Genital warts

Genital warts, also called condylomata acuminata or venereal warts, are growths in the genital area caused by a sexually transmitted virus.

Genital warts are the most common sexually transmitted disease. It isestimated that 1% of sexually active people between the ages of 18 and 45 have genital warts; however, as many as 40% of sexually active adults are believed to carry the human papillomavirus (HPV) that causes genital warts.

Genital warts vary somewhat in appearance. They may be either flat or resemble raspberries or cauliflowers. The warts begin as small red or pink growths and grow as large as four inches across, interfering with intercourse and childbirth. The warts grow in the moist tissues of the genital areas. In women, they occur on the external genitals and on the walls of the vagina and cervix;in men, they develop in the urethra and on the shaft of the penis. The wartsthen spread to the area behind the genitals surrounding the anus.

Risk factors for genital warts include:

  • Multiple sexual partners
  • Infection with another STD
  • Pregnancy
  • Anal intercourse
  • Poor personal hygiene
  • Heavy perspiration

There are about 80 types of human papillomavirus. Genital warts are caused byHPV types 1, 2, 6, 11, 16, and 18. HPV is transmitted by sexual contact. Thetime between infection and appearance of the first symptoms varies from oneto six months.

Symptoms include bleeding, pain, and odor as well as the visible warts.

Diagnosis is usually made by examining scrapings from the warts under a darkfield microscope. If the warts are caused by HPV, they will turn white when a5% solution of white vinegar is added. If the warts reappear, the doctor mayorder that tissue samples be examined to rule out cancer.

No treatment for genital warts is completely effective because therapy depends on destroying skin infected by the virus. There are no drugs that kill thevirus directly.

Genital warts were treated until recently with applications of podophyllum resin, a corrosive substance that cannot be given to pregnant patients. A milder form of podophyllum, podofilox (Condylox), has been introduced. Women are also treated with 5-fluorouracil cream, bichloroacetic acid, or trichloroacetic acid. All of these substances irritate the skin and require weeks of treatment.

Genital warts can also be treated with injections of interferon. Interferon works best in combination with podofilox applications.

Surgery may be necessary to remove warts blocking the patient's vagina, urethra, or anus. Surgical techniques include the use of liquid nitrogen, electrosurgery, and laser surgery.

Genital warts are non-threatening growths and are not cancerous by themselves. Repeated HPV infection in women, however, appears to increase the risk of later cervical cancer. Women infected with HPV types 16 and 18 should have yearly cervical smears. It is not unsual for genital warts to return after all present methods of treatment--including surgery--because HPV can hide in apparently normal surrounding skin.

The only reliable method of prevention is sexual abstinence. The use of condoms minimizes but does not eliminate the risk of HPV transmission. Thepatient's sexual contacts should be notified and examined.

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