Genital Warts / HPV

What are Genital Warts / HPV?

Genital Warts, or Condylomata Acuminata, are sexually transmitted infections characterised by single/multiple fleshy growths on the anogenital skin. They are caused by human papillomaviruses, of which more than 100 types are known. Genital Warts are mostly caused by HPV types 6 and 11.

Genital Warts can occur on the cervix, vagina and vulva in females, and on the penis and urethra (urinary canal) in males. They may also occur around the anus and in the anal canal in both males and females.

Warts on other sites like hands, fingers and feet are not sexually transmitted and are caused by varieties of HPV different from those causing genital warts.

Genital Warts are spread by unprotected sexual intercourse and intimate skin-to-skin contact with an infected partner. Autotransmisstion from hands and fingers to anogenital region is also possible.

Incubation Period of Genital Warts / HPV

Genital Warts / HPV can incubate for months or years before exhibiting symptoms.

Symptoms of Genital Warts / HPV

  • Condylomata Acuminata: papular, flat, exophytic, filiform, cauliflower-shaped warts
  • Fleshy growths on anogenital skin
  • Usually multiple warts > 5 to 15, 1-10mm in size
  • Itch and discomfort
  • Usually painless, unless traumatized
  • May be small to large
  • Slow growing

Testing for Genital Warts / HPV

  • Clinical signs and symptoms
  • Characteristic appearance
  • Vaginal examination for cervical warts
  • 5% acetic acid for mucosal warts
  • Skin biopsy
  • HPV DNA

Treatment of Genital Warts / HPV

The goal of treatment is to remove visible exophytic warts, not the eradication of HPV. It is important to check for urethral meatal warts, anal warts, and for female genital warts.

1. Topical wart creams

  • An immune response modifier that activates an internal defensive response, when applied to skin infected with HPV.
  • Applied 3x a week at bedtime, washed-off next morning
  • Duration: until clearance or 16 weeks maximum
  • Low recurrence rate – 10-15%
  • Side effects are skin redness, burning sensation, erosions after 3–4 weeks
  • Not approved for use in pregnant women or internally

2. Cryotherapy – Liquid nitrogen

  • Causes wart destruction, thrombosis of vessels
  • Treatments done weekly to fortnightly intervals, freeze-thaw-freeze cycle
  • Open application by spray or cotton swab
  • Simple, relatively inexpensive
  • Safe during pregnancy
  • Side effects are redness and swelling, blister formation, scarring, pigmentary changes
  • High initial response; most lesions can be cleared in the first two sessions

Follow Up of Genital Warts / HPV

  • Regular PAP smears for females
  • Reassurance. Complete clearance will occur sooner or later.

Prevention of Genital Warts / HPV

Vaccination against genital warts is available. A human papillomavirus (HPV) vaccine is available against HPV strains 6 and 11, which causes more than 90% of all genital warts. 3 injections are required over 6 months.

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