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Genital warts

Definition

Genital warts are soft growths on the skin and mucus membranes of the genitals. They may be found on the penis, vulva, urethra, vagina, cervix, and around and in the anus.

Genital warts are spread through sexual contact.

Alternative Names

Condylomata acuminata; Penile warts; Human papilloma virus (HPV); Venereal warts; Condyloma; HPV DNA test; Sexually transmitted disease (STD) - warts; Sexually transmitted infection (STI) - warts; LSIL-HPV; Low-grade dysplasia-HPV; HSIL-HPV; High-grade dysplasia HPV; HPV

Causes

The virus that causes genital warts is called human papilloma virus (HPV). More than 70 different types of HPV exist. Certain types of HPV can lead to precancerous changes in the cervix, or to cervical cancer or anal cancer. These are called high-risk types of HPV.

Not all types of HPV cause genital warts. Other types of HPV cause warts on other parts of the skin, such as the hands.

HPV infection around the genitals is common. Most people have no symptoms. In women, HPV can spread to areas inside, on the walls of the vagina and cervix. They are not easy to see without special medical procedures.

Important facts about HPV:

  • HPV infection spreads from one person to another through sexual contact involving the anus, mouth, or vagina. The virus can be spread, even if you do not see the warts.
  • You may not see warts for 6 weeks to 6 months after becoming infected. You may not notice them for years.
  • Not everyone who has come into contact with the HPV virus and genital warts will develop them.

You are more likely to get genital warts and spread them more quickly if you:

  • Have multiple sexual partners
  • Are sexually active at an early age
  • Use tobacco and/or alcohol
  • Have a viral infection, such as herpes, and are stressed at the same time
  • Are pregnant
  • Have a weakened immune system due to an illness or medication

If a child has genital warts, you should suspect sexual abuse as a possible cause.

Symptoms

Genital warts can be so tiny, you cannot see them.

The warts can look like:

  • Flesh-colored spots that are raised or flat
  • Growths that look like the top of a cauliflower

In females, genital warts can be found:

  • Inside the vagina or anus
  • Outside the vagina or anus, or on nearby skin
  • On the cervix inside the body

In males, genital warts can be found on the:

  • Penis
  • Scrotum
  • Groin area
  • Thighs
  • Inside or around the anus

Genital warts can also occur on the

  • Lips
  • Mouth
  • Tongue
  • Throat

Other symptoms are rare, but can include:

Exams and Tests

The health care provider will perform a physical exam.

In women, this includes a pelvic exam.

An office procedure called colposcopy is used to spot warts that cannot be seen with the naked eye. It uses a light and a low-power microscope to your health care provider find and then take samples (biopsy) abnormal areas in your cervix.

The virus that causes genital warts can cause abnormal results on a Pap smear. If you have these types of changes, you will probably need more frequent Pap smears for a while.

An HPV DNA test can tell if you have a high-risk type of HPV known to cause cervical cancer. This test may be done:

  • As a screening test for women over age 30
  • In women of any age who have a slightly abnormal Pap test result

Treatment

Genital warts must be treated by a doctor. Do not use over-the-counter medicines meant for other kinds of warts.

Treatment may include:

  • A skin treatment done in the doctor's office
  • Prescription medicine that you apply at home several times a week

The warts may be removed with minor procedures, including:

If you have genital warts, all of your sexual partners must be examined by a health care provider and treated if warts are found. Even if you do not have symptoms, you must be treated. This is to prevent complications and spreading the condition to others.

You will need to return to your health care provider after treatment to make sure all the warts are gone.

Regular Pap smears are recommended if you are a woman who has had genital warts, or if you partner had them. If you had warts on your cervix, you may need to have Pap smears every 3 to 6 months after the first treatment.

Women with precancerous changes caused by HPV infection may need further treatment.

Outlook (Prognosis)

Many sexually active young women become infected with HPV. In many cases, HPV goes away on its own.

Most men who become infected with HPV never develop any symptoms or problems from the infection. They can still pass it on to current and sometimes future sexual partners.

Even after you have been treated for genital warts, you may still infect others.

Possible Complications

Some types of HPV can cause cancer of the cervix and vulva. They are the main cause of cervical cancer.

Genital warts may become numerous and quite large. These will need further treatment.

When to Contact a Medical Professional

Call your doctor if:

  • A current or past sexual partner has genital warts
  • You have visible warts on your external genitals, itching, discharge, or abnormal vaginal bleeding. Keep in mind that genital warts may not appear for months to years after having sexual contact with an infected person.
  • You think a young child might have genital warts

Women should begin having Pap smears at age 21.

Prevention

HPV can be passed from person to person even when there are no visible warts or other symptoms. Practicing safer sex can help reduce your risk of getting HPV and cervical cancer:

  • Always use male and female condoms. But be aware that condoms cannot fully protect you. This is because the virus or warts can also be on the nearby skin.
  • Have only one sexual partner, who you know is infection-free.
  • Limit the number of sexual partners you have over time.
  • Avoid partners who take part in high-risk sexual activities.

Two vaccines are available:

  • They protect against the HPV types that cause most cervical cancers in women.
  • They are recommended for girls and women ages 9 through 26.
  • They are given as a series of three shots.
  • One of the two vaccines protects against genital and anal warts in boys and men. It is recommended for boys and men ages 9 through 26.

Ask your health care provider whether the HPV vaccine is right for you.

References

Advisory Committee on Immunization Practices (ACIP). Recommendations on the use of quadrivalent human papillomavirus vaccine in males. MMWR. 2011;60:1705-1708.

American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement: HPV vaccine recommendations. Pediatrics. 2012. DOI: 10.1542/peds.2011-3865.

Berman Bm Amini S. Condyloma acuminata. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, Pa: Elsevier Saunders; 2013:chap 46.

Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules for Persons Aged 0 Through 18 Years and Adults Aged 19 Years and Older - United States, 2013. MMWR. 2013;62(Suppl1):1-19.

Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Philadelphia, Pa: Elsevier Mosby; 2009:chap 11.


Review Date: 11/10/2013
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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