Genital Warts

What is human papillomavirus?

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted disease (STD) in the world. Health experts estimate that there are more cases of genital HPV infection than of any other STD in the United States. According to the American Social Health Association, approximately 5.5 million new cases of sexually transmitted HPV infections are reported every year. At least 20 million Americans are already infected.

Scientists have identified more than 100 types of HPV, most of which are harmless. About 30 types are spread through sexual contact. Some types of HPV that cause genital infections can also cause cervical cancer and other genital cancers.

Like many STDs, genital HPV infections often do not have visible signs and symptoms. One study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) reported that almost half of the women infected with HPV had no obvious symptoms. People who are infected but who have no symptoms may not know they can transmit HPV to others or that they can develop complications from the virus.

What are the Symptoms?

Genital warts have an average incubation period of three months, although they can develop anywhere within three weeks to eight months of exposure. The warts typically occur around the genital areas, the anus and the urinary passageways, appearing as single or multiple cauliflower-like pink or red swellings. They can be large and protruding, or flat. Other possible symptoms include itching, burning and tenderness around the affected area. Often, however, the warts may initially be painless and not cause any symptoms so patients may not be aware that they are infected.

Genital warts are most common among individuals aged 15 to 29. People who engage in frequent sexual activity with multiple partners have a higher risk of contracting the virus.

How are genital warts spread?

Genital warts are very contagious and are spread during oral, genital, or anal sex with an infected partner. About two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within three months of contact.

In women, the warts occur on the outside and inside of the vagina, on the opening (cervix) to the womb (uterus), or around the anus. In men, genital warts are less common. If present, they usually are seen on the tip of the penis. They also may be found on the shaft of the penis, on the scrotum, or around the anus. Rarely, genital warts also can develop in the mouth or throat of a person who has had oral sex with an infected person.

Genital warts often occur in clusters and can be very tiny or can spread into large masses in the genital or anal area.

Why Should Genital Warts be Treated?

Not only are genital warts highly contagious, but there is strong evidence that the HPV virus causes cervical cancer in women, cancer of the penis in men, and anal cancer in both sexes. The HPV virus can also be transmitted from a pregnant woman to her child through the birth canal as she gives birth. 

It is important that all sexual partners be treated for genital warts. If only one partner is treated, it is likely that he or she will easily be reinfected by the untreated partner. In addition, the presence of other concommitant sexually transmitted diseases is much more likely in patients with existing genital warts. Early recognition and prompt treatment can help prevent later complications.

What are the Treatments?

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

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

Cryosurgery
Liquid nitrogen is applied directly to the wart in order to freeze the growth and destroy the infected tissue.

Electrosurgery
A heated electric wire is applied to the growth and destroys the wart.

Laser Therapy
A stream of laser light is directed at the infected site to destroy the wart. View the Laser Applicatons fact sheet for more information.

Surgical Excision
The skin is cut, and the wart is removed.

Liquid Acid Application
The wart is disintegrated by the application of either podophyllin or TCA (trichloracetic acid).

Alpha-interferon
Patients with recurrent or extensive lesions who have previously been treated with other forms of therapy, as well as those with previously non-treated lesions, are prime candidates for interferon treatments. The drug alpha-interferon attacks the HPV virus instead of the infected cells. It may be used alone or in conjunction with chemical and surgical treatments of genital warts. Alpha-interferon is usually injected into the wart or infected area three times per week for up to three weeks. There is evidence that warts treated with the drug will not recur. Side effects are mini-mal and temporary. Some patients may feel slight chills and other flu-like symptoms. Pregnant women should not be treated with alpha-interferon. Evidence suggests that the drug can harm an unborn fetus.

Podophylox 
A prescription podophyllin gel is now available for patient application at home (not to be used on perianal warts).

Bleomycin
A medicine from the anti-cancer drug group, it is injected in a diluted form into the tissue at the base of the wart. This results in gradual death and sloughing of the infected wart. Pregnant women should not be treated with bleomycin. Evidence suggests that the drug can harm an unborn fetus.

What Should I Do After Treatment?

Genital warts can be very resistant. Many require more than one treatment. Close follow-up for a few months after complete clearing is necessary to ensure the absence of recurrences and new smaller warts within or near the treated area.

American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709
1-877-HPV-5868 (1-877-478-5868) (2:00 p.m. to 7:00 p.m. ET)
http://www.ashastd.org

National Cancer Institute
1-800-4 CANCER (1-800-422-6237)
http://cancernet.nci.nih.gov