Genital Warts
Genital warts are growths on the surface of the skin or mucous membrane which occur in the genital area.
WHAT CAUSES GENITAL WARTS?
Human papillomavirus (HPV) causes genital warts. HPV is the name given to a group of viruses which are very common in humans. HPV is so common that almost all sexually active people will be infected with it at some point in their lives. There are over 100 types of HPV that can infect humans, and around 40 types can infect the genital area.
Some HPV types cause genital warts while other HPV types cause warts on the hands or feet, or other areas. There are other types of HPV which do not cause warts or other obvious symptoms and most people with HPV will not be aware that they have it. The HPV virus is usually cleared by the body’s own immune system over time.
HOW DO I KNOW IF I HAVE GENITAL WARTS?
Genital warts are not always noticeable. If they are noticeable they look like flesh coloured lumps or bumps on the skin. They can be small or large, raised, or flattish, single, or multiple, or can cluster in groups and can look a bit like tiny cauliflowers. They can occur on the vulva, vaginal area, cervix, penis, anal area, groin, or buttocks. They are usually painless although sometimes they may be slightly itchy or sore. Genital warts can also be inside the vagina or anus, or on the cervix, and in that case people may not be aware they have them.
Warts may appear a few weeks after infection or may take many months, or even years, to appear after the person was infected. There is usually no way of knowing when someone was infected.
Some types of HPV cause a subclinical infection of the cervix (meaning no obvious signs or symptoms). These HPV types can cause changes which, if left undetected and untreated, may eventually lead to cancer of the cervix. The Cervical Screening Test screens for these types of HPV and if you have a cervix it is important to have regular cervical screening from the ages of 25 to 74. (See SHFPACT Info brochures on Human Papilloma Virus (HPV) and The Cervical Screening Test for more information). The HPV types which cause genital warts do not lead to cancer of the cervix.
HOW DO YOU GET GENITAL WARTS?
HPV and genital warts are transmitted by skin to skin contact during vaginal or anal sex. It is possible but very rare for spread to occur with oral sex. Warts which occur on other parts of the body are caused by different types of HPV virus and do not seem to cause genital warts.
HOW ARE GENITAL WARTS DIAGNOSED?
Genital warts are diagnosed by looking at them. There is no swab or blood test that can diagnose them. If you think that you may have genital warts it is important that you see a doctor about it to be diagnosed and to discuss treatment.
HOW ARE GENITAL WARTS TREATED?
Genital warts usually go away by themselves over one to two years, although occasionally they do not go away on their own. Most people choose to have genital warts treated. There are several treatments available for genital warts. Most of these treatments take some time to be effective.It is very important to see a doctor for a correct diagnosis and to discuss the treatments available, and which will work best for you. Do not use over the counter treatments for other warts to treat genital warts. The doctor may sometimes recommend a combination of treatments.
Treatment can have side effects such as skin irritation, ulceration, pain, and discomfort. You can use paracetamol or other oral analgesia and warm salt baths to help relieve these side effects.
PODOPHYLLOTOXIN PAINT (CONDYLINE)
This is a liquid that is applied directly to the warts. Several treatments are usually necessary, and treatment is applied in cycles. Podophyllotoxin must not be used inside vagina, urethra, or anus, and must not be used in pregnancy.
CRYOTHERAPY (FREEZING)
This is a liquid that is applied directly to the warts. Several treatments are usually necessary and treatment is applied in cycles. Podophyllotoxin must not be used inside vagina, urethra, or anus, and must not be used in pregnancy.
LASER TREATMENT
This is sometimes used for warts that are extensive, difficult to reach, or are resistant to other treatment. This is usually done under sedation.
IMIQUIMOD CREAM
This is a cream that helps stimulate the immune system to destroy the cells infected with the wart virus. It also cannot be used in pregnancy. It is applied directly to the warts. It needs a doctor’s prescription and is relatively expensive, although some private health insurance funds may cover it.
CAN GENITAL WARTS RECUR?
Treatment for genital warts treats the visible genital warts by destroying the cells that contain the virus, but does not get rid of the wart virus that is in the body. Therefore, the virus can persist, and warts may recur, needing further treatment. In the majority of people the body’s own immune system will get rid of the virus over time and genital warts do eventually resolve and stop recurring.
REDUCING TRANSMISSION OF THE WART VIRUS
The wart virus is most easily transmitted when there are visible warts present, although transmission is also increased just before they appear and just after treatment. It can also occur with no visible warts present. You may have the wart virus for a long time before any warts appear. To reduce the risk of transmission it is best to avoid skin to skin contact with the affected area until the warts have been treated, and for a short time afterwards. It is important not to shave or wax the area where the warts are, this can spread the virus and cause more warts to occur.
CAN GENITAL WARTS BE PREVENTED?
The HPV vaccine (Gardasil 9®) is a vaccine that is available in Australia and can prevent infection with several HPV types: two of the HPV types which cause over 90% of genital warts, and seven of the HPV types which cause 90% of cervical cancer.
The vaccine is most effective when it is given before any sexual activity occurs and is given as a two-dose vaccine through the National Immunisation Program for all children aged 12-13 usually through the school vaccination program. The HPV vaccine is also available free as part of the National Immunisation Program for people 14 to 20 years old as a course of three vaccines through a GP. The first dose needs to be given before the age of 20 for the course to be free.
For those 20 years and older, the HPV vaccine is available as a course of three vaccines through a GP, although there is a cost involved. If you did not receive this vaccine through the National Immunisation Program, and you are interested in having it, discuss this with your doctor.
DEALING WITH GENITAL WARTS
People can feel upset, embarrassed, or ashamed when they are diagnosed with genital warts, or any sexually transmissible infection. These feelings are common and normal. Remember though that wart viruses are just viruses like the ones that causes colds. They are very common, very easy to catch, and it does not reflect on you as a person in any way. If you do feel that you need support or would like to talk to someone, mention this to your doctor.
References:
Australian STI Management Guidelines
Melbourne Sexual Health Centre
Cancer Council of Australia
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