Genital Warts

Genital warts are soft warts that occur on the skin and mucous membranes of the genitals. Genital warts are also known as condyloma acuminata or venereal warts.

Cause of Genital Warts

40 of the 100 known HPV strains are the culprit of genital warts. Human papillomavirus remains dormant in warm moist areas and invade the host primarily through cuts and abrasions. About 90% of genital warts are caused by two strains of HPV i.e. (HPV-6 and HPV-11). There is no cause for alarm if you see yourself with genital warts caused by these two strains for these are low risk cancer causing agents. Certain strains can give you run for your money since they have high potential for causing cancer. HPV-16 is the major cause of cervical cancer in women. HPV-16, 18, 31 and 45 are also high risk virus strains. They also are called oncogenic strains since they cause 100% of cervical cancers.

The virus enters the body from the microscopic abrasions that resulted from the sexual activity. They penetrate into the mucous membranes and the skin. The virus remains dormant within the cells for months and years without evidence. Two-thirds of people who have sexual contact with infected partner are likely to develop the infection within 3 months. Using birth control pills can lead to increased sexual contact and hence greater risks to develop genital warts. Having sex at an early age and having multiple sex partners is an invitation to genital warts which may lead to HPV infection.

Symptoms

Though painless, genital warts can be bothersome and itchy.

Here are the signs if you have genital warts:

  • Painless bumps formed that can range from 1 mm to 1 cm
  • Itching and discharge
  • Bleeding when the wart is in the urethral opening.
  • Have growth in multiple regions

If there is any history of sexually transmitted diseases, there are more chances of developing genital warts. In men, the infection occurs in urethra, scrotum, penis and rectal region. The outgrowth can be smooth raised mass or it can be rough projections called anal warts. They might be cauliflower like lesions in certain cases and remain hidden in pubic hair or foreskin in men.

In women they are generally smaller in size and appear in moist regions like vaginal opening and the labia minora. Lesions are visible on the vaginal canal, cervix and anorectal area. Women may experience bleeding, itching or vaginal discharge after sexual intercourse.

Diagnosis

Diagnosis is always based on the appearance and history of the disease. Here are some of diagnostic techniques:

  • Acetowhitening – 5% Acetic acid is applied on the affected area for 5 to 10 minutes. The infected area will turn white in colour after application of the acetic acid. This technique is called Acetowhitening for it makes the lesions appear white after the application of acetic acid.
  • Colposcopy – Magnification of the suspicious area is another good option to detect the warts. A colposcope is used to magnify the lesions present in the vaginal area and on the cervix. The magnified area can be projected on the computer screen and lesions can be studied.
  • Pap smear – It is another common technique done to detect lesions in the genital areas. It is microscopic examination of the cells taken from the affected area. They detect the cancer cells and the viral infections very efficiently.
  • Biopsy – can be done if the lesions are unusual and reoccur after treatment. Certain lab tests can also be performed to be sure of the infection.

Self-care

Genital warts have no other body symptoms except their appearance so there are certain precautions that can be taken once you found them developing:

  • Do not touch the warts, neither squeeze or prick them.
  • Take necessary precautions so that they don’t grow and become worse.
  • Be careful to prevent the transmission to your partner.

Medical treatment

There are certain medicines that are prescribed by the doctor that might include:

  • Imiquimod
  • Podophyllin and podofilox
  • Trichloroacetic acid (TCA)

The treatment provided goes through three stages which are:

  1. First-line treatment that involves the use of salicylic acid ointments.
  2. Second-line treatment that involves immunotherapy and cryosurgery.
  3. Third-line treatment is given in last stage where surgical excision is done.

Immunotherapy is done by injecting the antigens to provoke an immune response in the body against the infection i.e. wart virus. An old effective treatment is chemotherapy in which dilutes gluteraldehyde is topically applied over the affected area. Peeling of dead skin cells are also done by treating the warts with keratolysis, this includes usage of catalytic chemicals.

Some of the regular surgical methods are cryosurgery and laser surgery. Cryosurgery is surgical removal using liquid nitrogen while laser surgery is removal of the warts by exposing it to 585nm dye laser. Laser treatment is much more effective as it doesn’t leave scars but it is very expensive and requires multiple seating. Cauterization is can also be practiced however it is a short term treatment and the lesion can reappear.

A Cryotherapy is generally required if you face following symptoms:

  1. You cannot use medicines to treat the wart.
  2. It is not responding to conventional treatment.
  3. It increases rapidly and had been there for a long period of time.
  4.  If you develop symptoms such as pain, bleeding and itching.

The two most effective techniques that are used in cryosurgery are:

  • Spray technique – In spray technique the liquid nitrogen is sprayed 1 cm away from the skin until a tiny ice ball is formed. This tiny ball is formed once the cryogen has penetrated through the cells.
  • Dipstick applicator – In this method a cotton ball dipped in liquid nitrogen which is applied on the affected area. The procedure is repeated every week until the warts dry up.

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