Genital warts

Genital warts are a sexually transmitted disease (STD). For some people, the infection causes no visible symptoms. Others experience recurrent bouts of genital wart outbreaks. Although there's no cure for genital warts, treatment is available.


Causes/associated factors
Genital warts are caused by the human papilloma virus (HPV). HPV is one of the most common causes of sexually transmitted diseases worldwide. There are at least 100 types of HPV. About 30 types affect the genital tract. Of these, about 10 are associated with abnormal Pap smears (a screening test for cervical cancer), cervical cancer and other genital cancers. The rest cause genital warts and only mild cervical changes. The risk of contracting genital warts increases with the number of sexual partners you have. Genital warts are most commonly diagnosed from ages 17 to 33.

Transmission
Genital warts spread through direct contact during vaginal, oral or anal sex. The condition is highly contagious, especially when the warts are present or untreated. You're not as contagious once the warts are removed, but HPV can remain in the surrounding normal tissue and cause recurrences. You may even be contagious once the warts are gone.

Signs/symptoms
For most people, HPV causes no visible symptoms. Warts may develop in hidden areas, such as in the vagina, anus, cervix or urethra (the tube that drains urine, and semen for males, outside the body). For others, warts appear on the genital or anal areas and sometimes in the mouth and throat. Depending on sexual practices, the warts may develop wherever there was exposure to the virus.
When warts appear, they typically show up within three months after exposure as soft, fleshy, pink or red bumps. They may develop within one month or show up years later, however. The bumps may appear in tiny groups or accumulate into masses up to several centimeters in diameter. Larger groups of warts often resemble heads of cauliflower. Genital warts may cause itching, burning, tenderness, bleeding or pain during sex.


Diagnosis
If you've been exposed to genital warts or suspect an infection, consult your doctor. Sometimes, the condition is diagnosed through simple observation of the warts. For verification, the doctor may do a biopsy of the suspicious area.
At the same time, your doctor may also check for other sexually transmitted diseases or screen for cancer. For some women, an HPV infection is detected through analysis of an abnormal Pap smear.

Currently, there is no test to determine which HPV infections will lead to cancer.


Treatment
Depending on the location, size and number of genital warts, as well as your personal preference, the warts may be removed with:
a patient-applied medication (such as podofilox, podophyllum or imiquimod)
a doctor-applied medication, such as fluorouracil (5-FU, for example)
cryotherapy (freezing the warts)
an injection of interferon (an antiviral medication)
traditional or laser surgery
electrocautery (burning the warts)
When you have visible genital warts, it's best to abstain from sexual activity. Although treatment can help prevent the spread of the disease, remember that the virus is still in your body and you may be contagious even after the warts are removed.

If left untreated, genital warts may disappear on their own, remain unchanged, or grow in size. Remember, untreated genital warts are contagious.


Complications
If you have an impaired immune system, HPV may cause a more serious infection or not respond well to treatment.

A secondary skin infection may develop in areas subject to friction.

Certain types of HPV may cause cancer of the cervix, vagina, vulva (external portion of the female genitals), penis or rectum. Women with warts should have frequent Pap smears and pelvic exams.

Blockage of the urethra by warts may occur.

The nature and location of genital warts can have profound emotional and social effects. If you become anxious, depressed or angry about having genital warts, discuss your feelings with your doctor.

Pregnancy-specific information
If you have genital warts and are considering becoming pregnant, it's best to have warts treated before conception. The warts may enlarge during pregnancy and cause more significant problems.
If you have genital warts, your baby can be infected when passing through the infected birth canal during delivery. Rarely, HPV can cause warts in an infant's throat. A newborn may contract this condition by breathing infected vaginal secretions while passing through the mother's infected vaginal canal during delivery.

Large accumulations of genital warts that obstruct the birth canal may require a cesarean delivery.

Most genital wart medications should be avoided during pregnancy, so your doctor will consider treatment options carefully.


Senior-specific information
Growing older is not a risk factor for this condition.

Prevention
Abstinence is the most effective way to prevent genital warts. If you're sexually active, mutual monogamy with an uninfected partner will reduce the risk of contracting genital warts and other sexually transmitted diseases. If you're not in a mutually monogamous relationship, reduce the risk of contracting genital warts and other STDs by:
limiting your number of sexual partners
making sure each sexual partner is tested for STDs and completes proper treatment, if necessary, before you have sexual contact
using a latex or polyurethane condom consistently during any vaginal, oral or anal sexual contact
Keep in mind that a condom doesnin preventing the spread of STDs -- use only water-based lubricants. The chemicals in other lubricants may break down the latex in the condom.

Research on an HPV vaccine is underway.