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Forever Mom Kelly Ashey

Genital Warts Introduction Genital warts are sexually transmitted and cause lesions on the vagina, penis, anus and cervix. It is a viral infection that is extremely common, frequently showing up on pap smears and causing my patients a great deal of concern. Since I get a lot of questions about this problem, I thought it would be a good topic for discussion this month. This disease is also called human papillomavirus or HPV. Other names are venereal warts and condyloma acuminatum. Although the majority of the time it is felt to be transmitted by sexual contact, there is evidence that it can be spread through the use of contaminated towels and, possibly, from a contaminated toilet seat. I have had patients with HPV who are married and deny having sexual relations with anyone other than their spouse. This has occurred enough times that I am convinced some of these patients have contracted genital warts by means other than sexual activity. Children have also contracted genital warts when there has been no reason to suspect sexual abuse. It is well established that HPV can be transmitted from mother to child during the birthing process, but may not show up for years. Since it is transmitted by inoculation with a live virus, it would be rather short-sighted to assume it is always transmitted sexually. Nevertheless, the vast majority of these cases are most certainly transmitted sexually. Etiology HPV is the virus that causes genital warts. There are over 70 different types of HPV. Genital warts are most frequently caused by HPV-6 and HPV-11. Different strains of HPV also cause common warts, plantar warts, and flat warts. HPV-16, 18, 31, 33 and 35 have been associated with cancer of the cervix and, rarely, penile cancer. Once the virus has infected an individual, it is considered to be a permanent infection of the skin. Although the visible lesions can be treated and will resolve, the remaining normal appearing skin has been shown to still contain the virus. This is called a latent infection when the virus is not visible, but is found in the skin using an electron microscope. Ninety percent of cervical cancers have detectable HPV within them. Genital warts can be transmitted from the mother to the child during childbirth. Occasionally, the child will develop the warts on his or her larynx. This may not become apparent for years. Infants and children may be affected while they are being bathed or changed. HPV is highly contagious. Twenty-six percent of sexual partners will develop the infection after a single exposure to an infected individual. The average incubation period is probably one to six months. Epidemiology HPV is the most common and fastest spreading sexually transmitted disease in the United States. Genital warts occur most frequently in the age group from 15 to 30 years old. Males and females are affected equally. With advancing age the frequency of infection decreases. In college age women, the rate has been reported to be as high as 46%. In women 40 to 55 years-of-age the rate drops to under ten percent, and in women older than 55 years, the prevalence is only five percent. Signs and Symptoms Genital warts usually present as a soft, skin-colored lesion on the shaft of the penis, or the outside of the vagina. They may be rough and cauliflower-like. Penile lesions are usually smooth and form bumps from as small as the size of a pin head to as large as a pencil eraser. They occasionally can itch and become irritated. Sexual intercourse can cause them to bleed. When genital warts are on the cervix, they are not easily visible. Many times, however, they will show up on a routine pap smear. In this case, a procedure called colposcopy is indicated to evaluate the extent of the infection. A colposcope magnifies the cervix so that the lesions can be better visualized. Usually, genital warts cause no symptoms whatsoever. Individuals may frequently not even realize they have the infection. Complications The main complication is the possible development of cervical or penile carcinoma. Another complication is the transmission of the virus to an infant as he or she passes through the birth canal. As mentioned earlier, it may not show up for years. It may present as lesions on the larynx which is the inside of the throat. Most cases of genital warts do not cause any complications and, many times, will regress spontaneously over a period of several years. Types other than HPV-16 and HPV-18 are unlikely to cause any complications. Diagnosis The diagnosis of genital warts is usually made by the observation of the typical appearing lesions. If there is any question about the diagnosis, then a biopsy of the lesion may help. As mentioned above, they are frequently diagnosed on a routine pap smear. Treatment There are numerous, different effective treatments. One of the most common is the application of podophyllin, applied directly to the warts. It is left on for several hours and then washed off. The treatment may need to be repeated every week until the lesions are gone. Imiquimod (Aldara) 5% cream is applied overnight three times weekly until the lesions disappear. It can be used for up to 16 weeks. Liquid nitrogen can be applied to freeze the lesions. This also may require several weekly sessions. A medication called Podofilox (Condylox) can be applied by the patient. Surgical removal of the lesions is also effective as well as laser treatment. Since podophyllin can cause birth defects, it should not be used in pregnancy. Topical 5-fluorouracil is sometimes effective. The injection of interferon has also been used with some success. Even after visual resolution of the lesions, biopsies of the normal skin will reveal the virus when electron microscopy is used to view the biopsy site. Prevention The use of condoms will markedly decrease the transmission of HPV. Latex condoms, especially when used with a spermicidal cream, may afford some protection. It should be noted that this is not 100% effective in preventing infection. Abstinence by men and women should be utilized until treatment is completed. Circumcision in men may occasionally prevent recurrence. Recurrence is common with all forms of treatment. The sharing of bath towels should always be avoided. References Wiedermann BL, et al. Condyloma Accuminata. Griffith' 5 Minute Clinical Consult. 2004, Electronic version 4.0.139. Abel EA et al. Condyloma Accuminatum. Scientific American-Medicine 7, VII; pp 17-20. The information provided above is offered as a community service about health-care issues and is not a substitute for individual consultation. Advice on individual problems should be obtained from your personal physician. This information is based on research by the author and represents his interpretation of the literature. * * * Readers may send questions to our email address. This column is for informational purposes only and is not a substitute for professional or medical advice. * * *

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