Condyloma acuminata, better known as HPV genital warts, are a sexually transmitted disease (STD) caused by the human papillomavirus (HPV). HPV genital warts can affect both women and men and can affect both the genital and the oral area.
What are genital warts?
Genital warts are small growths on the skin usually having the same color of the surrounding tissues. These warts are caused by some types of the human papillomavirus: HPV type 6 and 11 are responsible for about 90% of genital warts. Although they rarely develop into cancer, it is always better to have them checked by a medical professional.
Signs and symptoms of genital warts and HPV
The main symptom of HPV genital warts looks like a soft bump on the skin. Sometimes they are very small, other times they are more pronounced with a top shaped like a cauliflower. They have the same color as the surrounding skin but may sometimes be slightly darker. They may occur as a single wart or as a cluster of multiple warts. The growth can be difficult to detect when they are internal such as inside the vagina or anus. Other symptoms include:
- Mucus discharge
Genital warts in men
In men, genital warts may affect the following areas:
- Anus both externally and internally
- Top inner thighs
Genital warts in women
In women, genital warts may affect the following areas:
- External genitalia, outside the vagina
- Inside the vagina
- The cervix (the part between the vaginal canal and the uterus)
- Anus both externally and internally
- Top inner thighs
In rare cases, they can also develop in the mouth, lips, tongue or throat.
What causes genital warts?
Genital warts are caused by HPV commonly through sexual intercourse. Oral, anal and vaginal sex can spread the virus through direct skin to skin contact, but also hand or fluid contact from an infected partner can cause the infection. Most of genital warts are caused by HPV type 6 and 11, but they may be possible also due to other strains of the virus; different skin manifestations can also be caused by other strains of HPV.
What is HPV?
Human papilloma virus (HPV) is a sexually transmitted viral infection (STI). There are over 200 types of HPV and about 50 of them can be transmitted through sexual intercourse, while others affect other parts of the body such as the hands and feet: 90% of the infections resolve with no treatment and cause no symptoms and different strains are linked to a variety of conditions:
- HPV type 6 and 11 cause 90% of genital warts.
- HPV types 1, 2, 3, 4, 27, 57 cause cutaneous warts
- HPV type 16 and 18 cause 70% of cervical cancer and have a role in the development of cancers in the throat, mouth, anus, rectus, penis, vagina.
- HPV type 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 are other high-risk strains of the virus that can develop into genital cancer.
- HPV type 1, 5, 8, 9, 17, 20, 23, 38 are associated with non-melanoma skin cancer
HPV is the most common STD in north America with over 79 million Americans infected and the CDC estimates that at least 50% of sexually active men and women will get genital HPV at some point in their lives. An infected person with no signs and symptoms can still pass the infection and symptoms may develop years after the infection is caught.
Genital warts removal and treatment
There are multiple treatments available for genital warts, but they often resolve without treatment over months to years in healthy patients. To lower the chance of spreading the infection you should seek treatment and abstain from sexual activities or at least have only protected sex if the condom can provide protection from skin to skin contact.
Don’t try to use OTC treatments for skin warts for the treatment of genital warts; they are not intended for use in the genital area. There is no evidence supporting home remedies for the treatment of genital warts.
Among the treatments for genital warts there are:
- Imiquimod (Aldara, Zyclara), a cream applied 3 times per week for up to 16 weeks.
- Podophyllin and podofilox (Condylox), a cream applied twice daily for 3 days followed by a four-day rest period, repeated for up to 4 weeks.
- Trichloroacetic acid, an acid that burns off the wart and is applied once per week for 8-10 weeks.
- Sinecatechins (Veregen), a cream applied 3 times a day for up to 16 weeks.
- Cryotherapy, which is the freezing of the wart with liquid nitrogen.
- Excision, meaning the doctor will cut out the wart with surgical tools.
- Laser treatment, which uses high energy laser light to treat the wart.
- Electrocautery, which uses electricity to burn off the wart.
Sometimes, multiple treatments or a combination of treatments may be required.
Always follow the directions of your treating physician. Medications have side effects and may require special precautions or be intended only for external use. Some treatments are only administered by the physician itself.
Genital warts can be treated but cannot be cured. Once you remove the warts you are still infected with HPV for which there is no treatment available. The warts may come back months or years later with a recurrence rate of about 20-30%. HPV infection may also clear from the body without medical treatment.
Genital warts prevention
There are several ways of preventing HPV and genital warts.
Always using condoms when having sexual intercourse can lower the chances of getting HPV. The exposed areas not covered by the condom may still transmit the infection or get infected. Using a dental dam while practicing oral sex is also advised to help prevent the infection. HPV can be transmitted even if no genital warts are visible and if the person carrying it is completely asymptomatic. Other than direct skin to skin contact and oral sex, sharing toys can also transmit the infection.
For women, regular pelvic examinations and a Pap test (aka Pap smear) or a cervical screening test may help detect both the infection and possible changes in the cells that line the inside of the vagina.
Vaccines have been developed to protect against HPV type 6 and 11 which are the major cause of genital warts and against HPV type 16 and 18 which pose at high risk of cancer. The vaccine is now administered to boys and girls aged 9-14, but it is recommended for anyone under the age of 26.
- HPV-associated diseases.
S Ljubojevic, M Skerlev – Clinics in Dermatology, Mar 2014
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N Muñoz, X Castellsagué – Vaccine, Aug 2007
- Condyloma Acuminata.
KB Pennycook, TA McCready – StatPearls, Jul 2020
- World Health Organization (WHO)
- Center for Disease Control and Prevention (CDC)
- American Society of Colon and Rectal Surgeons (ASCRS)