December 15, 2006

STDs - Genital warts


Genital warts may be small, flat, flesh-colored bumps or tiny, cauliflower-like bumps. In men, genital warts can grow on the penis, near the anus, or between the penis and the scrotum. In women, genital warts may grow on the vulva and perineal area, in the vagina and on the cervix. Genital warts vary in size and may even be so small that you can't see them. They can lead to cancer of the cervix in women or cancer of the penis in men.
Genital warts are caused by the human papillomavirus (HPV). There are many kinds of HPV. Not all of them cause genital warts
Genital warts, also known as condylomata acuminata or venereal warts, are one of the most common types of sexually transmitted diseases. As the name suggests, genital warts affect the moist tissues of the genital area. They may look like small, flesh-colored bumps or have a cauliflower-like appearance. Genital warts may be as small as 1 to 2 millimeters in diameter — smaller than the width of a ballpoint pen refill — or may multiply into large clusters.
In women, genital warts can grow on the vulva, the walls of the vagina, the area between the external genitals and the anus, and the neck of the uterus. In men, they may be found on the tip or shaft of the penis, the scrotum or the anus. They can also develop in the mouth or throat of a person who has had oral sexual contact with an infected person.
Although genital warts can be treated with medications and surgery, they are a serious health concern. The virus that causes them — the human papillomavirus (HPV) — has been associated with cervical cancer. It has also been linked with other types of genital cancers.

Signs and symptoms
The signs and symptoms of genital warts include:
§ Tiny, gray, pink or red swellings in your genital area that grow quickly
§ Several warts close together that take on a cauliflower shape
§ Itching or burning in your genital area
§ Discomfort, pain or bleeding with intercourse
Often, however, genital warts cause no symptoms. Or they may be so small and flat that they can't be seen with the naked eye. In order to detect these warts, your doctor may apply an acetic acid solution to your genitals to whiten any warts. Then, he or she may view them through a special microscope called a colposcope.

Like warts that appear on other areas of your skin, genital warts are caused by a virus — HPV — that infects the top layers of your skin. There are more than 100 different types of HPV, but only a few can cause genital warts. These strains of the virus are highly contagious and spread through sexual contact with an infected person. About two-thirds of people who have sexual contact with someone who has genital warts develop the condition — usually within three months of contact, but in some cases not for years.

Risk factors
Having unprotected sex with multiple partners increases your risk of becoming infected with HPV. Other risk factors include:
§ Having another sexually transmitted disease
§ Poor nutrition and hygiene
§ Medical conditions that suppress the immune system
Sometimes warts may grow only during pregnancy, possibly due to changes in the immune system

When to seek medical advice
See a doctor if:
§ You have developed bumps or warts in your genital area
§ You have a sexual partner who has developed genital warts or has been diagnosed with them
For women, it's important to have regular pelvic exams and Pap tests, which can help detect vaginal and cervical changes caused by genital warts or the early signs of cervical cancer — a possible complication of HPV infection.
Have an initial Pap test within three years of having sex or at age 21, whichever comes first. Talk with your doctor about the right screening schedule for you going forward.
If you've had genital warts, you may need to have a Pap test every three to six months, depending on the severity of your condition. You may be able to reduce the frequency of your Pap tests after you've had three normal tests in a row.

Cervical cancer has been closely linked with HPV infection. Certain types of HPV also are associated with cancer of the vulva, cancer of the anus and cancer of the penis. Human papillomavirus infection doesn't always lead to cancer, but it's still important for women, particularly those who have been infected with certain higher risk types of HPV, to have regular Pap tests.
Genital warts may cause problems during pregnancy. If the warts enlarge, it may become more difficult to urinate. Warts on the vaginal wall may reduce the ability of vaginal tissues to stretch during childbirth. Rarely, a baby born to a mother with genital warts may develop warts in his or her throat. The baby may need surgery to prevent airway obstruction.

Your doctor can help you clear an outbreak of warts with medications or surgical treatments. The underlying virus is never completely eliminated, however, and genital warts may reappear even after treatment.
MedicationsTopical treatments that can be applied directly to your skin include:
§ Imiquimod (Aldara). This cream appears to boost your immune system's ability to fight genital warts. Avoid sexual contact while the cream is on your skin. It may weaken condoms and diaphragms and may irritate your partner's skin.
§ Podofilox (Condylox). Podofilox works by destroying genital wart tissue. Your doctor may want to administer the first application, and will recommend precautionary steps to prevent the medication from irritating surrounding skin. Never apply Podofilox internally.
§ Trichloroacetic acid (TCA). This chemical treatment burns off genital warts. TCA must always be applied by a doctor.
Don't try to treat genital warts with over-the-counter medications, which aren't intended for use in the moist tissues of the genital area. Doing so can cause even more pain and irritation.
SurgerySurgery may be necessary to remove larger warts, warts that don't respond to medications, or — if you're pregnant — warts that your baby may be exposed to during delivery. Surgical options include:
§ Freezing with liquid nitrogen (cryotherapy). Freezing works by causing a blister to form around your wart. As your skin heals, the lesions slough off, allowing new skin to appear. You may need repeated cryotherapy treatments.
§ Electrocautery. This procedure uses an electrical current to burn off warts.
§ Surgical excision. Your doctor may use special tools to cut off warts. You'll need local anesthesia for this treatment.
§ Laser treatments. This approach can be expensive, and is usually reserved for very extensive and tough-to-treat warts.

HPV can spread through skin-to-skin contact with any infected part of the body — but using a condom every time you have sex can significantly reduce your risk of contracting HPV, according to a 2006 study.
If warts are visible on your genital area or your partner's, avoid sexual contact until the warts are treated. If you've developed genital warts for the first time, inform your sexual partner so that he or she can be screened for infection and, if necessary, receive treatment.
A new vaccine known as Gardasil offers protection from the most dangerous types of HPV. The Food and Drug Administration (FDA) approved the vaccine in June 2006. The national Advisory Committee on Immunization Practices recommends routine vaccination for girls age 11 and 12, as well as girls and women ages 13 to 26 if they haven't received the vaccine already. The vaccine is most effective if given to girls before they become sexually active.

Adapted from
Mayo Foundation for Medical Education and Research (MFMER)