An Overview of Genital Warts

Genital warts, also known as condylomata acuminata, are one of the most common sexually transmitted infections. It's estimated that 340,000 to 360,000 people are affected by genital warts each year in the United States, though many infections do not cause symptoms.

They can vary in size and sometimes appear shaped like a cauliflower. In most instances, the warts are too small to be seen.

In women, genital warts most commonly occur on the labia and near the opening of the vagina. On men, they are most common at the tip of the penis but may occur along the shaft as well. Both men and women may develop warts around the opening to the anus. Anal sex is not necessary for these to occur. Men and women may also develop genital warts in the mouth or throat related to oral sex.

Genital warts are caused by human papillomavirus (HPV). There are roughly 100 different types of HPV infections with around 30 of which are transmitted as sexually.

If you've been learning about genital warts you may be feeling confused and just a little nervous. That is because there is a lot of misunderstanding about the HPV virus and the complications of different strains of the virus.

Around 90% of genital warts are caused by HPV 6 and HPV 11. In contrast, roughly 70% of cervical cancers are caused by HPV 16 and HPV 18 and most oral cancers caused by HPV are due to HPV 16. Another 20% of cervical cancers are caused by HPV types 31, 33, 34, 45, 52, and 58.

In other words, the strains of HPV which cause genital warts are different than the strains which cause cervical cancer and vice versa. On the other hand, the risk factors for developing HPV—both the genital-wart-causing strains and the cervical-cancer-causing strains—are the same.

HPV Infections

Many people are infected with HPV infections, but most of the time, even with the cancer-causing strains, the virus is eliminated from the body before any symptoms occur. If you are infected with one of these viruses, you may not have any symptoms, may develop genital warts, or may have an abnormal pap smear suggestive of dysplasia or precancerous changes of the cervix.

HPV can be contracted by anyone who is sexually active. There are several factors that increase the risk of developing genital warts:

• Unprotected vaginal sex
• Anal sex
• Oral sex
• Genital-to-genital contact
• Childbirth
• Previous sexually transmitted diseases
• Multiple sexual partners

In addition, while smoking does not increase the risk of contracting HPV, it may delay the body's ability to clear the virus.

While certain cases of HPV may resolve on their own, certain types of HPV can lead to the development of cervical, penile, and anal cancers, among others. In these cases, the virus does not directly cause the cancers, but rather leads to inflammation that can, in turn, lead to cancer. Other factors, such as smoking, which slow the clearance of the virus from the body, may contribute to the development of cancer.

Regular testing for HPV is recommended in order to screen for cervical cancer and other complications of HPV. There is no standard test to diagnosis HPV. It is important that women undergo regular pap screenings to detect abnormalities that may indicate an HPV infection.

If there is an abnormality, a DNA test, which can test for high-risk strains of HPV, can be conducted.

It's important to note, however, that the HPV tests that you may have taken do not test for the genital-wart-causing strains of the virus.

There is no cure for HPV. Treatment is available for symptoms, such as genital warts, cervical cancer, and cervical changes. However, treatment will depend on the diagnosis and the severity of the infection. Common treatments include:

• Medication
• Cryotherapy (freezing)
• Electrocautery (burning)
• Injection of interferon into the warts
• Laser treatment
• Surgery to remove the warts

There are both over-the-counter (OTC) medications and medications which are applied by a physician that are available. Self-treatments include Podofilox, Imiquimod, and Sinecatechins. Physician-applied treatments include podophyllin, trichloroacetic acid, and bichloroacetic acid. These treatments are usually applied once a week by a physician. Treatment will remove the warts but not the infection.

Avoiding risk factors, such as multiple sexual partners, can reduce your risk of contracting HPV and thus genital warts. Condoms may lessen your risk but do not always prevent the spread of HPV, as only skin-to-skin contact alone is needed. If you are between the ages of nine and 26, immunization may help prevent infection.

Immunization

Immunization is available which may protect you against contracting the HPV virus. There are now three different types of shots available, but only two of these are designed to protect against the genital wart and cervical cancer-causing strains of the virus. 

Immunizations currently available and the HPV strains which they are designed to prevent include:

• Gardasil (approved in 2006) protects against HPV 6, 11, 16, and 18
• Cervarix (approved in 2009) protects against HPV 16 and 18
• Gardasil 9 (approved 2014) protects against HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58

Genital warts, caused by certain strains of HPV, are one of the most common sexually transmitted infections. There are many misconceptions surrounding the development of both genital warts and HPV. It is important to remember that not all strains of HPV cause genital warts and the strains that do cause genital warts do not cause cervical cancer. However, the risk factors for all strains of HPV remain the same, including unprotected sex. If you are experiencing any symptoms of genital warts, seek medical attention to rule out other conditions and learn about which medication could help treat your symptoms.