Genital warts and Human Papilloma Virus, all you need to know

Genital warts are common, and usually cause no symptoms. But most women find them disfiguring and annoying. They may sometimes be painful or itchy, and can rarely interfere with childbirth.

They are usually flat and papular growths on the external genital region, or inside the vagina and on the penis in men. Genital warts can also occur at other sites that include the cervix, the urethra and around the anus.

90% of genital warts are caused by strains of the Human Papilloma Virus (HPV) types 6 or 11. It is worth noting that these HPV types are not associated with cancer of the cervix, which is a common worry in patients with genital warts.

Other HPV types (16, 18, 31, 33, and 35) may be found occasionally in visible genital warts as co-infections with HPV 6 or 11. These other types of HPV are associated with changes of the cervix that may be associated with cancer of the cervix. In addition to warts on genital areas, HPV types 6 and 11 have been associated with conjunctival, nasal, oral, and laryngeal warts.

Diagnosis of genital warts is usually made by visual inspection. A biopsy may be done if the diagnosis is uncertain or if there is no response to treatment. More complex tests like the use of HPV DNA testing is not recommended, as this does not give additionally relevant information to aid treatment.

The main reason for treating genital warts is to relieve symptoms, including relieving cosmetic concerns. If left untreated, genital warts can resolve spontaneously, remain unchanged, or increase in size or number. Available treatments for genital warts likely reduce, but probably do not eradicate, HPV infectivity. No evidence indicates that the presence of genital warts or their treatment is associated with the development of cervical cancer.

There are various treatment choices, and patient preference is paramount. No treatment appears superior to any other, and none is ideal for all patients or all warts. Because of uncertainty regarding the effect of treatment on future transmission of HPV and the possibility of spontaneous resolution, an alternative is to fore go treatment and await spontaneous resolution.

Treatment modalities include applications of solutions, gels, creams or ointments on the warts. Some of these may damage adjacent normal skin and must be applied by a trained health worker. Other modalities are use of cold energy (called cryotherapy), heat energy or even surgical removal of the warts. Most warts will respond within 3 months of treatment, but recurrence is also common.

In pregnancy, the warts may be left alone until after delivery, or surgically removed if necessary. Majority of women will have a normal delivery, but any concerns must be discussed with their Obstetrician.

Two HPV vaccines are available, both of which offer protection against the HPV types that cause 70% of cervical cancers (types 16 and 18); one vaccine also protects against the types that cause 90% of genital warts (types 6 and 11). These vaccines are most effective when administered before sexual contact. Either vaccine is recommended for 11 - 12 year old girls and for females aged 13–26 years who didn’t receive the vaccine when they were younger. One of the vaccines can be used in males aged 9–26 years to prevent genital warts. Women should get regular Pap smears as recommended, regardless of vaccination or genital wart history. Women with genital warts do not need to get Pap smears more often than recommended.

All couples must be informed that genital HPV infection is very common and many types of HPV are passed through sexual contact. Most sexually active adults will get HPV at some point, though most will never know it because HPV infection usually has no symptoms. A diagnosis of HPV in one sex partner is not indicative of sexual infidelity in the other partner, but if one sex partner has genital warts, both partners benefit from screening for other sexually transmitted infections.