Genital warts or condylomata acuminata are very common viral infection which are acquired through sexual contact.Genital warts are common in both male and female and can occur at any age. While there is no cure for genital warts, treatment options are focused on reducing the visible warts and prevent further transmission and complications.
Genital warts are caused by the human papillomavirus (HPV). There are several strains of HPV that can cause genital warts, but HPV type 6 and 11 are most common accounting for 90% of the cases. These two subtypes are considered low risk because they rarely cause premalignant changes or cervical cancer in women. While HPV-16, 18, 31, and 45 are considered a high risk as they can lead to premalignant changes and cervical cancer.It is important to understand that common warts (harmless tumors) are not same as genital warts and are caused by different strains of HPV.
Risk Factors for Genital Warts
Genital warts are highly contagious and are spread through direct skin to skin contact during genital, oral or anal sex. Since HPV may be associated with no visible sign and symptoms of infection, a person can get HPV and pass it on without knowing it.
The following factors directly or indirectly increase your risk of having genital warts:
- Becoming sexually active at an young age.
- Having multiple sexual partners.
- Having other sexually transmitted disease.
- Having sex with a partner whose sexual history you don’t know.
- Taking oral contraceptives for long time ( possibility of sexual contact without barrier protection)
- Having weakened immune system.
Signs and Symptoms of genital warts:
Some individuals who get HPV may never develop any signs and symptoms. Most people develop lesions within 3 months of sexual contact with the partner having genital warts.In some cases it may take several months to years to develop lesion. Genital warts usually appear as a small,smooth or rough, flesh-colored bump which may be arrange in a groups resembling cauliflower appearence. They are commonly seen on the vulva,labia, vagina, cervix, tip of the penis,scrotum, anus, skin around the anus, and urethra. It may be associated with Itching, discomfort, discharge and bleeding during intercourse. Sometimes they appear so small and smooth that they can’t be seen with naked eyes.
Diagnosis of genital warts
Diagnosis of genital warts is usually made by visual inspection of warts. If the lesion are very small, the area is magnified using colposcopy or other enhancing techniques like acetic acid test. If the diagnosis is uncertain or unresponsive therapy, it may be confirmed by biopsy.
There is no cure for genital warts. The aim of treatment is focused on reducing the visible warts and prevent further transmission and complications. There are several treatment options available; however, no treatment is 100% effective. Once human papillomavirus infects there is no way eliminating the virus, till date. In about 10%-20% people, genital warts may go away without treatment.If it doesn’t go away or causing any discomfort and pain it can be treated medically using topical treatments and surgically using lasers, excision or cryotherapy. Some of the recommended Regimens are listed below.
Topical treatment of genital warts
Imiquimod 5% cream: It should be applied three times a week for 16 weeks. one may follow once daily regimen at bed time for 3 days then rest 4 days or applied every other day for 3 applications in a week and repeat this cycle for 16 weeks.
Podofilox 0.5% solution or gel: It should be applied twice daily for 3 days then rest 4 days and repeat the cycle as necessary not to exceed more then 4 cycles.It should not be used during pregnancy.
Trichloroacetic acid (TCA) or bichloracetic acids: These agents should only be applied by professionals.
Always get suggestions from professional before applying these treatment. Don’t try to treat genital warts yourself with over the counter medications.
Surgical treatment of genital warts
If topical treatment doesn’t work or if the warts are too large to be treated with topical medications, surgical options may be considered, which are listed as below.
Surgical excision: Surgical excission has highest sucessive rate ranging from 63%-91% and has less recurrence rate.
Cryotherapy: Cryotherapy is performed using liquid nitrogen and has good response rate. Repeated treated may be needed which can be performed every 1-2 weeks. Cryotherapy is safe during pregnancy.
Carbon dioxide laser treatment: This is used as an alternative therapy for unresponsive, extensive or recurrent genital warts. This therapy may completely destroy the warts but is expensive, healing time is longer and there may be chances of scarring.
Other alternative options that can be considered may be Electrodesiccation and curettage.
Interferon alpha-n3: Intralesional Interferons are also being used for treatment of unresponsive genital warts, but due to their adverse effects they are not recommended for primary treatment.
Home remedies for genital warts:
While many home remedies are advertised and promoted for the treatment of genital warts, there is no effective remedies or evidence to suggest that these remedies actually works.
Genital Warts Prevention
Firstly, you may consider HPV vaccination. Currently there is a HPV vaccine called “Gardasil” which is approved for both male and female between ages 9-26. This vaccine is given in 3 doses over 6 months and is effective in preventing infection with 4 common type of virus ( 6,11,16,18) that causes genital warts and most cervical cancers. Another vaccine which is effective against HPV types 16 and 18 in preventing cervical cancer is Cervarix. However, both vaccine are less effective in those who have already been infected with HPV.
Human papillomavirus is very common and no treatment options are 100% effective. The only way to lower the risk of infecting with HPV is to avoid sex or practise safe sex by using condoms, avoiding multiple partner and having sexual relationship with partner who is known to be disease free.
Finally, if you suspect you have genital warts contact your health care professional. Don’t feel shame about having genital warts, its very common and you are not the only one. Feel free to talk about your condition to your partner and health care professional.You may prevent further transmission to your partner and avoid possible complications that you may encounter later.