Friday, March 14, 2014

What Are Genital Warts? What Causes Genital Warts?

Genital warts are also known as venereal warts or condylomata acuminate. Genital warts are one of the most common kinds of STDs (sexually transmitted diseases) or STIs (sexually transmitted infections).

A genital wart is an infection of the skin, in genital or anal area, as well as the mucous membranes of the rectum, cervix and vagina.

According to Medilexicon's medical dictionary, a genital wart is:
"A contagious projecting warty growth on the external genitals or at the anus, consisting of fibrous overgrowths covered by thickened epithelium showing koilocytosis, due to sexual contact with infection by human papillomavirus; it is usually benign, although malignant change has been reported, associated with particular types of the virus."
It used to be thought that young children with genital warts or anal warts were victims of child abuse. However, a study explained that this may not necessarily be the case.

This article does not cover non-genital warts. We have a separate article called What are warts? What causes warts?

What causes genital warts?

Genital warts, like other non-STD warts, are caused by various types of the human papilloma virus (HPV) that infect the top layers of the skin. There are over 100 different types of HPV that may cause warts, but only a small number of strains can cause genital warts. Those that do cause genital warts, unlike other wart-causing HPVs, are highly contagious and are passed on through sexual contact with a person who is infected. HPV types 6 and 11 cause the majority of genital warts. 
It is estimated that over 60% of people who have sexual relations with a person who has genital warts will become infected and develop them too. Generally, the genital warts will appear about three months after infection - however, in some cases there may be no symptoms for many years.

A study found that 10% of young women in England have been infected with one or more strains of the human papillomavirus by the age of 16. Another study found that 26% of US girls aged 14 to 19 have at least one sexually transmitted disease. 

What are the risk factors for genital warts?

  • Having unprotected sex
  • Having unprotected sex with many different people
  • Having sex with a person whose sexual history is unknown
  • Starting sexual relations at a young age (however, this study seems to contradict this)
  • Having stress and other viral infections (such as HIV or herpes) at the same time
A US study found that women with certain gene variations appear to be protected against cervical cancer.

What are the complications of genital warts?

  • Cancer - HPV infection has been closely association with cervical cancer, as well as cancer of the vulva, anus and penis. The majority of cervical cancers globally are caused by HPV infection. Even though not all HPV infections lead to cervical cancer, it is crucial for a woman's long-term health that she has regular Pap tests. This study revealed that some HPV infections are also closely linked to head and neck cancers. Another report says that HPV is also linked to oral cancer.

  • Pregnancy problems - pregnant women who have genital warts may have problems urinating. If there are warts on the vaginal wall her vaginal tissues may stretch less during childbirth. There is a very small risk that a mother with genital warts when she gives birth may cause the baby to have warts in his/her throat (laryngeal papillomatosis) - when this does happen surgery may be needed to prevent the airway from becoming obstructed.

    Hormonal changes that occur during pregnancy may cause genital warts to grow, bleed, or increase in number.

  • Diagnosing genital warts

    • Women - genital warts may exist on the vulva, cervix, upper thighs, inside the vagina, on the anus, and inside the anus. (vulva = lips around the opening of the vagina. Cervix = entrance to the uterus or womb)

    • Men - genital warts may exist on the penis, scrotum, urethra, upper thighs, on the anus, and inside the anus. (urethra = tube than urine passes through. scrotum = sac that holds the testicles)
    If oral sex raises the risk of genital warts developing in the mouth or throat.

    A patient needs to be examined by a health care professional - this could be a nurse - to confirm a diagnosis of genital warts. In the UK people can either go to their GP (general practitioner, primary care physician), a GUM (genitourinary medicine) clinic, or a sexual health clinic.

    Even if a person's partner has no symptoms it is still possible to have genital warts. People should go for a checkup if:
    • The patient or partner has genital warts symptoms
    • The patient recently had unprotected sex with a new partner
    • The patient or partner have had unprotected sex with somebody else
    • The patient's partner tells him/her that he/she has an STD
    • The patient has an STD
    • The patient is pregnant
    • The patient is trying to get pregnant
    A healthcare professional can usually diagnose genital warts if any are visible. The examination may involve looking inside the vagina or anus. On rare occasions a biopsy of the wart may be taken.

    Sometimes, even if no warts are detected, the doctor or nurse may ask the patient to come back at a later date. Visible warts may not appear straight after infection. 

    What do genital warts look like?

    • They may appear as flesh-colored or gray swellings (bumps) in the patient's genital area.

    • If several are clustered together they may appear to have a cauliflower shape.

    • Some genital warts are so tiny that they can only be detected with a colposcopic exam of the cervix and vagina or a Pap smear.

    What is the treatment for genital warts?

    Doctors will only treat patients who have visible warts. The type of treatment depends on:
    • The location of the warts
    • How many warts there are
    • What the warts look like
    Treatment is aimed at getting rid of the visible warts and lowering the number of viruses present. If the amount of viruses can be lowered the patient's immune system has a better chance of fighting them off. The following treatments are effective in getting rid of visible warts:
    • Topical medication - a cream or liquid is applied directly onto the warts for a few days each week. This may be either administered by the patient at home or at a clinic - it depends on the kind of treatment. Treatment may continue for several weeks.

      Zyclara cream - in March 2011, the FDA approved Zyclara cream for the treatment of external genital and perianal warts for people aged at least 12 years. Studies had showed that Zyclara, used once per day, effectively clears genital warts within eight weeks.

    • Cryotherapy - the warts are frozen, often with liquid nitrogen. The freezing causes a blister to form around the wart. As the skin heals the lesions slide off, allowing new skin to appear. Sometimes repeated treatments are needed.

    • Electrocautery - electric current is used to destroy the wart. The patient will generally be given a local anesthetic.

    • Surgery - the wart will be cut out (excised). A local anesthetic will be used for this.

    • Laser treatment - an intensive beam of light is used to destroy the wart.
    It is not uncommon for doctors to use more than one treatment at the same time. Treatments are not painful, but may sometimes be uncomfortable, with some soreness and irritation for one or two days. Ordinary over-the-counter painkillers may be taken by patients after treatment. Some patients who feel sore may find that a warm bath helps. After the bath make sure you dry the affected area completely. Do not use bath oils, soap, creams, etc., until well after the treatment is completed.

    Over-the-counter treatments for ordinary warts (non genital warts) are not suitable for genital warts treatment.

    Genital warts will usually eventually go away, even if left untreated. They do sometimes get bigger in size and populate in larger numbers, without treatment. Experts say that untreated genital warts are not harmful for to the health of the infected person, but they may be uncomfortable and not look appealing. However, treating warts greatly reduces the risk of passing them on to another person.

    A US Study found that male circumcision cuts the risk of genital herpes and human papillomavirus (HPV) infection, but not syphilis. However, the USA has - by far - the highest rate of male circumcision in the developed world, and also a much higher rate of sexually transmitted diseases among males.

    Why are Pap tests important?

    A pap test is also known as a Pap smear. It is a procedure to test for cervical cancer in women. The test involves collecting cells from the woman's cervix. Cervical cancer is a possible complication of HPV infection.

    Women should have regular pelvic exams and Pap tests. These also help detect cervical and vaginal changes which may be triggered by genital warts.

    Experts say that a woman should have a Pap test either at the age of 21 or within three years of having sex, whichever comes first. Women who have had genital warts should have a Pap test every three to six months.

    There is a greater chance of curing a woman's cervical cancer if it is detected and treated early. A Pap smear can also detect changes in the woman's cervical cells that may indicate a higher probability of cancer developing in future.

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