Genital warts

Definition

Genital warts, or condylomata acuminata, are also called venereal warts. These warts are painless, pink or grayish growths on the skin and mucous membranes of the genitals and anal area. They are usually found in clusters. Genital warts are very contagious and spread through sexual contact with an infected person.

Description

Genital warts are the most common sexually transmitted disease (STD) in the general population of the United States. It is estimated that 1% of sexually active people between the ages of 18 and 45 have genital warts; however, studies indicate that as many as 40% of sexually active adults may carry the virus that causes genital warts. Certain strains of the virus that cause genital warts may also cause cervical changes and cancer.

Causes & symptoms

Genital warts are caused by several subtypes of HPV, the same virus that causes warts on other parts of the body. Symptoms develop about one to six months after being exposed to the virus. Once contracted, the virus remains in the infected person's body. This is true even if the warts are not visible. In addition to the visible warts, symptoms may include bleeding, pain, odor, itching, and redness in affected areas. These symptoms may appear without the warts, and the warts may appear without other symptoms. Stress may contribute to recurrent outbreaks.

Genital warts may be difficult to detect. At any given time, at least a quarter of all HPV infections are in a state of regression, in which the infection remains dormant in the body and there are no outbreaks of warts or other readily detected symptoms. In addition, warts that occur deep inside the vagina, on the cervix, or within the anus may go undetected.

HPV can be transmitted through oral, anal, or genital contact with an infected person, even if warts are not visible. Care must be taken, because the virus may also be transmitted via objects that have been recently exposed to the virus. These may include unwashed or improperly cleaned medical equipment, as well as underwear, tanning beds, and sex toys.

Risk factors for contracting genital warts include:

  • multiple sex partners
  • infection with another sexually transmitted disease (STD)
  • pregnancy
  • anal intercourse
  • poor personal hygiene
  • heavy perspiration

Genital warts vary somewhat in appearance. They may either be flat or resemble raspberries in appearance. The warts begin as small, red or pinkish growths. They may grow in clusters as large as four inches across, and may interfere with intercourse and childbirth. The warts grow on warm, moist tissue. In women, they occur on the external genitalia, the cervix, and the walls of the vagina. In men, they develop in the urethra and on the shaft of the penis. The warts may also spread to the area surrounding the anus.

Diagnosis

Genital warts are usually identified and diagnosed by their characteristic appearance. A sexual history should be taken, and tests for other STDs may be administered. If cervical warts are suspected, a colposcopy exam to view the cervix is necessary for diagnosis. A Papanicolaou (pap) smear may be performed, and the doctor may order a biopsy of the warts to rule out cancer.

Man with genital warts. (Custom Medical Stock Photo. Reproduced by permission.)

Treatment

Genital warts are contagious, and should be assessed and treated under the supervision of a healthcare practitioner. A traditional Chinese medicine practitioner or an acupuncturist will probably recommend treatments to cleanse the liver and enhance immune functioning. A generally recommended homeopathic remedy is the application of a tincture of Thuja occidentalis (common names thuja, northern white cedar, and arborvitae, or tree-of-life) directly to the warts. A homeopathic physician should be consulted for a work-up for further treatment.

The direct topical application of vitamin A, thuja, lomatium (Lomatium dissectum) isolate, or tea tree oil (Melaleuca alternifolia) helps resolve warts and prevent recurrence of outbreaks. With the exception of the tea tree oil, these herbs should also be taken internally in addition to direct application. It has also been noted that deficiencies of folic acid and vitamins A and C contribute to this condition. Such deficiencies may be risk factors for a progression to abnormal cervical cells and cancer; therefore, supplementation is recommended. It should be noted that beta-carotene is often suggested as an alternative to taking high dosages of vitamin A.

Treatments that focus on emotional and psychological factors have been shown to be effective in reducing or eliminating outbreaks of warts. Hypnotherapy and techniques of stress reduction and relaxation are highly recommended.

Allopathic treatment

There is no cure for genital warts, as the virus cannot be destroyed once it enters the body. The warts themselves may be burned off with electrocautery or lasers; frozen with liquid nitrogen for easy removal; or surgically removed. Podophyllum resin, trichloroacetic acid, interferon inducers, 5-fluorouracil cream, bichloroacetic acid, or trichloroacetic acid can be used as a topical treatment. These medications require several weeks of treatment and may irritate the skin. Pregnant women should be sure to inform their health care provider of this condition, as some of the medications for warts may cause fetal abnormalities. Genital warts can also be treated with injections of interferon, either into muscle tissue or directly into the lesions.

Unfortunately, regardless of the treatment regime, genital warts have a high rate of recurrence. Several courses of treatment may be required. Sexual partners should be diagnosed and treated as well. Because of the connection between certain strains of HPV and cervical cancer, infected women should also have yearly pap smears.

Expected results

As with many warts, genital warts may spontaneously disappear over time. Although the warts are not cancerous by themselves, HPV infection in women appears to increase the risk of later cervical cancer. Recurrence is common with all methods of treatment.

Prevention

The only reliable method of prevention is sexual abstinence. The use of condoms is often recommended; however, condoms protect only a limited area and should not be relied upon for complete protection from genital warts. Circumcision may sometimes prevent recurrence of the visible warts.

Resources

BOOKS

Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life Books, 1996.

Rakel, Robert E., ed. Conn's Current Therapy. Philadelphia: W. B. Saunders, 1998.

Tierney, Lawrence M., M.D., et al., eds. Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1998.

OTHER

"Genital warts." The Merck Manual Online. http://www.merck.com/pubs/mmanual/section13/chapter164/164l.htm.

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