Genital Warts: Symptoms, Causes and Treatment
Genital warts (Condylomata accuminata in Latin) are small growths in the genital area that are the result of a virus passed through skin-to-skin contact during sex. They are very common, particularly in young, sexually active people. Some five in a hundred people between 16 and 25 years of age are affected by genital warts. In fact, as many as half of the population may carry the virus at some time but never develop warts, so they are actually unaware that they have the virus. Many people believe that genital warts are dirty or a sign of sexual promiscuousness though this is not true.
The warts take the form of small lumps that can be either fleshy or firm. They may itch but are not usually painful. Genital warts are annoying in the short-term but rarely cause serious long-term problems. They will eventually disappear on their own but this can take a long time and in the meantime they can multiply. Therefore, it is always advisable to treat them so that they go away in the shortest time possible.
People can carry and pass on the wart virus without knowing it as the period of time between being infected with the virus that causes genital warts and developing them can be anywhere from a few weeks to several years. Therefore, if a partner does not have any visible signs of genital warts it does not inevitably mean that they are not carrying the virus because the virus can lie dormant for a long time.
Symptoms of Genital Warts
Most people first feel a small lump or spot in the genital area. When they examine themselves they usually find more. The growths can be soft and fleshy or firm, and are either white or dark in appearance. The warts can quickly grow in size and number, especially if a person’s immune system is not very strong.
Genital warts are not painful but they can be quite itchy or may bleed. They can appear anywhere in the genital area. That is, in men on the penis or under the foreskin and in women at the entrance to the vagina, the labia or lips of the vagina and occasionally also on the vaginal walls and on the cervix. In both sexes, the warts can appear in the perianal area, which, however, does not imply they have had anal sex.
Causes of Genital Warts
The virus responsible for genital warts is called the Human Papilloma Virus (HPV). The strains of virus that cause genital warts are usually different from those that cause warts on hands or on the soles of the feet. The only way to get the virus is by having sexual contact. The virus enters the skin of the genital area during direct contact with the skin of a partner who is carrying it. Once contracted, the virus lives within the cells of the bottom layer of the skin and may stay there causing no visible signs (a dormant or latent infection) or it may cause thickening of the skin in several areas and produce warts.
There are about 100 strains of HPV. Nine out of ten people suffering from genital warts have either strain 6 or 11 or a combination of these. Strains 6 and 11 are not thought to increase the risk of cancer. Less than one in ten people have strains 16, 18, 31 or 33. These strains have been linked with an increased risk of cancer of the cervix and, in rare cases, cancer of the penis or anus. For information on other types of warts caused by different strains of the HPV please refer to this article.
Despite the general belief, a person does not need to have a lot of partners to get the human papilloma virus. Just one will do. Genital warts often occur for the first time when someone is in a committed and faithful relationship.
Other Factors Affecting the Infection with HPV
The main factor that affects warts is the response of the immune system to the virus. Therefore, genital warts often appear for the first time in pregnant women because their immune system is weaker and allows the dormant virus to surface. People with HIV and those taking steroids and drugs used after organ transplants or cancer treatment may also have weak immune system that is unable to fight the human papilloma virus. In addition, high blood sugar levels can be a factor and make warts worse.
Treatments for Genital Warts
There is no effective remedy for genital warts that people can buy over the counter. Over-the-counter treatments for hand warts or verrucas (warts on the sole of the foot) are not suitable for genital warts. Depending on the site, type and number of warts treatments that are applied by a doctor or home treatments may be recommended. However, effective treatments are only available on prescription from the doctor.
The treatment is aimed at getting rid of the warts rather than the virus itself which is expected to run its course. The focus is on shrinking or eliminating the warts by painting or spraying on various substances to the surface of the wart. If the warts are stubborn, a patient may have to go into hospital for minor surgical treatment.
The most common treatments applied by a doctor include:
- Podophyllin resin – is a solution that is painted onto the warts causing them to shrink. It is especially effective on soft multiple warts but is not suitable for pregnant women.
- Liquid nitrogen (or cryotherapy) – works by freezing the surface of the warts so that the top layer of cells is destroyed. It is especially useful for very firm (keratinised) warts that are few in number.
- Trichloroacetic acid (TCA) – is a strong acid solution that acts by burning the wart but is not often used now. It is effective for stubborn warts.
- Interferon – it is injected into wart lesion to slow cell growth and promote immune system function. However, it cannot be used on pregnant women.
- Fluororacil – is a cream used to destroy the warts. Fluororacil is suitable for stubborn warts only but is rarely used as it can cause severe irritation or ulcers. This treatment may not be used during pregnancy.
Home treatments are prescribed by the doctor but applied by the person at home. They include:
- Pododophyllotoxin (e.g., Condyline solution, Condilox cream, Podofilox gel, Warticon cream/solution) – it is a purified version of podophyllin, a resin extracted from certain perennial plants. This gel is as effective as the clinic treatment with podophyllin resin mentioned above. But, pododophyllotoxin does not work as well as liquid nitrogen for very firm (keratinised) warts and cannot be used in pregnancy.
- Imiquimod (Aldara cream) – this treatment stimulates the immune system directly at the site of the wart and helps to fight viruses by promoting the release of cytokines. Imiquimod is particularly successful at eliminating warts for good, including very persistent warts.
- Sinecatechins (Veregen) – it is not exactly known how this extract from tea leaves works but it has been shown to eliminate genital warts. It is believed that sinecatechins stimulate the immune system and so help the infection to clear faster.
- Complementary treatments – they include tea tree oil, herbal medicines or creams, such as aloe vera, birch bark, celandine, dandelion, echinacea, fresh onion juice and homeopathy to name just a few. However, there is no scientific evidence that these treatments work for genital warts. Having said that, conventional drug treatments do not always work either. As with conventional drugs, the warts may return.
Surgical treatments can be used to remove especially stubborn warts and they include:
- Electrosurgery/diathermy or burning (cauterising) – they all use heat to destroy the warts.
- Laser treatment – a laser beam transmits energy to the wart and destroys it.
- Minor surgery under local anesthetic – the warts are cut out surgically. This is good for growths that are on a stalk, i.e., pedunculated.
Treatment during pregnancy: Warts may take longer to respond to treatment in pregnant women because of the weakening effects of pregnancy on the immune system. It is also dangerous to take some of the most common treatments such as podophylin, podophyllotoxin, fluororacil and interferon during pregnancy but cryotherapy, for example, is safe and effective. Fortunately, warts tend to regress rapidly after the baby is born.
Warts will eventually go but it may take a while. Most people find that the warts improve gradually after treatment and within three months they usually disappear. But for some people the response may be much quicker and genital warts may go almost immediately while others take much longer than three months.
After the warts have gone the virus can remain in the body for several months and during this time the warts can reoccur. On average the virus remains for about six months but there is no test to tell whether a person still carries it or not. In general, the longer the warts stay away, the less chance there is of them reappearing. Though the virus is less contagious once the warts have gone, it can still be passed on to someone else for as long as it remains in the body.
It is important to note that conventional treatments listed above act on the warts not the virus. To fight the virus people need a strong immune system and so it helps to avoid stress, exercise regularly, eat a healthy, nutritious diet, get enough sleep and learn to relax, as well as to take alcohol in moderation and give up smoking.
Preventing Genital Warts
The only people who have no chance of developing genital warts are those who have never had any genital sexual contact. Everyone else is at risk. Condoms will have some effect in reducing the risk of contracting warts but they only protect the skin they are covering while warts can be transmitted from or caught anywhere on the genital skin. In addition, a lot of people have some genital contact before they put the condom on.
Where to Find More Information: Planned Parenthood