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Genital Warts

 


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Class
Sexual health
Description
Genital warts, also known as anogenital warts, venereal warts or condylomata acuminata, are warts that appear in and around the vagina, penis and anus.

Genital warts are the most common viral sexually transmitted infection (STI) in the UK. Every year since records began in the early 1970s, there has been an increase in the number of people diagnosed with genital warts. In 2008, there were 92,525 cases of genital warts reported by genito-urinary medicine (GUM) clinics, an increase of 3.4% on the previous year. It is estimated that there are 151.7 new cases of genital warts per 100,000 population. The highest rates occur in women aged 16-19 years (849.6 per 100,000) and men aged 20-24 years (816.2 per 100,000). The number of recurrent or repeat outbreaks of genital warts is also on the increase.
Causes
Genital warts are caused by a virus - known as the human papillomavirus (HPV). There are more than 100 different types of HPV known, each type is identified by a number. Two types of HPV, known as HPV 6 and HPV 11, are responsible for causing 90% of all genital warts. The virus is highly contagious and is easily passed from one person to another through sexual contact. As the virus is so common, anyone who is sexually active can become infected. However, not everyone infected with HPV will develop warts. In fact the majority of people carry the virus without showing any visible signs, and therefore the virus can spread from person to person without their knowing it.

As HPV is passed on through sexual contact, having a large number of sexual partners or having sex from a young age can increase the chances of becoming infected with HPV. Other risk factors include not wearing a condom during sexual intercourse, having sex with a partner whose sexual history is unknown, and having previous STIs.
Symptoms
Genital warts usually appear as small, fleshy growths or lumps and may appear anywhere on the genital or anal skin, even inside the vagina and anus. They may be so small that they remain unnoticed, or they may grow to cover large areas. They are painless but may itch and very occasionally bleed, particularly if they are affecting the anus or the urethra. It can take weeks or many months after coming into contact with HPV before genital warts appear.
Treatment
The aim of treatment is to remove visible genital warts, however this does not clear the virus and for this reason warts do sometimes come back. Commonly used treatments for genital warts include:
  • self-applied cream or lotion containing imiquimod or podophyllotoxin. Imiquimod acts by stimulating the body's immune system to attack the virus, while podophyllotoxin prevents the virus from multiplying.
  • freezing with a cold spray (cryotherapy)
  • excising (surgically removing the wart) or 'burning' (electrocautery') - performed with the skin numbed by a local anaesthetic.
Can I protect myself from getting HPV infection?
Condoms provide some protection but are not 100% effective as they do not cover the entire genital skin. However, condoms are very good at protecting against other STIs such as chlamydia, gonorrhoea and HIV.

There is a vaccine, called Gardasil, normally used to provide protection against cervical cancer in adult females aged 16 to 26 years, that also provides protection against genital warts caused by HPV 6 and HPV 11. However, although Gardasil provides protection against the types of HPV responsible for 90% of cases of genital warts, it does not provide protection against all types of HPV virus and therefore it is still possible to get genital warts. The vaccine has not been evaluated in males and therefore cannot be used to provide protection for men.

Gardasil is not available on NHS prescription, it has to be obtained on a private prescription issued by a doctor.
When to see your pharmacist
Unlike warts that appear on other parts of the body, there are no treatments for genital warts that you can buy without a prescription. Wart treatments sold at your local pharmacy do not work for genital warts and they may burn if applied to the delicate skin in the genital area. There are treatments that can be prescribed for genital warts, and you can discuss any concerns or questions about these treatments with your pharmacist.

Your pharmacist will also be able to give you the address of your local genitor-urinary medicine (GUM) clinic where you can obtain further help, advice and treatment about genital warts in confidence.
When to see your doctor
Any lump in the genital or anal skin that fails to clear after a few days should be examined by a doctor. You do not need a referral from your own doctor to visit a GUM clinic and you can be assured that your consultation at the GUM clinic will remain strictly confidential.
Living with genital warts
Left untreated, genital warts may disappear or they may grow larger in size. Even if the warts do disappear, it does not mean that HPV has been totally eliminated from the body. There is still the risk that genital warts will appear again (called recurrent infection), and there is still the risk that HPV may be spread to your partner. Using a condom will reduce the risk of spreading the infection, but it will not totally eliminate the risk as skin areas may still come into contact during sexual activity.

Treatment of genital warts can be painful and it may leave scarring if large areas need to be treated. It is generally accepted that treatment of genital warts reduces, but does not eliminate, the risk of spreading HPV. The virus may remain in the body even though visible signs of the genital warts have gone. There is also the risk that genital warts will reappear. If this does happen, the genital warts can be treated again, possibly using a different form of treatment.

Genital warts can cause problems if you become pregnant. The genital warts may appear for the first time, reappear or they may grow larger in size. There is also a risk that the virus may be spread to the baby during childbirth. It is therefore considered better to have genital warts removed, but you should always tell the doctor or nurse removing the genital warts that you are pregnant in case any of the treatments being used could affect your unborn baby.

The HPV virus responsible for genital warts may also cause cervical cancer. While the virus does not affect fertility directly, cervical cancer and its treatment can lead to infertility. It is essential that women go for regular cervical smear tests to detect any abnormal changes in the cervix.

It is always better to tell your partner that you have or have had genital warts, so that you may make decisions about your love-making together.


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