Genital warts are growths or bumps that appear on the vulva, vagina, anus, cervix, penis, scrotum, or thigh. They may be raised or flat, single or multiple, small or large, or clustered to form cauliflower-like shapes. The warts are caused by the human papillomavirus (HPV), which also causes cervical cancer and other genital cancers.
HPV is one of the most common causes of sexually transmitted disease in the world. Nearly 24 million Americans are infected with HPV. Some cause common skin warts, while about one third of the HPV types are transmitted by sexual contact and reside in genital tissue without causing warts. HPV infection often shows no symptoms—it is estimated that almost half of the women infected with HPV have no obvious symptoms.
Like other STDs, individuals with HPV infection are largely unaware of the potential risk they pose for transmission to others. More than 80 HPV types have been identified, many of which are known to cause genital warts. Some types also have been associated with cancer.
Genital warts are transmitted by direct, skin-to-skin contact during vaginal, anal, or oral sex with an infected partner. A common theory is that the virus enters the genital tissue through micro-abrasions caused by sexual activity.
Incredibly, HPV can be detected in 93 percent of all cervical cancers, yet the virus alone is not sufficient to induce cervical cancer. Other factors include oral contraceptive use, poor nutrition, a weakened immune system, pregnancy, and smoking. Although most HPV infections do not progress to cancer, it is particularly important for women who have had evidence of HPV infection or genital warts to have regular Pap smears.
In a Pap smear, cells are scraped off the cervix and sent to a laboratory to be examined under a microscope. The cells are examined for the presence of the HPV virus, which can be an indicator of cervical cancer.
Visible warts can be diagnosed by directly observing the genital area. Infections without visible warts can be diagnosed by using a mini-magnifying scope or through blood tests. Latent infection, when the disease isn't actively producing warts, can be diagnosed only by detecting HPV by PCR testing. If a person has genital warts that reappear quickly after treatment, or warts that have pigment and are larger than one centimeter in diameter, their doctor should check the tissue by doing a biopsy to test for cancer.
Approximately 25 percent of patients with genital warts are infected with another STD, and patients should be screened for chlamydia, gonorrhea, syphilis, and HIV. The best way to diagnose HPV infection in women is via a Pap smear test, as part of a regular health check-up.
Scientists have not found a cure for HPV—once someone contracts the virus, it is with them for life. The goal of treatment is to remove warts and to reduce other overt symptoms of the infection. The genital warts themselves can be removed by surgically freezing them, burning them with acid or lasers, or applying prescription creams, but removing the warts doesn't eradicate the virus.
Genital warts tend to grow rapidly during pregnancy, probably because of the woman's suppressed immune system. Genital warts may cause a number of problems during pregnancy. If the warts are in the vagina, they can make the vagina less elastic and cause obstruction during delivery. Warts in the throat is probably the most life-threatening complication to a fetus exposed to HPV during vaginal delivery.
The only way to prevent HPV infection is to avoid direct contact with the virus. If warts are visible in the genital area, sexual contact should be avoided until the warts are treated. Use of barrier protection (condoms) during sexual intercourse may provide some protection, but is not a guarantee.
Unprotected sex is the most common contributing factor to infection with HPV and greatly increases chances for developing of cervical dysplasia, which are precancerous changes of the cervix. Other sexual behaviors, such as multiple sex partners and sexual intercourse at an early age, increase the risk for cervical dysplasia, too. HPV infection can be spread even if warts aren't present.