiquimod 5% cream57 (grade B, level I)*
Imiquimod 3.75% has not been evaluated for the treatment of genital warts
51 22–63 Apply with finger 3 nights/wk for 16 wk Wash off in the morning Localized erythema, burning, inflammation; rarely, hypopigmentation Might weaken latex condoms and diaphragms No No; safety unknown
Podophyllotoxin 0.5% solution or gel7 (grade B, level I)*
More efficacious and less toxic than podophyllin
56 2–90 Apply with swab or finger 2 times/d for 3 d, then 4 d off, for up to 4 cycles. Limit of 10 cm2/d of skin surface or 0.5 mL/d Localized burning, pain, itching, erosion, inflammation No No; it is an extract of podophyllin, which is teratogenic
Provider-applied treatments
Cryotherapy812 (grade B, level I)* 27–88 25–55 Once per wk with cotton swab, spray, or cryoprobe (not in the vagina) Localized pain, inflammation, scarring Risk of vaginal perforation if using cryoprobe Yes Yes
TCA10,11,13 (grade B, level I)* 63–70 35 Once per wk with cotton swab or toothpick Localized pain and ulceration
Can neutralize with sodium bicarbonate solution
Yes Yes
Excision14 (grade B, level I) 35–72 19–79 Local anesthesia then excision of lesions Pain, bleeding, infection Yes Yes
Electrocautery14 (grade B, level II) 61–94 22 Local anesthesia then destruction of lesions with cautery tools Pain, bleeding, infection Operator should wear a virus-filtering mask Yes Yes
Alternative treatments
Podophyllin 25% in tincture of benzoin1416 (grade C, level I) 23–72 23–65 Once per wk with cotton swab or toothpick
Limit 10 cm2 of skin surface or 0.5 mL per treatment
Localized burning, pain, itching, erosion, inflammation Limit < 2 cm2 of skin surface No; is teratogenic
Sinecatechins (green tea extract) 15% ointment17,18 (grade B, level II; 2 trials) 57 6.5 Apply 3 times/d for up to 16 wk Localized erythema, burning, pain, rash, ulceration No; not studied No; not studied
Fluorouracil 1% gel or 5% cream19,20 (grade C, level II)
Useful for large numbers of vaginal or urethral-meatal warts in which cryotherapy or TCA are not tolerated
80–90 No data Insert applicatorful into vagina 3 nights/wk Erythema, erosion, edema Yes No; is teratogenic
Interferon21 (grade C, level II) 44.4 21.1 One applicatorful in vagina twice daily for 5 d/wk for 4 wk Headache, tenderness, transient fever Yes No; not studied
Observation*14 40–60 No data No data No data No data No data

Visible genital warts can be psychologically and physically distressing for patients. While warts are often asymptomatic, at other times they can cause pain, itching, burning, irritation against clothing, and occasionally bleeding.4 They can also cause pain and bleeding during sexual activity.

Treatment of benign, symptomatic genital warts is aimed at alleviation of physical symptoms and cosmetic improvement. From 40% to 60% of untreated warts will spontaneously resolve in 9 to 12 months,14 but many patients are psychologically distressed by the presence of warts and require intervention to eradicate them (Box 1).

Box 1.

Getting started

  • Discuss the treatment options with the patient, including observation, and consider the location of the warts, extent of involvement for painful treatments (cryotherapy or trichloroacetic acid), and the possibility of pregnancy

  • Order a pregnancy test and discuss contraception with fertile women if treating with imiquimod, podophyllotoxin, or podophyllin

  • Start treatment with a first-choice therapy and continue for the recommended duration

  • Reassess at the end of the treatment and repeat the treatment if lesions are not cleared, or if new ones have appeared

  • If lesions do not seem to be responding to treatment after 2 or 3 cycles, try an alternate first-choice therapy. If there is a response to treatment, you can keep going with the same therapy, repeating cycles of treatment as needed

  • Continue in this manner until you find the treatment that works for this patient. Choose a second-choice therapy if you fail to find a suitable first-choice therapy

  • In situations in which the first-choice therapies have failed, are contraindicated, or are not tolerated by the patient, and the second-choice therapies are not available, or not feasible (eg, periurethral warts), try a not-generally-recommended therapy. They are not usually recommended because of lack of evidence, more severe side effects, or teratogenicity, but are still useful in difficult cases

  • If all available options for treatment have failed, then refer the patient to a local sexually transmitted infection clinic, gynecologist, dermatologist, or urologist for treatment

Genital warts are caused by several strains of HPV and are spread by skin-to-skin contact during sexual activity. They are, therefore, considered a sexually transmitted infection (STI).22 A number of different treatments are available. Some of these treatments can be self-applied by the patients, while others require treatment by a nurse or physician. In this article, I have included older treatments (eg, podophyllin) that might now be relegated to use only in difficult cases, as they are familiar to many general practitioners who have been in practice for decades. It might be useful for them to know where these treatments now stand. I have also included some new, less-used treatments (interferon, sinecatechins) because readers might have heard about them and wondered about their use.

The diagnosis of genital warts is made by visual inspection for the appearance of lesions consistent with warts. They can appear as papillomatous plaques or flat lesions, and can be singular or multiple, or can coalesce into condylomata acuminata. They can vary from flesh-coloured to white, pink, or brown. The locations involved in women can be the cervix, vagina, vulva, urethral meatus, and perianal region. In men, the scrotum, penis shaft, corona and under the foreskin, and perianal region can be involved.23

The differential diagnosis includes sebaceous glands, seborrheic keratoses, molluscum contagiosum, psoriasis, lichen planus, melanocytic nevi, fibroepitheliomas, neoplasia, and condylomata lata (syphilis).23 Occasionally, a biopsy is indicated to confirm the diagnosis and rule out malignancy. Testing for acetowhitening with a 3% to 5% acetic acid solution (household vinegar) is not recommended because it is considered too nonspecific to be useful.4 Human papillomavirus types 16 and 18 cause more than 70% of cases of invasive cervical cancer.24 More than 90% of cases of benign disease (genital warts) are caused by types 6 and 11.15

Transmission of HPV to a neonate can result in laryngeal papillomatosis in the newborn. As this is a rare, non-malignant condition, and it is unclear whether the newborn becomes infected during birth or post partum, cesarean section is not recommended for prevention (grade C, level II).4

There is a consensus of expert opinion that attempts should be made to reduce the HPV load in pregnant women by treating genital warts before vaginal delivery, although there is no evidence that such treatment reduces viral load (levels I to III).4 There is a lack of evidence that treatment of visible warts eradicates the HPV infection or prevents transmission of the virus.4,25

Other management and prevention

Quadrivalent HPV vaccine protects against HPV types 6, 11, 16, and 18, the strains that most commonly cause benign warts and cervical cancer. Initial studies in women showed that it is 90% to 100% efficacious in preventing genital warts.26 After the introduction of a vaccination program in 2007, 4-year follow-up of young, sexually active women in Australia showed a marked decline in the prevalence of genital warts from 11.7% to 4.8% by 2009, and an ongoing, slower decline since then. There has been an associated, but less dramatic, decline in the incidence of warts in heterosexual men as well, presumably through reduced exposure to the virus as more of their partners were vaccinated.27,28

At this time, Canada has approved the quadrivalent HPV vaccine for women aged 9 to 26 years. It is recommended that women who present with genital warts and who have not yet been vaccinated should be offered the vaccine (3 doses at 0, 2, and 6 months). While it does not clear current HPV infection, it might help prevent reinfection with other strains (in particular the higher risk types 16 or 18). There is grade A, level I evidence that the quadrivalent HPV vaccine prevents cervical cancer3,4 (not addressed in this paper) and grade B, level I evidence that it prevents genital warts.23,27

The quadrivalent HPV vaccine has an increased cost utility; it reduces the cost burden, as it prevents both genital warts and cervical cancer, compared with a vaccination for cervical cancer alone.3

Other than administering the quadrivalent HPV vaccine, the following recommendations are made to prevent and manage genital warts:

  • All women should have Papanicolaou smears to screen for co-infection with oncogenous strains.

  • Women should be screened for other STIs according to STI guidelines. Screening partners for warts is not indicated.4 Genital warts do not need to be treated unless they are symptomatic.

  • Anoscopy should be performed to confirm the diagnosis of symptomatic (itching, painful, bleeding) intra-anal warts. Asymptomatic warts can be observed, so a diagnosis is unnecessary. They can occur without a history of anal-receptive intercourse.

  • Contraception might need to be discussed and prescribed, particularly if using a wart treatment that is contraindicated in pregnancy. Keep in mind that imiquimod might weaken latex barrier devices such as condoms and diaphragms.

  • Condoms do offer protection, although incomplete protection, against transmission of HPV (grade B, level II).29,30

  • Follow-up at 2 to 3 months after achieving wart clearance is recommended, to check for recurrence or new lesions.

  • Patients with recalcitrant (difficult to treat), symptomatic warts should be referred to local STI clinics, gynecologists, dermatologists, or urologists.

Case resolution

Your diagnosis is genital warts. You do a Pap smear and screen for gonorrhea and chlamydia. You advise the patient that condoms might help to prevent transmission. After discussion of treatment versus observation, she decides that she would like to treat the warts because they are bothering her. You prescribe her an oral contraceptive before initiating treatment, and you also arrange for her to receive the quadrivalent HPV vaccine. You prescribe imiquimod 5% cream, to be applied at home 3 nights a week for 16 weeks. When you see her again, 2 months after she finishes the treatment, there are no longer any visible warts.

Limitations

This review was limited by the evidence available, in English, at the time of writing. Systematic reviews were available for 5 of the therapies, but even so, some of the studies used in the reviews were not of high quality (eg, studies of fluorouracil).20 Other therapies have a lot more research behind them (eg, imiquimod). Information on safety in pregnancy is lacking for imiquimod, interferon, and sinecatechins. And some research results are still pending (eg, for the HPV vaccine). This topic would be worth reviewing again in 4 years.

Conclusion

When, and how, to treat genital warts is a decision that the patient and clinician should make together. The choice of treatment should consider the severity of the symptoms—both psychological and physical—and weigh that against the adverse effects of the treatment. The final decision might depend on the extent of the warts and the tolerance the patient has for painful treatments, or the time that the patient is willing to invest in repeated treatments. The advent of patient-applied therapies reduces the burden of repeated visits to a clinic.

Notes

EDITOR’S KEY POINTS

  • Nearly all external genital warts are benign and not associated with cervical or penile cancer.

  • Treatment of genital warts is aimed at alleviation of symptoms and emotional distress. Most cases of genital warts will resolve spontaneously, usually within 12 months, if left untreated.

  • There is no evidence that treating visible genital warts will prevent transmission of the virus.

  • The quadrivalent human papillomavirus vaccine is efficacious in preventing genital warts, but will not clear those that are already present.

Footnotes

This article has been peer reviewed.

This article is eligible for Mainpro-M1 credits. To earn credits, go to www.cfp.ca and click on the Mainpro link.

La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro de juillet 2013 à la page e304.

Competing interests

None declared

References

1. Canadian Task Force on Preventive Health Care New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ. 2003;169(3):207–8. [PMC free article] [PubMed] [Google Scholar]3. Money DM, Roy M. Canadian consensus guidelines on human papillomavirus. J Obstet Gynaecol Can. 2007;29(8 Suppl 3):S1–56. [Google Scholar]4. Workowski KA, Berman S, Centers for Disease Control and Prevention Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110. [PubMed] [Google Scholar]5. Gotovtseva EP, Kapadia AS, Smolensky MH, Lairson DR. Optimal frequency of imiquimod (Aldara) 5% cream for the treatment of external genital warts in immunocompetent adults: a meta-analysis. Sex Transm Dis. 2008;35(4):346–51. [PubMed] [Google Scholar]6. Moore RA, Edwards JE, Hopwood J, Hicks D. Imiquimod for the treatment of genital warts: a quantitative systematic review. BMC Infect Dis. 2001;1:3. Epub 2001 Jun 5. [PMC free article] [PubMed] [Google Scholar]7. Yan J, Chen SL, Wang HN, Wu TX. Meta-analysis of 5% imiquimod and 0.5% podophyllotoxin in the treatment of condylomata acuminata. Dermatology. 2006;213(3):218–23. [PubMed] [Google Scholar]8. Stefanaki C, Katzouranis I, Lagogianni E, Hadjivassiliou M, Nicolaidou E, Panagiotopoulos A, et al. Comparison of cryotherapy to imiquimod 5% in the treatment of anogenital warts. Int J STD AIDS. 2008;19(7):441–4. Erratum in: Int J STD AIDS 2008;19(10):722. [PubMed] [Google Scholar]9. Stone KM, Becker TM, Hadgu A, Kraus SJ. Treatment of external genital warts: a randomised clinical trial comparing podophyllin, cryotherapy, and electrodesiccation. Genitourin Med. 1990;66(1):16–9. [PMC free article] [PubMed] [Google Scholar]10. Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloroacetic acid. Sex Transm Dis. 1993;20(6):344–5. [PubMed] [Google Scholar]11. Godley MJ, Bradbeer CS, Gellan M, Thin RN. Cryotherapy compared with trichloroacetic acid in treating genital warts. Genitourin Med. 1987;63(6):390–2. [PMC free article] [PubMed] [Google Scholar]12. Yliskoski M, Saarikoski S, Syrjänen K, Syrjänen S, Castrén O. Cryotherapy and CO2-laser vaporization in the treatment of cervical and vaginal human papillomavirus (HPV) infections. Acta Obstet Gynecol Scand. 1989;68(7):619–25. [PubMed] [Google Scholar]13. Sherrard J, Riddell L. Comparison of the effectiveness of commonly used clinic-based treatments for external genital warts. Int J STD AIDS. 2007;18(6):365–8. [PubMed] [Google Scholar]14. Wiley DJ, Douglas J, Beutner K, Cox T, Fife K, Moscicki AB, et al. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis. 2002;35(Suppl 2):S210–24. [PubMed] [Google Scholar]15. Mayeaux EJ, Jr, Dunton C. Modern management of external genital warts. J Low Genit Tract Dis. 2008;12(3):185–92. [PubMed] [Google Scholar]16. BASHH HPV Special Interest Group . United Kingdom national guideline on the management of ano-genital warts, 2007. Macclesfield, UK: British Association for Sexual Health and HIV; 2007. Available from: www.bashh.org/documents/86/86.pdf. Accessed 2013 May 28. [Google Scholar]17. Tatti S, Stockfleth E, Beutner KR, Tawfik H, Elsasser U, Weyrauch P, et al. Polyphenon E: a new treatment for external anogenital warts. Br J Dermatol. 2010;162(1):176–84. Epub 2009 Jul 27. [PubMed] [Google Scholar]18. Tatti S, Swinehart JM, Thielert C, Tawfik H, Mescheder A, Beutner KR. Sinecatechins, a defined green tea extract, in the treatment of external anogenital warts: a randomized controlled trial. Obstet Gynecol. 2008;111(6):1371–9. [PubMed] [Google Scholar]19. Batista CS, Atallah AN, Saconato H, da Silva EM. 5-FU for genital warts in non-immunocompromised individuals. Cochrane Database Syst Rev. 2010;(4):CD006562. [PMC free article] [PubMed] [Google Scholar]20. Syed TA, Qureshi ZA, Ahmad SA, Ali SM. Management of intravaginal warts in women with 5-fluorouracil (1%) in vaginal hydrophilic gel: a placebo-controlled double-blind study. Int J STD AIDS. 2000;11(6):371–4. [PubMed] [Google Scholar]21. Yang J, Pu YG, Zeng ZM, Yu ZJ, Huang N, Deng QW. Interferon for the treatment of genital warts: a systematic review. BMC Infect Dis. 2009;9:156. [PMC free article] [PubMed] [Google Scholar]22. Ault KA. Epidemiology and natural history of human papillomavirus infections in the female genital tract. Infect Dis Obstet Gynecol. 2006;2006(Suppl):40470. [PMC free article] [PubMed] [Google Scholar]23. Australia and New Zealand HPV Project . Guidelines for the management of genital HPV in Australia and New Zealand. 5th ed. Viral Sexually Transmitted Infection Education Foundation; 2007. [Google Scholar]24. Ogunmodede F, Yale SH, Krawisz B, Tyler GC, Evans AC. Human papillomavirus infections in primary care. Clin Med Res. 2007;5(4):210–7. Epub 2007 Dec 17. [PMC free article] [PubMed] [Google Scholar]25. Lacey CJ. Therapy for genital human papillomavirus-related disease. J Clin Virol. 2005;32(Suppl 1):S82–90. [PubMed] [Google Scholar]26. FUTURE I/II Study Group. Dillner J, Kjaer SK, Wheeler CM, Sigurdsson K, Iversen OE, et al. Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial. BMJ. 2010;341:c3493. [PMC free article] [PubMed] [Google Scholar]27. Donovan B, Franklin N, Guy R, Grulich AE, Regan DG, Ali H, et al. Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data. Lancet Infect Dis. 2011;11(1):39–44. Epub 2010 Nov 8. [PubMed] [Google Scholar]28. Fairley CK, Hocking JS, Gurrin LC, Chen MY, Donovan B, Bradshaw CS. Rapid decline in presentations of genital warts after the implementation of a national quadrivalent human papillomavirus vaccination programme for young women. Sex Transm Infect. 2009;85(7):499–502. Epub 2009 Oct 16. [PubMed] [Google Scholar]29. Manhart LE, Koutsky LA. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis. 2002;29(11):725–35. [PubMed] [Google Scholar]30. Winer RL, Hughes JP, Feng Q, O’Reilly S, Kiviat NB, Holmes KK, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354(25):2645–54. [PubMed] [Google Scholar]

Genital Warts

Some types of HPV can cause genital warts, which can appear as fleshy, painless, cauliflower-shaped skin growths. Warts are often small and hard to see, though, and can have different appearances: they might be smooth or rough, or large or small. There might be just one wart, or several.

Genital warts may appear within several weeks after sex with someone who has the wart-causing-types of HPV, or it may take several months or years to appear. It’s also possible that warts may never appear. This makes it hard to know exactly when or from whom someone got the virus.

Warts may appear around the vulva, in or around the vagina, in or around the anus, the groin (where the genital area meets the inner thigh), on the penis, on the scrotum (balls), or the cervix (although this is less common than external warts). Warts usually do not cause itching, burning, or pain. However, most HPV infections will not lead to visible warts and most people will not know they have the virus.

Genital warts may or may not return after the first episode. Some people only have one episode of warts, while others have recurrences, when warts reappear. When warts are present, the virus is considered active. When warts are gone, the virus is latent (sleeping) in the skin cells – it may or may not be contagious at this time.

A healthy immune system is usually able to clear the virus, or suppress it, over time.

How are warts transmitted?

The types of HPV that cause genital warts are usually spread by direct skin-to-skin contact during vaginal, anal, or possibly oral sex with someone who has this infection. Any person who is sexually active can get genital warts.

HPV may be more likely transmitted when warts are present, but the virus can be passed on even when there are no visible symptoms.

The types of HPV that cause genital warts are usually different from those causing warts on other body parts, such as the hands. People do not get genital warts by touching warts on their hands or feet.

Warts are not commonly found in the mouth, so some experts believe that transmission through oral sex is not as likely as with genital-to-genital or genital-to-anal contact.

Diagnosing Genital Warts

A healthcare provider will check a person’s genital area and may even use a magnifying lens to find and identify warts. Sometimes, warts can be very hard to see. Also, it can be hard to tell the difference between a wart and normal bumps on the genital area.

To look for warts or other abnormal tissue, the healthcare provider may put acetic acid (vinegar) on the genitals. This causes warts to turn white and makes them easier to see, especially if they are viewed through a magnifying lens such as a colposcope. However, the vinegar can sometimes cause other normal bumps to be highlighted, so this method of diagnosis can be misleading.

A biopsy is not necessary for diagnosing genital warts. This is only done if the bump is unusual looking or discolored.

HPV DNA tests are only approved for use as part of cervical cancer screening and, and are not used to diagnosed warts. These are no blood tests clinically available to diagnose a person for HPV.

Treatment for Genital Warts

While there is no medical cure for HPV, there are several treatment options available for genital warts. The goal of any treatment should be to remove visible warts to get rid of annoying symptoms. Treating the warts may possibly help reduce the risk of passing the infection on to a partner who may have never been exposed to the wart-types of HPV.

When choosing what treatment to use, the healthcare provider will consider the size, location and number of warts, changes in the warts, patient preference, cost of treatment, convenience, adverse effects, and their own experience with the treatments. No one treatment is best for all cases. Some treatments are done in a clinic or doctor’s office; others are prescription creams that can be used at home for many weeks.

Treatments done in the doctor’s office include:

  • Cryotherapy (freezing off the wart with liquid nitrogen). This can be relatively inexpensive, but must be done by a trained healthcare provider.
  • Podophyllin (a chemical compound that must be applied by a healthcare provider). This is an older treatment and is not as widely used today.
  • TCA (trichloracetic acid) is another chemical applied to the surface of the wart by a healthcare provider.
  • Cutting off warts. This has the advantage of getting rid of warts in a single office visit.
  • Electrocautery (burning off warts with an electrical current)
  • Laser therapy (using an intense light to destroy warts).This is used for larger or extensive warts, especially those that have not responded well to other treatments. Laser can also cost a lot of money. Most healthcare provider do not have lasers in their office and the provider must be well-trained with this method.
  • Interferon (a substance injected in to the wart). This is rarely used anymore due to extensive side effects and high cost. Less expensive therapies work just as well with fewer side effects.

At-home prescription creams (these are only available by a prescription):

  • Podofilox cream or gel (Condylox®). This is a self-applied treatment for external genital warts. It may be less expensive than treatment done in a healthcare provider’s office, is easy to use and is safe, but it must be used for about 4 weeks.
  • Imiquimod cream (Aldara®). This is also a self-applied treatment for external genital warts. It is safe, effective and easy to use. This cream is different than other commonly-used treatments, which work by destroying the wart tissue. Aldara® actually boosts the immune system to fight HPV, and may make recurrences less likely.

IMPORTANT: Over-the-counter wart treatments should not be used in the genital area.

Reducing Your Risk

Any person who is sexually active can come across this common virus. Ways to reduce the risk are:

  • If someone had visible symptoms of genital warts, they should not have sexual activity until the warts are removed. This may help to lower the risk of passing the virus.
  • Condoms used the right way from start to finish every time you have sex may help provide protection – but only for the skin that is covered by the condom. Condoms do not cover all genital skin, so they don’t protect 100%.
  • Spermicidal foams, creams, jellies (and condoms coated with spermicide) are not proven to be effective in preventing HPV and may cause microscopic abrasions that make it easier to contract STIs. Spermicides are not recommended for routine use.
  • Vaccines that protect against the HPV types found with most cases of genital warts.

When someone has HPV, they are not likely to be reinfected if exposed again to the same type. This is probably due to the immune system’s response to the virus. However, it is possible to be infected with a different type of HPV from a new partner. It is important for partners to understand the “entire picture” about HPV so that both people can make informed decisions based on facts, not fear or misconceptions.

Pregnancy and Genital Warts

Most pregnant women who have had genital warts previously but no longer do would be unlikely to have any complications or problems during pregnancy or birth. Most children are born healthy to women with a history of genital warts.

Because of hormone changes in the body during pregnancy, warts can grow in size and number, bleed, or, in extremely rare cases, make delivery harder. Very rarely, babies exposed to the wart-types of HPV during birth may develop growths in the throat. This so seldom happens, though, that women with genital warts do not typically need to have a cesarean-section delivery unless warts are blocking the birth canal.

It is important that a pregnant woman notify her healthcare provider or clinic if she or her partner(s) has had genital warts. This way they can determine if they need to treat the warts, or not, during the pregnancy.

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90,000 Genital warts in women, causes and treatment

Genital warts are pinkish warts that sometimes look like cauliflower on mucous membranes and skin.

In men they are found

  • in the genital area,
  • in the urethra.

In women :

  • in the vagina,
  • on the cervix,
  • in the anal region.

They are caused by the human papillomavirus (HPV), the most common cause of sexually transmitted diseases (STDs).Genital warts are referred to as sexually transmitted diseases. This is the “top of the pyramid” hiding in the cells of the skin and mucous membranes. This is a marker of the presence of a venereal infection in the body.

What are the symptoms of genital warts?

Condylomas can cause

  • itching,
  • burning,
  • frequent urination,
  • pain during sexual intercourse,
  • discomfort in the lower abdomen.

What is the danger of genital warts?

The relationship between the papillomavirus and cancer has been identified.If you have had genital warts in the past, then there is a high risk of developing oncology of a certain type. HPV was detected in 85% of neoplasms of the cervical canal. A number of scientists believe that HPV is the leading cause of cancer of the penis, vagina, vulva and anal canal.

What are the causes of genital warts?

HPV, which causes genital warts, is transmitted through sexual contact with an infected partner. Often, rashes appear in the first three months after intimate contact.Condoms reduce the risk of contracting genital warts, but they do not provide a complete guarantee, since they only protect the mucous membranes.

If you are sick, HPV can be passed on to your baby during labor.

Where do you get warts from?

The human papillomavirus, having penetrated into the cells of the body, dies for a long time. Many of us are infected with it, but do not know about it. HPV may not cause you to have genital warts for many years, and only when immunity decreases, the virus will develop into a disease – characteristic formations will appear.

Anyone living sexually exposes themselves to the risk of infection with genital warts.

  • STDs: thrush (candidiasis), trichomoniasis, mycoplasmosis, chlamydia, ureaplasmosis, etc.,
  • taking certain medications, in particular, chemotherapy and immunosuppressants;
  • smoking.

The proliferation of genital warts increases with pregnancy . Therefore, it is important to be attentive to your health, especially if you are expecting a baby.

How is genital warts diagnosed?

If you find papillary formations on or near the genitals, be sure to contact your venereologist.

1. An experienced specialist determines genital warts by its appearance (visually). But in order to confirm the diagnosis, it is necessary to identify the DNA of the virus in the patient’s blood. This is done using Polymerase Chain Reaction (PCR) .

2. You should also conduct a study of urogenital microflora to exclude the presence of other sexually transmitted diseases (STDs) in the blood.The doctor will offer you and your sexual partner to be tested for STDs (smears, blood).

3. If necessary, the doctor uses the colposcope (special microscope) for diagnosis, performs urethroscopy (instrumental examination) and prescribes laboratory tests.

4. To exclude cancerous and precancerous processes, material from the cervix is ​​taken from women for cytological examination , the material is also taken from the man for cytology.

5. And since the disease is associated with a decrease in immunity, the doctor will prescribe a blood test to determine the immune status or send you for a consultation with an immunologist.

Treatment of genital warts

Treatment of genital warts involves two tasks: removing warts and reducing HPV in the body.

There are many ways to remove genital warts:

• Cryodestruction – condylomas are destroyed by exposure to low temperatures (liquid nitrogen).

• Thermocoagulation method – they act on genital warts with high temperatures.

• Chemical destruction – condylomas are treated with preparations containing concentrated acids.

• Laser destruction – influence on growths with a surgical laser.

• Radiosurgical destruction – genital warts are exposed to radio waves.

For the treatment of genital warts in St. Petersburg, you can contact the highly professional specialists of our clinic.

Genital warts are the result of the development of HPV in the body, therefore it is important to strengthen the immune system in order to reduce the content of the virus. Since today there are no effective antiviral drugs, genital warts will appear again with weakening of the immune system. The concentration of the virus in the body is associated with the state of the immune system, therefore the most promising method is immunomodulation .

If you have genital warts, treatment should be started immediately.For treatment in St. Petersburg, please contact our clinic. You can count on the attentive service and the most up-to-date treatment.

See also : Prevention of STDs, Visiting a urologist, Visiting a gynecologist.

Treatment of genital warts – Volgograd

Genital warts (condilomata acuminata) are single or multiple papillary growths on a thin or wide stalk that can appear on the genitals and around the anus and are a symptom of genital papillomavirus infection.Transmission of human papillomaviruses (HPV) occurs predominantly through sexual contact, therefore genital warts are referred to as sexually transmitted diseases or sexually transmitted diseases (STDs). At the same time, household (through personal hygiene items) and vertical (from mother to fetus, especially during childbirth) routes of infection transmission are not completely excluded. A feature of human papillomavirus infection is that it can be in a latent (dormant) state indefinitely (without clinical manifestations – genital warts).The incubation period (the period from the moment of infection to clinical manifestations) of genital warts ranges from 3 weeks to 8 months, on average – 2-3 months. Sometimes HPV remains in the body in a latent state for a number of years, and in rare cases, throughout a person’s life, while the virus is under the control of the immune system. Accordingly, the provoking factors for the manifestation of HPV are a decrease in immunity as a general one – as a result of stress, bad habits (smoking, alcohol abuse, etc.)and lack of sleep, malnutrition, etc., and local immunity – with concomitant infections of the genital tract (trichomoniasis, gonorrhea, syphilis, chlamydia, etc.). Therefore, the approach to examination (in order to eliminate provoking factors) and treatment of papillomas in men and women with genital warts should be complex. All patients with genital warts should be screened for syphilis and other sexually transmitted infections. With frequent relapses, consultation with an immunologist is necessary.Given the prevalence of HPV infection (including types of “high cancer risk”), all women are shown an annual cytological examination of smears from the cervix for the timely detection of cervical dysplasia. There are many treatments for genital warts. Unfortunately, none of them are perfect or versatile. Currently, there is no treatment that completely eliminates the human papillomavirus. After any treatment, the risk of relapse is about 30%.Therefore, the goal of therapy is to eliminate clinical manifestations (actually remove genital warts and, accordingly, a significant decrease in the concentration of the virus) and reduce the risk of recurrence (i.e., the maximum possible elimination of provoking factors of decrease, both general and local, immunity).

In the conditions of our Medical Center, our dermatologists will offer you an examination plan, as well as recommendations for the prevention of relapse. We carry out symptomatic treatment of genital warts by electrocoagulation or cryodestruction (liquid nitrogen) – the method is selected individually at a face-to-face consultation.

Let’s talk about venereal warts (genital warts) with the dermatovenerologist of CITILAB CLINIC Vitaly Viktorovich Shishkin.

Genital warts are a common form of human papillomavirus infection (HPV).

Outwardly, they manifest themselves as neoplasms of the skin and mucous membranes in the form of papillae of the color of ordinary skin, which, expanding, become similar to cauliflower.

Usually located on the epithelium of the genitals, anus and perineum, less often on the lips and mouth.

Infection with the virus occurs during sexual intercourse (genital, oral, anal) with an infected partner.

Domestic infections are rare.

It is also possible to transmit HPV from mother to child during childbirth.

HPV is widespread and highly infectious.

A total of 100 types of human papillomavirus infect humans.

Of these, genital warts can cause 6,11, 42, 43, 44 strains of the virus.

The risk of contracting HPV increases:

  • with a decrease in general and local immunity;
  • the presence of other STIs in the body (chlamydia, gonorrhea, ureaplasmosis, trichomoniasis, herpes, candidiasis)

How does the disease develop?

The virus, having penetrated into the human body (at the same time it can be several different strains of the virus), begins to multiply in the cells of the epithelium.A large amount of the virus changes the growth of the cell and it begins to divide uncontrollably, forming a tumor-like formation – genital warts.

Treatment

The main method of treatment remains the removal of formations, i.e. genital warts.

It is completely painless under local anesthesia.

In modern conditions, the following are used:

  1. Radiosurgical method or radio wave scalpel, it quickly, painlessly, precisely removes warts without leaving scars.
  2. Cryodestruction (destruction by cold), condyloma is frozen, after which it dies and is rejected.
  3. Removal by laser. The tissue of the condyloma is “burned” with the formation of a dry crust in its place, in this case, moderate cicatricial changes remain.
  4. Electrocoagulation (the oldest method) – warts are cauterized with an electrode (electrocautery), leaving pronounced scars.
  5. Chemical method – cauterization of formations with special solutions of acids or alkalis, the method is based on a chemical burn of the wart tissue.The latter method gives relapses more often than others.

The risk of disease recurrence after removal is 30%, therefore it is necessary to prescribe antiviral drugs and immunity correctors.

For the prevention of HPV:

  • compulsory examination and treatment of sexual partners
  • use of protective equipment – condoms
  • vaccination against cervical cancer girls 11-12 years old (three times)

Dear friends, make an appointment with the most experienced doctor dermatovenerologist.Shishkin Vitaly Viktorovich by phone 211-00-81. Or leave a request on the website, we will be happy to call you and make an appointment! Be healthy and always confident in yourself!

Treatment of genital warts of the perianal region and anal canal

Treatment of genital warts of the perianal region and anal canal

Genital warts (genital warts, genital warts, viral papillomas ) is a disease that is an overgrowth of the anal skin around the papillary layer around the papillary layer.Perianal warts in the later stages look like a “brush”, “cauliflower”, “cock’s comb” around the anus, at the very beginning – in the form of single growths, papules that cause the patient significant discomfort and disrupt his quality of life.

Both men and women are equally susceptible to the disease. The causative agent of genital warts is a human papillomavirus (HPV), the reservoir of which is epithelial cells.

The main symptoms of genital warts:

1.discomfort during bowel movements;

2. discomfort, pain when walking or having sex.

3. itching and burning;

4. discharge, maceration and ulceration of the warts themselves and the skin under them.

Permanent injuries, for example, when going to the toilet, can contribute to the fact that warts exude a fetid fluid, bleed, and can fester if a secondary infection “joins” them.

Possible complications

As a result of the accumulation and mutation of the human papillomavirus (HPV) in the local “reservoir”, genital warts can degenerate over time into malignant formations.The diagnosis “genital warts” causes “psychological discomfort” in patients with subsequent changes in lifestyle, sexual dysfunctions, and the development of depression.

Treatment methods

With small genital warts, when there are areas of healthy anal skin between single formations, it is necessary to start with conservative treatment.

Various drugs are used, both local and systemic.

One of the points of application is the cytotoxic effect on cells infected with the virus.Cytotoxic drugs are applied to warts in such a way as not to affect healthy skin areas. The three-day course of treatment can be repeated after a four-day break.

In addition to cytotoxic drugs for conservative treatment, antiviral drugs are used, usually prescribed in the form of ointments.

Drugs from the group of immune response modifiers, the local antiviral effect of which is due to the induction of their own α-interferon and other cytokines, have shown high efficiency in the complex (in combination with surgery) or isolated conservative treatment of genital warts.

In case of complications of genital warts, large in size, conservative treatment, as a rule, is ineffective, and surgery is necessary.

Surgical treatment

Removing growths only at first glance seems to be a simple task, especially with a circular lesion by growths of the entire anal skin to the very mucous membrane of the rectum. In the most difficult cases, staged interventions may be required, since the simultaneous removal of a significant amount of tissue can cause deformation of the anal canal.

Used electrothermocoagulation, laser coagulation (destruction), high-frequency radioablation, cryodestruction and classical surgery for excision of education.

The operation is performed under local anesthesia .

Methods of coagulation using various sources of high energy (laser radiation, electrocoagulation or the use of a radio wave scalpel) favorably differs from traditional surgery in that it allows you to achieve bloodless surgery due to good coagulating properties.In some cases, there is significant bleeding due to a good blood supply to pathological growths. Moreover, with coagulation, there is no risk of spreading the virus to other tissues.

Modern medicine, unfortunately, does not yet have such a method of treatment that would completely destroy the human papillomavirus by 100%, but the operation in combination with complex systemic and local therapy can significantly reduce the amount of the virus in the tissues adjacent to the focus.

Medical Center Axon

Genital warts (genital warts, genital warts)

They are a viral disease – wart-like formations on the mucous membranes. Formed on the external genitals and skin of the perineum as a result of infection with the human papillomavirus. The main route of transmission is sexual. Over time, there was evidence of the possible transmission of the virus from mother to child during pregnancy and childbirth.It is unlikely, however, it is not completely excluded, the possibility of transmission of the virus through blood, objects and clothing and breastfeeding. Once in the human body, the papillomavirus spreads through the bloodstream and becomes attached to the epithelial cells of the genital organs, perineum or anus. The virus then invades the epithelial cell and integrates into its DNA, causing the cell to function differently. The affected cell begins to actively grow and divide, as a result of which, after a while, the growth characteristic of the disease appears.As a rule, genital warts appear at once. Most often, several genital warts appear at once, sometimes many, up to several dozen. Less common are cases in which warts appear gradually over several days. One of the most formidable complications of the human papillomavirus in men is cancer of the penis, in women – cancer of the cervix.

Symptoms of genital warts

They appear as small flat or papillary nodules of normal skin color.Gradually, filamentous growths are formed, which tend to cluster. In many cases, genital warts sometimes cause itching, burning, or tenderness. They can cause minor irritation, depending on their anatomical location. Women with genital warts in the vagina may experience bleeding after intercourse or irregular menstruation. Rarely, bleeding or urinary obstruction may occur if genital warts are in the urethra.The incubation period is usually 2-3 months, but under certain circumstances this time can be shortened or extended up to several years. The higher the immune status of a person, the longer the incubation period will last and the more insignificant the manifestations of the disease will be. But long-term carriage of the virus can undermine the strength of even the strongest organism, especially affecting the local immunity of the pelvis and genitals.

A carrier of genital infection is prone to contracting all other sexually transmitted diseases.After the incubation period, growths appear on the patient’s body, resembling cauliflower in appearance. In large growths, exudate accumulates, which gives the lesion its peculiar features – moisture, bleeding painful cracks, an unpleasant odor.

In men genital warts most often appear on the coronal groove of the penis and frenulum, less often on the head, body of the penis, sponges of the external opening of the urethra.

In women – most often on the mucous membrane of the external genital organs: in the area of ​​the labia minora (less often the large ones), in the vagina, on the cervix, in the area of ​​the urethra, perineum and anus.Moreover, their very rapid growth is observed in pregnant women. With oral intercourse, the oropharynx is affected. The appearance of genital warts often depends on their location. Usually, on the external genitals, they look like dense papules, sometimes with filamentous outgrowths on the surface. In the groin and gluteal fold, the papules have an uneven surface and rise above the surface of the skin. Due to constant friction, they are damaged, get wet, a secondary infection can join and an unpleasant odor, as well as bleeding, can appear.On the skin of the vulva, warts are whitish or acquire a brown tint, on the mucous membranes – pale pink or reddish. Patients complain of itching, mild pain, a feeling of irritation of the vulva skin, difficulty walking and having sexual intercourse.

Warts themselves do not go away, and if accidentally or intentionally damaged, a bleeding and poorly healing ulcer forms in their place.

Diagnostics and treatment

It is not difficult for an experienced physician to determine genital warts by its appearance alone.However, to confirm the diagnosis, it is necessary to detect the DNA of the virus in the patient’s blood. Examination for genital warts necessarily includes studies for gonorrhea and chlamydia, blood for syphilis and HIV. This is because STDs are often combined with each other, and sometimes have common symptoms.

In the treatment of genital warts, two tasks must be solved – the removal of the warts themselves and the reduction of the amount of the virus in the body. To date, there is no drug that can destroy or remove from the body the causative agent of infection of the genitals.Therefore, treatment is carried out by local removal of genital warts and a course of immunocorrective therapy.

There are several methods for treating genital warts:

Cryotherapy – removal of genital warts with liquid nitrogen. A small amount of liquid nitrogen is applied to the warts and freezes it. After such a procedure, the condyloma disappears, leaving a small wound that will heal in 1-2 weeks.
Chemical destruction – condyloma is treated with drugs containing concentrated acids.As a rule, one application is enough to leave a small scab at the site of the warts, which will disappear on its own after a few days.
Thermocoagulation method – exposure to the tissue of warts with high temperatures of high-frequency radiation or directly with an electric knife. This method necessarily requires the use of local anesthesia. As a rule, within a week after the operation, the patient can return to a full sexual life.
Laser therapy – a method of influencing genital warts with a beam of laser beams.Under their influence, the condyloma tissue evaporates, leaving a dry crust in its place.
Radiosurgical destruction – removal of genital warts by radio waves.

Prevention

To avoid infection with papillomavirus, you must adhere to simple rules of sexual hygiene. Condom does not provide a 100% guarantee of infection protection. Therefore, it is always safer to have one sexual partner whom you fully trust, and to refuse casual relationships. At the slightest suspicion of the appearance of genital warts in the genital area, you should immediately seek advice from a venereologist, urologist or gynecologist.You should not try to diagnose and treat yourself. First, improper use of drugs for the treatment of genital warts is fraught with either an insufficient dosage, or, on the contrary, an excessive amount of the drug, which can damage healthy tissues. Secondly, there is always a risk of confusing genital warts with some other disease, for example, with a malignant tumor. Therefore, it is better not to risk it and entrust your health to professionals.

Condyloma. Full description: causes, symptoms, diagnosis, treatment

Condyloma is an inflammatory phenomenon, which is expressed by a specific proliferation of mucous membranes and skin.In case of neglect of the disease, condylomas often develop into ulcers. The disease requires timely treatment, self-medication is excluded!

Symptoms:

Condylomas usually occur in those places that are injured during sexual intercourse. Moreover, from the moment of infection with the virus until the appearance of the first genital warts, it can take from a week to several years.

The disease begins to manifest itself as warty formations of flesh or pink color, which are located on the genitals.The size of these formations ranges from a millimeter to several centimeters, while the rash can grow, taking on the appearance of a cauliflower.

In men, condylomas often occur on the head of the penis, the crown of the head, the inner layer of the foreskin and the frenum. In women, the labia majora and labia minora, the frenulum of the labia, the external opening of the urethra, the clitoris, the hymen, the cervix and the vagina are affected.

Warts usually appear 1-6 months after infection and initially appear as tiny, soft, moist, pink or red bumps.They grow rapidly and can form “stems”. Multiple warts, due to their rough surface, look like a cauliflower. Warts can grow very quickly in pregnant women, in people with a weakened immune system (such as those with AIDS or receiving medications that suppress the immune system), and skin inflammation.

Reasons:

The main cause of genital warts is the human papillomavirus. However, in many people, this virus is dormant and has no health impact.The provoking factor in the development of condyloma is the untidiness of a person and non-observance of a number of hygiene standards.

The causative agent of the disease is the human papillomavirus, which causes a change in the nature of tissue growth. The virus is transmitted from person to person, most often through sexual contact.

There are more than 100 types of papillomaviruses, some of which are harmless to humans, while others cause warts, genital warts or cancer.

More than 40 types of papillomaviruses can lead to the formation of genital warts in the anus or genitals.

When to see a doctor:

As soon as you have anxiety in the genital area and neoplasms – immediately contact a specialist

Diagnostics:

As a rule, a doctor’s examination is sufficient to diagnose genital warts; in the typical course of the disease, there is no need to determine the type of human papillomavirus. When making a diagnosis, it is necessary to exclude diseases such as wide warts (one of the manifestations of syphilis), as well as molluscum contagiosum.

For genital warts in men, papular necklace of the penis is often taken (manifested by the presence of several rows of separately located papules on the penis, the diameter of which is 1-2 mm), but this case is not a deviation from the norm.

In women, micropapillomatosis of the labia may be mistaken for condylomas (separate papules that are symmetrically located in the vestibule of the vagina or on the inner surface of the labia).

Treatment:

Modern medicine offers a large number of methods for treating genital warts, but none of these methods allows you to get rid of the human papillomavirus.Modern therapy for genital warts is inherently symptomatic, its main goal is to reduce the effect of symptoms of the disease on the patient’s life

Cryodestruction with liquid nitrogen. This method involves the destruction of genital warts using low temperatures. The procedure does not require anesthesia, is easily tolerated and leaves no scarring.

Laser treatment. The method involves burning out genital warts with a laser. The procedure requires anesthesia, and residual scars are also characteristic of it.Laser therapy is used as a back-up treatment.

Electrocoagulation. Impact on the focus of the disease of high temperatures. The method also requires pain relief and is characterized by residual scars.

Use of the drug podophyllotoxin (contraindicated in pregnant women, women of childbearing age need reliable contraception during treatment). The drug causes genital warts necrosis. Of the side effects, moderate burning sensation and soreness can be noted. Treatment with the drug is recommended to be carried out under the supervision of a physician, despite the fact that detailed instructions are attached to the medicine.

A specialist consultation can be obtained by phone: +7 (495) 961-27-67

90,000 Treatment of genital warts

Warts – a type of warts, which are soft papillary neoplasms prone to fusion on the skin and mucous membranes, caused by the human papillomavirus (HPV). Condylomas are prone to irregular growth, often form in the anogenital region, are easily injured and bleed.Such neoplasms can cause significant physical and psychological discomfort, obstruct childbirth, and cause problems in sexual life. Sometimes the growth of genital warts causes severe itching at their location.

Genital warts

Genital warts, or genital warts, are one of the most common manifestations of the human papillomavirus (HPV), which is characterized by a long, chronic, and most importantly, recurrent nature of the course.More often, condylomas are located near and directly on the genitals: on the labia, in the vagina and cervix – in women, on the foreskin and head of the penis – in men, they can also occur in the perineum, anal region, rarely – in the mouth.

The main spread of HPV, which results in the appearance of genital warts, occurs during sexual intercourse with a carrier of the virus. Genital warts are formed in places injured during sexual intercourse.It is also possible intrauterine transmission of the virus from an infected mother to the fetus, as well as infection of the child during childbirth if the woman in labor has active HPV or genital warts on the mucous membranes of the genitals.

Diagnosis of genital warts

To confirm the diagnosis, a specialist may prescribe a cytological, histological or immunohistochemical study. A patient with genital warts must be tested for syphilis, HIV and other sexually transmitted infections.