Genital Warts

Genital warts are small soft growths that appear on the genitals. They are caused by low-risk strains of the human papillomavirus (HPV). According to the Centers for Disease Control and Prevention (CDC), HPV infection is a common type of sexually transmitted infection (STI). It is common for genital warts to spread quickly. Genital warts can be treated with prescription creams and solutions. 

What are genital warts, and what causes them?

Genital warts (condylomata acuminate) are the most easily recognized symptom of the human papillomavirus (HPV), a common sexually transmitted infection (STI). These warts are fleshy growths or bumps that appear on and around the genital area. They can cause discomfort, itching, or pain and look extremely unpleasant. Warts develop separately or in clusters; or can develop into large masses. 

According to the National Cancer Institute, the low-risk HPV strains (types 6 and 11) cause about 90 percent of genital warts. The HPV that causes genital warts is transmitted from person to person through sexual contact. Genital warts are contagious and can be transmitted through skin-to-skin contact as well as sexual intercourse. It is still possible to pass on a genital HPV infection even if genital warts are not present. 

HPV is unable to be transmitted through condoms; however, it can still be transmitted if a wart on or near the genital area is not covered. 

Risk Factors

Anyone who is sexually active is at risk of getting HPV. However, genital warts are more likely to occur in people who: 

• Smoke 
• Have a suppressed (weakened) immune system 
• Have multiple sexual partners 
• Are under the age of 30

How are genital warts diagnosed?

If you suspect that you may have genital warts, it is recommended that you visit your doctor or local sexual health clinic. You should seek medical advice if a recent or current sexual partner develops genital warts or HPV infection. Genital warts are often diagnosed upon appearance by a healthcare professional. In some cases, your doctor may order a biopsy. 

To diagnose genital warts, your doctor will:

• Ask for details about your sexual and medical history. 
• Perform a physical examination of the areas where the warts are occurring. 

A more detailed exam may include the following:

• Urethra examination. A specialist performs this examination if it is suspected that there may be genital warts inside the urethra.
• Vaginal examination. This is typically done using a vaginal speculum; a metal or plastic tube that allows the nurse or doctor to see inside that vagina. If your pap smear result is abnormal, a colposcopy may be performed.  
• Anal examination. This exam is typically performed with a device called a proctoscope. This small plastic tube enables the nurse or doctor to examine the skin inside the anus. 

If you experience a second outbreak of genital warts, you should seek medical attention if any of the following signs and symptoms occur:

• You develop any new symptoms that were not present during your last diagnosis
• The size of your warts has increased 
• The warts appear in a different area than last time 
• The number of warts significantly increased 
• The warts are a different texture or colour

Treatment 

Genital warts are typically treated with prescription topical preparations such as:

• Podofilox (Condylox) and Podophyllin. Podophyllin is a plant-based resin typically used to treat clusters of smaller warts. The resin kills the warts by poisoning the cells of genital warts. This cream is used in treatment cycles. 
• Imiquimod (Zyclara, Aldara). This cream works by boosting the immune system's ability to fight HPV infection. Imiquimod is applied directly onto the genital warts, and the process can be repeated three times a week. 
• Sinecatechins (Veregen). This topical cream is used to treat warts around the anal canal and external warts. Mild side effects may include pain, burning, itching, and redding of the skin.

• Trichloroacetic acid. This is a chemical topical treatment that can be used for internal and external genital warts. Side effects may include pain, mild skin irritation, or sores. 

Over-the-counter wart removers should not be used for genital warts as it is not intended for use in the genital area. 

Surgery may be required to remove larger warts that do not respond to topical medication, or you are pregnant, as the baby can be exposed to them during delivery. 

Surgical options include:

• Laser treatments. This treatment is used to remove tough-to-treat warts by destroying the cells of the warts. Side effects may include pain and scarring. 
• Cryotherapy (freezing with liquid nitrogen). Cryotherapy works by causing a blister to form around the wart, and as the skin heals, the lesions fall off, allowing new skin to appear. This treatment may need to be repeated. Side effects may include pain and swelling. 
• Surgical excision. Your doctor will use specific tools to cut off the warts. This treatment will require general or local anaesthesia. 

Electrocautery. Warts are burnt off using an electrical current. There may be some swelling and pain after the procedure.

Prevention

You can take measures to significantly reduce the risk of developing genital warts and other STIs. 

• The HPV vaccine. This vaccine protects against infection with the human papillomavirus. The CDC advises that adults and children from the ages of 9 to 26 years, adults aged 27 to 45 years old, and people who are pregnant. 
• Eat well, exercise, and sleep well. This will help your immune system stay in good shape to help fight off the HPV infection. 
• Avoid sharing sex toys; otherwise, ensure that they are sanitized or covered in a condom before use. 
• Use condoms during anal and vaginal sexual intercourse to prevent transmission of HPV and other STIs. 
• If engaging in oral sex, use a dental dam (polyurethane square) to cover the anus and female genitals, or use a condom to cover the penis. 

If you are a woman engaging in sexual intercourse with another woman, use a dental dam to cover your vulva when touching your partner's vulva.