Genital Warts

What are Genital Warts?
Genital warts are caused by the human papilloma virus (HPV). It is the most common sexually-transmitted disease caused by a virus. The warts are grey or flesh-colored growths found in the genital and area of both men and women. HPV infection may not be obvious, and can occur at any age.

What is the Treatment?
No single treatment is effective in eliminating warts and preventing them from coming back. Genital warts may go away on their own in about 10%-20% of people over a period of three to four months.

• Cryotherapy: This technique freezes the wart using liquid nitrogen. It is an excellent first-line treatment because response rates are high with few side effects.
• Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. The laser physically destroys the HPV-induced lesion. Disadvantages include high cost, increased healing time and scarring.
• Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia.

What are the Symptoms?
In men, genital warts can infect the urethra, penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many fingerlike projections (anal warts). Others may appear pearly, cauliflower-like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Infection with HPV may be dormant or undetectable, with some lesions hidden by hair or in the inner aspect of the uncircumcised foreskin in males. In some instances, men may experience irritation, bleeding or itching after sexual intercourse.

In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals warrant a thorough examination of the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. However, in some instances, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.

The size of genital warts can range from less than one millimeter across, to several square centimeters when many warts join together. It is also very common for genital warts to appear in more than one area. In some rare cases, warts can obstruct the urethral opening (the opening where urine exits the body), causing bleeding or urinary obstruction.

Genital warts are generally painless and asymptomatic. However, for most people, it is their visual appearance that is most bothersome.

How Can I Prevent Genital Warts?
In 2006, an HPV vaccine (Gardasil) was approved by the FDA for use in girls and women aged 9-26. This vaccine has been shown to be safe and 100% effective in preventing infection with the four most common HPV types (6, 11, 16, and 18) in women who have had no previous exposure to the virus. However, it is less effective in women who have already been infected with HPV, and it does not protect against all types of HPV infection. Studies are underway to determine whether the vaccine is safe and effective in older women and in males.

Because no treatment is 100% effective, it is important to prevent the spread of HPV, which causes genital warts and some cancers, whenever possible. Transmission of genital warts can be decreased if you use condoms and refrain from sexual activity until therapy is completed.

What to Expect Following Treatment
Complete the necessary treatment as outlined by your dermatologist. Women with genital warts should see their gynocologist for a routine Pap smear and investigation for HPV infection of the vaginal canal and cervix.

If the genital warts are not successfully treated with the initial therapy, follow-up with your dermatologist to discuss options for alternative treatment.