Understanding Genital Warts

Human Papillomavirus (HPV) is a group of related viruses that can infect the genital area and other mucous membranes, such as the mouth and throat. HPV is the most common sexually transmitted infection (STI) worldwide. Some strains of HPV can lead to genital warts, which are a common symptom of HPV infection.

Genital warts are a symptom of HPV infection caused by certain strains of the virus, most commonly HPV types 6 and 11. These warts can appear on the genitals, in the pubic area, on the inner thighs, or around the anus. They can vary in size and appearance, from small, flesh-colored bumps to larger clusters that resemble cauliflower.

While the infection is similar in men and women, there are some differences in how genital warts manifest and progress:

Women

Commonly appear on the vulva, in or around the vagina, cervix, and anus.

May develop internal genital warts on the cervix, which may not be visible and can only be detected through a Pap smear or other diagnostic methods.

May experience bleeding between periods or after intercourse, especially if warts are present on the cervix.

Certain strains of HPV that cause genital warts can also increase the risk of cervical cancer.

Men

Are often found on the penis, scrotum, and around the anus.

Do not have internal genital warts in the same way, as their internal genital structures are different.

May notice small, flesh-colored bumps on the genital or anal areas.

Are at a lower risk of developing complications, they can still experience discomfort and psychological stress.

Source: Wikipedia

FAQ on Genital Warts

What do early signs of genital warts look like?

Genital warts look like skin-colored or whitish bumps that show up on your vulva, vagina, cervix, penis, scrotum, or anus. They kind of look like little pieces of cauliflower. You can have just one wart or a bunch of them, and they can be big or small. They might be itchy, but most of the time they don’t hurt.

What can be mistaken for genital warts?

Molluscum contagiosum can be mistaken for genital warts or pimples. If you notice any unusual skin lesions, see your doctor or health professional for an accurate diagnosis. There is no test for molluscum contagiosum. It is diagnosed through a physical examination by looking at the appearance of the lesions.

How long could I have had genital warts without knowing?

Keep in mind that genital warts may not appear for months to years after having sexual contact with an infected person.

How long do genital warts last?

Most HPV infections that cause genital warts will go away on their own, taking anywhere from a few months to two years. But even if your genital warts disappear without treatment, you may still have the virus. When left untreated, genital warts can grow very large and in big clusters.

Can I spread genital warts by touching myself?

A different strain of HPV causes the type of warts you find on other parts of your body. You can’t get genital warts by touching yourself or someone else with a wart on your hands or feet. Genital warts spread through: Intercourse, including anal, vaginal-penile and vaginal-vaginal.

Will genital warts grow back if you cut them off?

After treatment, warts may continue to grow if the therapy proved ineffective or didn’t entirely remove the wart. Additionally, if treatment required an incision to be made in the skin, that incision can become re-infected with HPV – meaning a new wart can grow.

What makes genital warts worse?

If you already have genital warts, shaving and waxing your pubic hair can lead to more widespread infection. That’s because these hair removal techniques can cause tiny cuts and abrasions or irritation of the skin, which can allow the virus to enter and infect a larger area of skin.

Treatment to beat them

Topical OTC creams

Topical Creams: Provider administration

There is no cure for HPV itself, but genital warts can be treated and removed. The choice of treatment depends on the size and location of the warts. Treatment options include

GENITAL WARTS
Podophyllin resinA brownish and yellowish chemical that is applied directly to the affected area and allowed to air-dry. This chemical will damage the warts.May cause a burning sensation as it dries. The solution can be absorbed into the body and can cause side effects. Thus, some providers may thoroughly wash off the solution 1-4 hours after application.
Podophyllin (Podocon-25) and podofilox (Condylox). Podophyllin is a plant-based substance that destroys genital wart tissue. A health care professional puts this solution on your skin. Podofilox contains the same active compound, but you can put it on at home.Never place podofilox inside your body. Also, this medicine isn’t recommended for use during pregnancy. Side effects can include mild skin irritation, sores and pain.
Imiquimod (Zyclara)This cream seems to boost the immune system’s ability to fight genital warts. Do not have sexual contact while the cream is on your skin. It might weaken condoms and diaphragms and irritate your partner’s skin.One possible side effect is a change in skin color where the medicine is used. Other side effects might include blisters, body aches or pain, a cough, rashes, and fatigue.
Trichloroacetic (TAC) or Bichloracetic acid (BCA)Chemicals that destroy the warts by burning them. A small amount is applied only to the warts and allowed to dry. The warts will turn a white color, shrink and then disappear. Can be repeated weekly and may require multiple treatments.Chemicals that destroy the warts by burning them. A small amount is applied only to the warts and allowed to dry. The warts will turn a white color, shrink and then disappear. Can be repeated weekly and may require multiple treatments.
Interlesional interferonApplied as cream or injection. Interferon triggers your immune system to fight infection. Interferon may be applied directly to genital warts as a cream or injected into the warts and the skin surrounding them. May require multiple treatments.Usually used if other treatment methods have failed.
GENITAL AND ANAL WARTS
Sinecatechins (Veregen)This ointment can treat genital warts on the body and warts in or around the anus. Side effects can include a change in skin color, itching or burning, and pain.

Electrocautery

Electrocautery removes genital warts on the penis, vulva, or around the anus by burning them with a low-voltage electrified probe. Electrocautery is usually done in a doctor’s office or a clinic. The injection of a numbing medicine (local anesthetic) is usually used for pain control.

Surgical removal

The doctor uses a local anesthetic to numb the skin or the cervix and then excises the wart or abnormal tissue using a scalpel. Stitches are typically necessary, which dissolve on their own in two to three weeks. Sexual activity should be avoided during the healing process, which can take about two to four weeks.

Laser therapy

A laser can be used to destroy genital warts. Laser surgery may be done in a doctor’s office or clinic, a hospital, or an outpatient surgery centre. Local or general anesthetic may be used. Which one you get depends on how many warts need treatment and the size of the area to be treated.

Cryotherapy: freezing the warts

Cryotherapy (cryosurgery) destroys genital warts by freezing them. A doctor applies a very cold substance, such as liquid nitrogen, around the warts to freeze them. You may have a mild or moderate burning sensation during treatment.

CO2 Laser therapy vs cryotherapy in treatment of genital warts

Generally, the efficacy of CO2 laser treatment of external genital warts was approximately two fold greater than cryotherapy and it was associated with lower recurrence rate.

Pregnancy

Genital warts are not dangerous for pregnant women. They may cause discomfort, itching and pain, but they are not dangerous. Existing warts may grow faster or bigger during pregnancy due to changes in your hormones or immune systems. This may make things like urinating uncomfortable.

The treatment of genital warts in infants includes removing them under general anesthesia or applying a topical medication (podophyllin). However, many babies who contract HPV during delivery never become symptomatic because their immune system is strong enough to fight the infection. 

Genital wart removal is recommended during pregnancy. Specific types of HPV (6 and 11) can be transmitted to infants and children causing respiratory problems.

Please note that Podofilox, Imiquimod, and Podophyllin are not recommended for use during pregnancy as they are absorbed by the skin and may cause birth defects in the baby.

Things to keep in mind after surgical procedures:

  • You may have a slightly odorous watery and/or bloody discharge for several weeks after procedure. You can wash the labia (vaginal lips) with warm water several times throughout the day and use sanitary pads not tampons.
  • Avoid intercourse or douching for at least 3 weeks following the procedure. (Note: douching is generally not recommended, ever, as it can worsen — and may cause — GYN conditions.)
  • Can use Tylenol or Advil as needed for pain relief.

Other names for GW

While these terms may be used in a medical context, “genital warts” is the most commonly recognized and straightforward way to refer to this condition.

Condyloma acuminatum:

  • “Condyloma” refers to a genital wart.
  • “Acuminatum” means pointed or acuminate, describing the appearance of the wart.

Venereal warts:

  • “Venereal” relates to sexual intercourse or sexually transmitted infections.
  • This term emphasizes the connection between the warts and sexual activity.

Anogenital warts:

  • “Ano-” refers to the anus, and “genital” refers to the reproductive organs.
  • This term is used to describe warts located in the genital and anal areas.

HPV-related lesions:

  • This term is more general and includes any abnormal tissue changes caused by the human papillomavirus, which can include genital warts.

Genital warts and vulvar neoplasia

Genital warts and vulvar neoplasia are two distinct conditions that affect the genital area in females. Here are the key differences between them:

Genital Warts

Genital warts are caused by certain strains of the human papillomavirus (HPV). They manifest as small growths or lumps on the genital and anal areas. Genital warts are generally considered benign (non-cancerous) and are categorized as a sexually transmitted infection (STI).

Caused by specific strains of HPV, primarily types 6 and 11.

Present as small, flesh-colored growths or lumps on the genital or anal area. They may be raised or flat and can vary in size.

Characterized by the presence of wart-like growths caused by HPV infection. Biopsy may reveal characteristic changes.

Generally considered benign and not associated with an increased risk of cancer. However, the same types of HPV that cause genital warts (such as types 6 and 11) can also cause other HPV-related cancers, like cervical cancer.

Vulvar Neoplasia

Vulvar neoplasia refers to abnormal cell growth in the vulvar tissues, which can be either benign or malignant. Malignant vulvar neoplasia can lead to vulvar cancer. It is not directly caused by HPV infection, but persistent HPV infection is a known risk factor for developing vulvar cancer.

The exact cause is not always clear, but it is often associated with chronic inflammation, older age, smoking, and long-term HPV infection.

Symptoms may include itching, pain, tenderness, or changes in the color or thickness of the skin on the vulva. In more advanced stages, a visible mass or ulceration may be present.

Involves abnormal cell growth in the vulvar tissues, which can be either non-cancerous (benign) or cancerous (malignant). Malignant cases are associated with cancerous changes in the cells.

May lead to vulvar cancer, especially in cases of malignant neoplasia. Persistent infection with high-risk HPV types is a known risk factor for vulvar cancer.

It’s important to note that both conditions require medical attention. Genital warts can be treated and managed, and regular screenings are essential to detect and manage vulvar neoplasia early, improving outcomes. Individuals with concerns about their genital health should consult with a healthcare professional for proper evaluation and guidance.

What can be mistakes with genital warts?

Several conditions can be mistaken for genital warts due to their similar appearance. Here are some possibilities:

Molluscum Contagiosum: Molluscum contagiosum is a viral skin infection that causes small, raised bumps on the skin. These bumps can resemble genital warts, but they tend to have a central dimple or indentation. Unlike genital warts, molluscum contagiosum lesions are often painless and may resolve on their own over time.

Skin Tags: Skin tags are small, soft growths that can develop in areas where the skin rubs against itself, such as the groin or genital area. While they may appear similar to genital warts at first glance, skin tags typically have a smoother surface and a narrower base than genital warts.

Sebaceous Prominence: Sebaceous prominence, also known as Fordyce spots, is a condition characterized by the appearance of small, raised bumps on the skin. These bumps are caused by enlarged oil glands and are usually painless. While they can occur in the genital area, they are not sexually transmitted and are not contagious.

Pearly Penile Papules (PPP): Pearly penile papules are small, dome-shaped bumps that commonly appear around the head of the penis. While they can resemble genital warts, PPP are harmless and not caused by a sexually transmitted infection. They are considered a normal variant of penile anatomy.

Folliculitis: Folliculitis is the inflammation or infection of hair follicles, often caused by bacteria, fungi, or ingrown hairs. It can cause red, inflamed bumps that may be mistaken for genital warts, especially if they occur in the pubic area. However, folliculitis typically resolves with proper hygiene and treatment.

If you notice any unusual bumps, lesions, or changes in the genital area, it’s important to consult a healthcare provider for an accurate diagnosis. A healthcare professional, such as a dermatologist or a doctor specializing in sexual health, can provide appropriate evaluation and recommend the necessary treatment, if needed. Additionally, practicing safe sex and getting regular STI screenings are essential for maintaining sexual health.

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