Genital Warts

What are genital warts?

Genital warts are skin-colored, tan, brown, or pink bumps that vary in size from barely visible to several centimeters in diameter. They occur on external genitalia and anus. It is the most common sexually transmitted infection, and it is caused by human papilloma virus (HPV). Approximate lifetime risk for HPV infection may approach 8 in 10 of sexually active young people. In majority of infected people HPV infection clears in about 1–2 years. However, in about 2% of healthy individuals, HPV infection persists. Furthermore, in a small minority of people with such persistent HPV infection cancer may develop.

How do genital warts feel?

In most people they do not cause any discomfort, but sometimes they can get inflamed becoming itchy or even painful. You may be infected without even knowing it, since sometimes genitalia and anus can have no visible warts or growths in spite being infected with HPV. In females the infection could only be inside the vagina in the portion of uterus called cervix without any visible outside growths.

My sexual partner has genital warts (HPV). What is the risk of me catching them?

The exact risk of transmission is not known, but in majority of cases both partners eventually acquire, or get HPV infection.

How can I protect myself?

You should use condoms during sexual intercourse. However, they do not offer a complete protection. The good news is that you are living in the 21st century, so there are very effective vaccines available such as Gardasil 9.

OK, I think I have genital warts, but how did I get them?

Genital warts are a sexually transmitted infectious disease, so chances are that you got them by having sex with someone who is infected. However, in children and babies HPV infection could have occurred during the birth from infected mother, from parent’s hands who has HPV infection while cleaning and tending the child, from autoinfection from a wart on child’s hand, or even from sexual abuse.

Is there any over-the-counter test for genital warts?

No, there is no over-the-counter test for genital warts or HPV infection. But if in doubt, your health care provider may take one wart off (i.e. do a skin biopsy) for microscopic examination.

What should I do if I think that I have genital warts?

You should go and see your health care provider. If your suspicion is confirmed, you should also inform your sexual partner about your diagnosis, so that she, or he gets checked as well.

How can my health care provider help me?

Your health care provider will listen to your story and examine you. If needed, additional testing will be done, such as cutting off (i.e. biopsy) a piece of the growth under local anesthesia for microscopic examination. In addition, you should get tested for other sexually transmitted diseases as well.  Sometimes your health care provider will refer you to a dermatologist for further examination and the treatment.

OK, so what is the treatment of genital warts?

Unfortunately, there is no absolute cure for genital warts. Moreover, there is no treatment proven to reduce transmission to others, or to prevent progression to cancer.

Treatment options include:

  • Observation (i.e. do nothing and wait for warts to resolve on their own).
  • Podophyllin. It is applied weekly by the health care provider and can be washed off 4–8 hours later by the patient.
  • Podofilox 0.5% solution or gel (brand name: Condylox). Apply it twice a day for 3 consecutive days of each week for 1-4 weeks.
  • Imiquimod 5% cream (brand name: Aldara). Apply it once a day 3 times per week for maximum of 16 weeks.
  • Sinecatechins 15% ointment (brand name: Veregen). Apply 0.5 cm (about quarter of an inch) 3 times daily for maximum of 16 weeks.
  • 5-FU 5% cream (brand name: Efudex).  Apply it twice a day.
  • Freezing the warts off with liquid nitrogen, which is a very, very cold fluid (-196°C, or about -320°F). It may require several (painful) treatments spread 2-4 weeks apart for complete clearance. Your health care provider does this. You may need to repeat the treatment every 2-4 weeks (safe in pregnancy).
  • Burning warts off using electrofulguration.
  • Surgical excision (i.e. cutting warts away).
  • Lasers (usually CO2 laser).

Note: Only freezing the warts off should be used during pregnancy and possibly surgical excision, or electrofulguration.

OK, it seems that my warts are gone. Can I still infect others?

The lack of visible warts does not mean that you are cured of HPV. Even without visible warts you might still have HPV infection and therefore spread it to others. The exact risk of transmission in such cases is still not known.

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