Genital Warts - An Update

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Genital warts (also known as ano-genital warts, Condyloma, Condylomata acuminate, or venereal warts) are highly contagious. They are transmitted during sexual intercourse and caused by some strains of human papillomavirus (HPV) affecting both men and women. Genital warts do not appear until two to four weeks after contact and sometimes months may elapse before the warts become visible. They are usually painless but may itch or produce a burning sensation. Genital warts are not life-threatening, but they can have an emotional effect, causing people to feel uncomfortable in existing or new relationships.

They often occur in clusters appearing as soft, moist, pink, or flesh-coloured swellings that can spread into large masses in the genital area. They can be flat. In the early stage of development, they are not visible so that at this time transmission may occur without a partner being aware of the potential for transmission. Genital warts can develop in the mouth or throat of a person who has had oral sex.

Genital warts are the most prevalent sexually transmitted infection seen at genitourinary medicine (GUM) clinics in the UK. It is estimated that as many as 6 million new cases of genital warts are diagnosed in the United States each year. The condition is becoming more prevalent.

They can occur at any age but the prevalence peaks at 20-24 years. If a toddler has genital warts, sexual abuse should be considered although one must bear in mind that the virus could have been acquired during childbirth.

Until the 19th century, genital warts were believed to be a form of syphilis or gonorrhoea but we now know that certain strains of HPV prove to be the culprits. Genital warts are highly contagious. You have a 60% chance of getting the infection with a single sexual contact. Other common types of HPV that cause warts on the hands and the soles of the feet do not cause genital warts. Rarely, the virus is transmitted from a mother to her baby during childbirth (vertical transmission). It is a popular myth that you can catch genital warts from a towel, doorknob, a toilet seat or the swimming pool. They can be caused by strains 6, 11, 30, 42, 43, 44, 45, 51, 52 and 54 of HPV; types 6 and 11 are responsible for 90% of genital warts cases. HPV types that tend to cause genital warts are not the same ones as those that cause cervical cancer (types 16 and 18). Genital warts are not usually passed on from warts affecting other parts of the body.

Genital warts are transmitted primarily by sexual intimacy, and the probability of infection increases in relation to the number of sexual partners. Smoking, oral contraceptives, multiple sex partners, and early coital age are risk factors for acquiring genital warts. Growth may be more rapid during pregnancy or when a person's immune system is weakened by diabetes, HIV/AIDS, chemotherapy, Hodgkin's disease or taking anti-rejection drugs following an organ transplant. Smokers are more likely to develop genital warts than non-smokers.

Genital warts per se do not cause any serious long-term health problems. They are associated with cervical carcinoma as a woman can acquire multiple strains of HPV. Medical providers consider any case of genital warts to be a warning of potentially pre-malignant and malignant conditions. Genital warts are a sexually transmitted disease and may, therefore, be accompanied by other sexually transmitted diseases.
No single treatment regimen for genital warts is better than another and no one treatment regimen is ideal for all cases. Two or more professional treatments are often required. Do not use over the counter cures for warts around the genitalia as severe irritation can occur. Genital warts can be treated by swabbing with the cell poison called podophyllotoxin. Pregnancy should be excluded before treatment commences. The area should be washed and dried before application. Warticon is applied at home twice daily for three days each week for four weeks. The skin should be washed one to four hours after application to reduce local irritation. Cryotherapy (freeze treatment), diathermy (heat) and laser are effective. Once an individual has been infected, the virus will be carried for life, even when the warts have been completely eradicated.

Most pregnant women, who have previously had genital warts, would be unlikely to have any complications or problems during pregnancy or childbirth. Unlike herpes, transmission of HPV to the baby occurs very rarely during childbirth so that genital warts are not an indication for caesarean-section unless they are so extensive that they restrict the birth canal. Some of the medications used to treat genital warts cannot be used during pregnancy, so it is important to tell your doctor if you could be pregnant.

If you have signs of genital warts, you should avoid sexual activity until the warts have been successfully treated. Condoms offer some protection against the virus, but they cannot completely prevent infection because the warts can be outside of the area protected by the condom. Spermicidal foams, creams, and jellies have not been proven to be protective. Women and men with more than one sexual partner, or if their partner has had more than one partner, should have regular examinations for sexually transmitted diseases, including genital warts. As with other sexually transmitted diseases, your partner must be treated as well, since an infected partner could easily transfer the virus back to you. Anyone with whom you've had sex should also be checked for genital warts.

The HPV vaccine, Gardasil, provides immunisation against the two strains of HPV that cause 70% of cervical cancer cases, and two strains of HPV that cause 90% of genital warts.