Genital warts, also known as condylomata acuminate, are contagious growths (bumps) developed on the mucous membrane of the genital area.

Caused by human papillomavirus (HPV), the disease is transmitted during oral, genital, or anal sex with an infected individual. Genital warts are, most of the times, characterized by painless flesh-colored lesions. The lesions tend to develop, in women, on the cervix, outside and inside the vagina or around the anus; in men, on the verge and/or the tip of the penis, the testicles (scrotum) or around the anus. Genital warts affect mostly young adults; 90% of wart patients are less than 40 years old.

From small to large clusters, genital warts may take different forms, flesh-colored bumps or cauliflower-like. Large clusters are especially common among immunocompromised (cancer patients, HIV/AIDS patients, etc.). The giant wart (giant condyloma acuminatum) Buschke-Lowenstein is a human-papillomavirus-induced cauliflower-like tumor of the genitoranal region; it is particularly extensive and highly recurrent.  In addition, genital warts are often subject of inconvenients: gene, oozing, foul odors.

Besides, warts, human papillomavirus also promotes the development of many types of genital cancers, primarily cervical cancer. In general, genital warts are difficult to be treated because of its location and its reoccurrence characteristic. Therefore, to prevent re-infection, both partners need to be treated.

Causes and Risk Factors

Besides Senile wart (or seborrheic keratosis) that occurs mainly in the elderly, there are more than one hundred kinds of virus type papillomavirus (HPV) causing contagious reactions on the skin and mucous membranes. However, genital warts are primarily transmitted by skin to skin contact with an infected person.

Genital warts are very contagious and are transmitted most often among young people sexually active. At birth, the papillomavirus can also be transmitted to the child by the infected mother; this form of contamination is called mother-to-child transmission.

Besides immunodeficiency factors, taking immune-suppression drugs and organ transplant can promote formation of warts.  No matter how you get the disease, recurrence or your recovery depends greatly on the health of your immunity. Therefore, it is extremely important to boost your immune system during your genital wart treatment.

You are at greater risk of being infected with genital warts if:

• Your immune system is weak
• You are sexually active at a young age
• You are polygamous and have unprotected sex
• You have a sexually transmitted disease (STD) such as HIV/AIDS
• You have unprotected sex with a partner you’ve just met
  

Genital Warts Symptoms

Genital warts can remain asymptomatic for a long period of time. The virus produces discrete changes in your genitals that cannot be seen with the naked eye. Therefore, your doctor can detect the microscopic changes only with special instruments. In that case, HPV can live in your genital area for a long period of time without causing obvious damage; this condition is called latent infection.

The same, depending on your health, genital warts symptoms can occur 15 days after being in contact with the virus.

Women – In women, genital warts often develop outside and inside the vagina, on the cervix and around the anus. Although rare, the warts may be associated with itching, pain and bleeding during intercourse.in addition, you may also experience flesh-colored or gray swellings in your genital area.

Men – genital warts in men can develop on the shaft or tip of the penis, on the scrotum and around the anus. As in women, the lesions may cause itching, pain and gray swellings in men genital area.

Besides genital warts, other form of warts can develop on the back of your hands and fingers, on your neck; they are usually painless but annoying. They may disappear spontaneously without taking any medication. In some people unfortunately, without treatment, the warts can persist for years.

Complications

If you are diagnosed with genital warts, it is very important that you follow your treatment as prescribed. Certain types of human papillomavirus, if left untreated, can turn into precancerous lesions and then cancer. All women that are sexually active should have regularly cervical screening; this recommendation is even more important if you have genital warts. Early detection of anomalies through the cervical smear is the best protection against cancer of the cervix. Complications of genital warts can lead to:

• Rectal cancer
• Cancer of the cervix
• Obstruction of the urethra in men
• Cervical dysplasia – development of abnormal cells on the surface of the cervix.
  

Diagnosis

You can examine your body to determine if you have genital warts. However, in the genesis of the infection, it can be difficult to detect the disease without a medical tool. In addition, at the beginning of genital warts, it is not easy to differentiate them from other skin disorders. Therefore, it is necessary to see a health care provider if you think you have warts or have been in contact with an individual who has the disease.

Physical exam – Usually, your doctor will do a physical exam to look at your genital area for signs and symptoms of warts, if there is any. He/she may apply a solution of diluted acetic acid on the infected areas to make the detection easier. If the changes in the genitals are not enough to confirm the disease, your physician will recommend a Pap test. If the test is abnormal, your doctor will suggest a colposcopy. You usually need to get two abnormal results in the Pap test prior to a colposcopy.

Pap test – The Papa test is a simple medical procedure consisting at removing cells from your cervix to examine under a microscope. The purpose of the test is not simply to confirm genital warts but mainly to detect precancerous or cancerous cells, which can cause the HPV infection. In case you have genital warts, the Pap test can be recommended every six months; it is important to prevent or detect cervical cancer in its early stage.

Colposcopy – this is a morphologic examination of the cervix and vagina using a binocular microscope, which can grow up to fifty times your genital organs. Most of the times, colposcopy is performed to:

• Discover an anomaly in the mucous membranes of the cervix or vagina
• Monitor the evolution of an infection of the cervix by a carcinogenic human papillomavirus (HPV)
• Detect a recurrence a cervical dysplasia due to a carcinogenic human papillomavirus infection.

Cone biopsy (conization) – conization is a surgical technique which involves removing a piece of the cervix to be examined under microscope.  This intervention is rarely used in the diagnosis of genital warts; however, it can be important if the warts cause cancerous tissue. Without treatment, these lesions can develop, after several years, to cancer of the cervix.

Cone biopsy is not performed to confirm genital warts, but to detect pre cancerous or cancerous tissue caused by the infection. A cone biopsy is an extensive procedure; it can cause vaginal bleeding for up to one week.

Genital Warts Treatment

To fight the infection, your doctor will use a symptomatic treatment. That is, he/she will treat the symptoms of the disease and not the cause. The goal of the treatment is to remove all visible genital warts and reduce the proliferation of the HPV. Depending on the severity of the infection, the treatment may require several months. The choice of medication depends on the extension, number of warts and their location. Along with any treatment, it is important that you boost your immune system to help your body fight the infection and prevent re-infection.

In general, there are two types of treatment that can be used to treat your genital warts:

Drug Treatments: local treatment based cream or ointment such as podophyllotoxin and trichloroacetic acid (TCA) or immunomodulators (imiquimod).

Surgical Treatments – surgery is designed to remove the warts with laser treatment, cryotherapy, electrocoagulation or conisation.

Medications

Podophyllotoxin and Trichloroacetic Acid (TCA) – those medications are the main treatments for genital warts. Usually, they are applied on the surface of the lesions to destroy the infected tissue. You can apply Podophyllotoxin on your own; trichloroacetic acid (TCA), however, should be applied by the doctor. It is important that you do not apply the Podophyllotoxin in your cervix; this can lead to serious consequence.

Imiquimod (Aldara) – this prescription medication is used to boost your immune system so that your body can get rid of the warts. You can apply the cream without supervision of your physician; however, you should avoid all sexual contact while the cream is on your skin.

Surgery

Laser treatment is barely used in the treatment of genital watrs. It is perfomed in the case of severe warts.  Laser treatment consists of using intense beam of light to destroy wart tissue.

Cryotherapy – cryotherapy can be used to treat genital warts by applying liquid nitrogen at -190 ° C, directly on the infected area with a cotton swab. In addition, cryotherapy is used to treat different ailments such as stress, insomnia, rheumatism, sore muscles and joints, itching and psoriasis.

Electrocoagulation – electrocoagulation is a technique of solidification and destruction of warts tissue by passing an electric current of high frequency.

Surgical excision – if the other methods fail to produce satisfaying result, your surgeon can perform a surgical incision to remove the warts. This treatment requires local anesthesia.   

Alternative Treatment

• Daily, Take Goldensea, Echinacea, and Astragalus (caps or tea)
• Apply distilled wite vinegar (5% acidity) on the warts
• At least twice a day, apply aloe vera (the sticky part) on the affected part
• Mix Castor Oil with baking soda, then apply the mixture to the infected area
• Increase the following in your diet: vitamin A, C, E, B complex, zinc, L-cysteine, and lactobacillus acidophilus
• Rub the inside of a piece of a banana peel onto the warts area every night.

Genital Warts Prevention

Practice monogamy – having multiple sexual partners increase your risk of contracting STDs including genital warts.

Use a condom – use a condom during sexual intercourse can help you reduce considerably the risk genital warts.

Avoid sexual contact with an infected person – although condoms can protect you from being infected, it would be better not to have sex with an infected person. Because if there are lesions located near the sexual organs or other body parts that are not covered by condoms, contamination can take place.

Early detection – if you are a woman, have a regular Pap smear from your doctor. This preventive practice can help you detect HPV contamination early and prevent formation of precancerous lesions or cancer of cervix.

This early detection is also important for the treatment to work effectively. It is recommended to have a Pap smear every three years after two normal annual smears for women 25 to 65 years.

Vaccination – A vaccine called Gardasil® is available on the market against HPV-16 and 18, the two major HPV responsible for cervical cancer. This vaccine can protect you up to 70% against the cervical cancer and genital warts. Earlier the vaccine is administered (that is, before the first sexual intercourse), the more effective it is.

• US Centers for Disease Control. “Genital HPV Infection – Fact Sheet”. Retrieved 2 January 2013.
• Juckett, G; Hartman-Adams, H (Nov 15, 2010). “Human papillomavirus: clinical manifestations and prevention.”. American family physician 82 (10): 1209–13. PMID21121531.
• Lacey, CJ; Woodhall, SC; Wikstrom, A; Ross, J (Mar 12, 2012). “2012 European guideline for the management of anogenital warts.”. Journal of the European Academy of Dermatology and Venereology : JEADV 27 (3): e263–70. doi:10.1111/j.1468-3083.2012.04493.x. PMID22409368
• UK Department of Health. “Your guide to the HPV vaccination from September 2012”. Retrieved 1 January 2013.
• UK Medicines and Healthcare products Regulatory Agency. “Human papillomavirus vaccine Cervarix: safety review shows balance of risks and benefits remains clearly positive”