Darrick Robles Genital warts, also known as genital warts and condylomas, are the most common sexually transmitted infection worldwide. It is highly contagious and the majority of all sexually active people will come into contact with HPV at some point. In 60% of cases, the infection happens at the beginning of sex life. Our doctors will tell you more about this infection.
What are genital warts (condyloma)?
Genital warts are warts on the skin and mucous membranes. They are related to infection with a virus from the human papillomavirus (HPV) family. Genital warts can appear on the external and internal genitals, the anus, and sometimes in the throat.
There are about 200 types of HPV, of which about 40 specifically infect the anal and genital areas. A distinction is made between HPV with a low risk of cancer (HPV 6 and 11), which includes those that cause external warts, and HPV with a high risk of cancer (HPV 16, 18, 31, 33, 35 and 45). The latter can cause cervical, anal and throat cancer. A person can get infected with several types of HPV over the years – and even more times with the same type. Most infections go away on their own, but in 10% of cases the infection is persistent and causes visible sores (lesions).
External, i.e. visible, warts are benign lesions. However, they should not be ignored as one type of virus can mask another. When external warts are present, one should always look for other cancerous or cancer-promoting lesions as well. These are caused by high-risk HPV and are found on the cervix, vulva, anus and, less commonly, the penis. In addition to the infected person, all sexual partners should also be examined.
Good to know: There is an effective vaccination against infections with HPV, which is mainly responsible for genital warts and cancer. It is recommended for all boys and girls between the ages of 9 and 14. Adolescents who have not been vaccinated against HPV by the age of 15 should do so as soon as possible and before their 18th birthday.
What are the different types of genital warts?
There are several different types of genital warts. The warts can be a few millimeters to several centimeters in size.
Acuminate condylomata
Condylomata acuminata, or papillomas, are the most common types. They are associated with growths on the skin or mucous membranes that have jagged edges. They look like cauliflowers. They can occur alone or in groups, localized or distributed. This type of genital wart is almost always benign. But there are two other types to look out for: condylomata lata and flat warts.
Condylomata lata
Condylomata lata cause skin bumps called papules. They can be brown, pink, or the color of skin. They have a smooth surface. They occur singly or widely distributed.
Flachwarzen
Flat warts are reddish-pink dots that are sometimes invisible but appear with the application of 5% acetic acid.
What are the symptoms of genital warts?
Genital warts appear in the following places:
- on the genitals (penis, scrotum, vulva, vagina)
- in the anus and in the anal canal
- in the throat, but this is less common.
symptoms in men
Symptoms in men vary and depend on whether the man is circumcised.
- In uncircumcised men, the lesions are mainly found on the foreskin, glans penis and frenulum.
- In circumcised men, the lesions are mainly found on the shaft of the penis.
Anus involvement is possible but more common in homosexual men than in heterosexual men.
symptoms in women
In women, external lesions mostly affect the labia and clitoris. In one third of all cases there is also damage to the vagina or cervix. The anus can also be affected.
Anal canal lesions are commonly associated with anal intercourse, the presence of lesions in the area of the anus, and the use of drugs that suppress the immune system.
Complications associated with genital warts
With the exception of very special cases (Buschke-Löwenstein tumor, Bowen’s disease), external warts, the most common form, do not develop into cancer. However, they can feel and look uncomfortable if they are very large. If such warts are present, it should always be checked for other HPV-related lesions that can cause cancer. These should be sought in the following areas:
- in women systematically in the cervix
- in men and women in the anus (anal canal) in the case of external warts around the anus
- sometimes in the urethra.
What is causing the infection?
The Human Papillomavirus
Genital warts are the result of infection of the skin and mucous membranes with a virus from the human papillomavirus (HPV) family. However, it is not the same strain that causes warts on the soles of the feet.
There are around 200 different types of HPV. A distinction is made between HPV with a low risk of cancer, which is the main cause of genital warts, and HPV with a high risk of cancer.
HPV infection usually has no symptoms and 90% of cases go away on their own. In the remaining 10% of cases, the infection is persistent and causes visible sores (lesions). Genital warts appear anywhere from 3 weeks to several months or even years after HPV infection. Without treatment, they disappear after 2 years. They can reappear after a treatment. Smoking increases the likelihood of recurrence. The virus can also lie dormant in the body and suddenly become active when the immune system is weakened (HIV, treatment with immunosuppressants, etc.).
risk factors
Although all sexually active people can become infected with HPV, infection seems more likely in people who had their first sex young, have frequently changing or many sexual partners, suffer from an immune deficiency (HIV-positive) or practice anal sex. Warts are more common in people with HIV and are more likely to return after treatment. These people also have a higher risk of anal cancer.
The transmission of genital warts
During sex
Human papillomavirus is transmitted through direct contact during sex:
- while stroking
- during oral sex (contact between mouth and penis, vulva, vagina or anus)
- during vaginal intercourse (penetrating the vagina with the penis)
- during anal intercourse (penetrating the anus with the penis)
- rubbing the genitals together
- sharing sex toys.
For pregnant women
At birth, the infection can be passed from mother to child. But that is very rare.
How is the diagnosis made?
The lesions caused by HPV can be seen with the naked eye, so diagnosis is not difficult.
However, further investigations can be carried out:
- Speculum exam and pap smear : when the lesions are in the vagina and are therefore difficult to see. The Pap smear can also detect cancerous or cancer-promoting lesions in the cervix.
- Anoscopy : this is used to check for warts in the anus.
- Urethroscopy : this is used to visualize the inside of the urethra if the lesions are in the urethral meatus or deeper in the urethra in men.
A tissue sample may be taken if the diagnosis is unclear or if the warts are still present after treatment.
How do I treat genital warts?
External warts are usually removed. There are several techniques available for this:
- electrocautery
- Laser
- liquid nitrogen
- Drugs that alter the immune response (imiquimod, podophyllotoxin)
The technique used depends on the type of lesion. For example, cold therapy is preferred for small external lesions. Drugs to modify the immune response are used for flat lesions and for lesions that are difficult to see and more or less flat.
If the warts don’t come back, you’ll need to use a protective method during sex for another 3 months after recovery.
Systematic screening for other sexually transmitted diseases (AIDS, syphilis, chlamydia, gonococci, and hepatitis B) is prescribed for the infected person and all partners.
How do I treat genital warts?
vaccination
The HPV vaccine protects against the types of viruses that cause cervical cancer and warts. It is recommended for all boys and girls between the ages of 9 and 14. Adolescents who have not been vaccinated against HPV by the age of 15 should do so as soon as possible and before their 18th birthday. A booster vaccination can be given between the ages of 15 and 19. It is also recommended for homosexual men up to the age of 26. Vaccination is more effective if given before sexual activity, before exposure to HPV.
Condoms
While condoms offer good protection against sexually transmitted diseases such as HIV or syphilis, they may be less effective against HPV infection. However, condoms have been shown to protect women from HPV infection in the cervix and vulva.
When should I go to the doctor?
We recommend that you see a doctor as soon as you spot warts. If your diagnosis is positive, you must tell all your sexual partners, as they will also need to be checked for lesions by a doctor. Sexual partners only need to be examined by the doctor. However, sexual partners must have a full gynecological examination (perineum, vulva, vagina, cervix) and a smear test.
Helpful tip: Public health officials recommend all women between the ages of 25 and 65 get tested for cervical cancer with a Pap smear.
- Between the ages of 25 and 29, the screening test is done every 3 years by Pap smear (followed by examining the appearance of the cells).
- From the age of 30, screening takes place every 5 years using an HPV-HR test (Pap test followed by DNA testing for high-risk HPV in the cells).
Gynecologists, general practitioners, midwives and medical laboratories can perform the Pap smear if medically prescribed.
How can Med-Healths help?
Our Med-Healths doctors can diagnose warts. In certain situations, they may prescribe treatment and screening for other STDs. In other cases, they will refer you directly to a specialist.
