Genital warts (or condyloma, condylomata acuminata, or venereal warts) is a highly contagious sexually transmitted infection. Caused by some sub-types of the human papillomavirus (HPV) genital warts are spread through direct skin-to-skin contact during oral, genital, or anal sex with an infected partner. Genital warts are the most easily recognized sign of genital HPV infection. Of the multiple strains of genital HPV, strains 6, 11, 30, 42, 43, 44, 45, 51, 52, and 54 can cause genital warts; types 6 and 11 are the most common.[1] Most people who acquire those strains never develop warts or any other symptoms. HPV is also responsible for over 90% of all cases of cervical cancer. (However, the HPV strains responsible for cervical cancer differ from the strains that cause genital warts.)
Genital warts often occur in clusters and can be very tiny or can spread into large masses in the genital or anal area. 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. While genital warts are approximately as prevalent in men, the symptoms of the disease may be less obvious. When 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.
Treatment
Genital warts often disappear even without treatment. In other cases, they eventually may develop a fleshy, small raised growth. There is no way to predict whether the warts will grow or disappear.
Depending on factors such as the size and location of the genital warts, a doctor will offer one of several ways to treat them.
* Imiquimod, (Aldara®) a topical immune response cream which can be applied to the affected area
* A 20% podophyllin anti-mitotic solution, which can be applied to the affected area and later washed off
* A 0.5% podofilox solution, applied to the affected area but should not be washed off
* A 5% 5-fluorouracil (5-FU) cream
* Trichloroacetic acid (TCA)
* Pulsed dye laser
* Liquid nitrogen cryosurgery
* Electric or Laser cauterization
With pregnancy, podophyllin or podofilox should not be used as they are absorbed by the skin and may cause birth defects in the fetus. In addition, 5-fluorouracil cream should not be used while trying to become pregnant or if there is a possibility of pregnancy.
In case of small warts, they can be removed by freezing (cryosurgery), burning (electrocautery), or laser treatment. Surgery is occasionally used to remove large warts that have not responded to other treatment.
Some doctors use the antiviral drug interferon-alpha, which they inject directly into the warts, to treat warts that have returned after removal by traditional means. The drug is expensive, however, and does not reduce the rate that the genital warts return.
Although treatments can get rid of the warts, they do not get rid of the HPV virus, so warts can recur after treatment. The body's immune system typically clears the virus anywhere from 8 to 13 months, but it occasionally remains in the body for a lifetime.[2] The state of the immune system determines the chances of ridding the virus entirely and can be affected by factors such as HIV infection, certain medications, stress, or illness.[3] There is even some suggestion that effective treatment of the wart may aid the body's immune response[citation needed].
Prevention
The virus that causes genital warts is spread by skin-skin contact. Condoms do not adequately protect against genital warts, because the infected spot may not be covered by a condom. The only reliable prevention is to have no skin contact with potentially infected tissue.
Gardasil, an HPV vaccine, protects women from the strains of HPV that cause 70% of all cervical cancers and 90% of all genital warts and has been approved by the Food and Drug Administration.[4] The license allows prescription to females between the ages of 9-26. This vaccine is most effective when administered before the girl has contacted any of the HPV strains which the virus protects. For this reason, the vaccine should be preferably administered before a girl becomes sexually active. This vaccine is currently being tested for males. Gardasil does not contains the preservative thimerosal.[5]
Hirsuties papillaris genitalis
It is a common misconception among men that hirsuties papillaris genitalis are in fact genital warts. Hirsuties papillaris genitalis is not contagious and no treatment for the condition is necessary. Some may deem it unsightly and there are various methods of ridding the penis of the condition such as carbon dioxide laser treatment.
Fordyce's spots
Genital warts should not be confused with Fordyce's spots, which are considered benign.
Pregnancy and childbirth
Genital warts may cause a number of problems during pregnancy. Sometimes the warts get larger during pregnancy, making it difficult to urinate. If the warts are in the vagina, they can make the vagina less elastic and cause obstruction during child birth.
Rarely, infants born to women with genital warts develop warts in their throats (laryngeal papillomatosis). Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent obstruction of the breathing passages. Research on the use of interferon therapy in combination with laser surgery indicates that this drug may show promise in slowing the course of the disease.
References
1. ^ eMedicine med/1037
2. ^ What is HPV? at plannedparenthood.org
3. ^ Learn about HPV > Myths and Misconceptions at American Social Health Association
4. ^ FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus
5. ^ GARDASIL® Questions and Answers. CBER - Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine. Retrieved on 2007-03-19.
