Genital Warts
Genital warts (condylomata acuminata) are growths in or around the vagina, penis, or rectum caused by sexually transmitted papillomaviruses.
Genital warts are common; in the United States an estimated 500,000 people per year develop genital warts. As many as 20 to 46% of sexually active young women have been infected with one of the viruses that causes these warts. Because of the location of these warts, condoms may not protect against infection.
Genital warts are caused by certain types of papillomavirus, other types of which cause the common warts that appear on other parts of the body. Several types of papillomavirus infect the genitals, but not all of them cause plainly visible external genital warts. Some types cause tiny raised areas on the cervix that may only be visible with a magnifying instrument called a culposcope. Although these less-visible spots generally do not cause symptoms, the papillomaviruses causing them increase the risk of developing cervical cancer and therefore should be treated (see Section 22, Chapter 252).
Symptoms and Diagnosis
Genital warts occur most often on warm, moist surfaces. In men, the usual areas are on the penis, especially below the foreskin (if the penis is uncircumcised). In women, genital warts occur on the vulva, vaginal wall, cervix, and skin surrounding the vaginal area. Genital warts may develop in the area around the anus and in the rectum, especially in people who engage in anal sex. Many people have no symptoms from the warts, but some feel occasional burning pain.
The warts usually appear 1 to 6 months after infection with papillomavirus, beginning as tiny, soft, moist, pink or red swellings. They grow rapidly and appear as rough, irregular bumps, which sometimes grow out from the skin on narrow stalks. Groups of warts often grow in the same area, and their rough surfaces give them the appearance of a small cauliflower. The warts may grow very rapidly in pregnant women, in people with an impaired immune system (for example, people with AIDS or those who are taking immunosuppressive drugs), and in people who have inflammation of the skin.
Genital warts usually can be diagnosed from their appearance. Unusual-looking or persistent warts may be removed surgically and examined under a microscope to make sure that they are not cancerous. Regular Papanicolaou (Pap) tests to detect the early stages of cancer are very important in women who have warts on the cervix.
Treatment
In many people, the immune system eventually controls the papillomavirus. Half the time, the infection is gone after 8 months; less than 10% of people are infected longer than 2 years.
No treatment is completely satisfactory, and some treatments are uncomfortable and leave scars. External genital warts may be removed by laser, freezing (cryotherapy), or surgery using local anesthetics. Podophyllin toxin, imiquimod, or trichloroacetic acid can be applied directly to the warts. This approach, however, requires many applications over weeks to months, may burn the surrounding skin, and frequently fails. Imiquimod cream produces less burning but may be less effective. The warts may return after apparently successful treatment.
Warts in the urethra may be removed by endoscopic surgery (a procedure in which a flexible viewing tube with surgical attachments is used). This is sometimes followed by injection of the wart with a chemotherapy drug, 5-fluorouracil. Interferon-alpha injections into the wart are somewhat effective, but they must be administered several times a week for many weeks and are very expensive.
In uncircumcised men, circumcision may help prevent recurrence. All sex partners should be examined for warts and other STDs and treated, if necessary.
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