| Warts are small, flesh-colored bumps on the skin. More commonly referred to as “kulugo”, some people believe that they are caused by frog’s urine when comes in contact with the skin. This is just a myth, and a lot of people are already aware that warts are actually caused by a virus, specifically the Human Papillomavirus (HPV). |
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| More common sites include the face and the neck but the genital area may also be affected; thus, the term Genital Warts. Yes, a person’s most private parts may also get the virus. |
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| Definition |
| Medically referred to as condyloma acuminata, genital warts are small, fleshcolored growths or tiny, cauliflower-like bumps located at the genital area. They may appear singly or in clusters. In males, the most common site is either the penis, near the anus, or the area between the penis and the scrotum. In females, they may grow either in the vaginal area or at the cervix. |
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| Genital warts are caused by the Human Papillomavirus (HPV) which is a common source of sexually transmitted infections (STI). Four types, namely, 6, 11, 16, and 18, are more closely associated with the condition. The Centers for Disease Control estimates that 6.2 million cases are reported each year. Predisposition to cancer is likely--cervical cancer for women and cancer of the penis in men. Thus, early detection is essential so as to prevent development of complications. |
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| The main mode of transmission is through oral, vaginal, or anal sex with someone who is infected. Genital warts may be so small that they are not visible to the naked eye. Furthermore, the virus has a very long incubation period, from four weeks to three months, and a person may already be infected without being aware of it. Not having a visible lesion does not necessarily mean that there is no infection. The condition is highly contagious, therefore, it is very important to be vigilant in order to avoid spreading the disease to other persons. |
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| Risk Factors |
1. Being sexually active at an early age |
2. Having multiple sexual partners |
3. Engaging in sexual intercourse with an infected person |
4. Stress and concomitant viral infections like HIV or herpes |
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| Diagnosis |
| Genital warts may be asymptomatic. In fact, the National Institute of Allergy and Infectious Diseases has reported that approximately 50% of infected women had no obvious signs and symptoms. If manifestations are present, the following are usually observed: |
1. Raised, soft, flesh-colored, painless bumps on the skin surrounding the genitals and anus which may develop into cauliflower-like bumps when left untreated. Color may vary, from gray to pink. Size is also variable. |
2. Increased moisture around the affected area. |
3. Itchiness around the area of the infection. |
4. Increased vaginal discharge. Some females even experience vaginal bleeding after sexual intercourse. |
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| Diagnosis is usually made during a physical examination. In cases with no obvious signs and symptoms, a health care practitioner may perform a test called aceto whitening. This is done by applying acetic acid (vinegar) to the affected area. Infected lesions are expected to turn white when this method is used. |
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| For females, colposcopy may be done to detect genital warts located in the vaginal canal or the cervix. A scope to magnify the area is used to confirm presence of the infection. A Pap smear is also recommended to diagnose the presence of this sexually transmitted disease. It is also a valuable initial screening for cancer of the cervix. |
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| If a child is diagnosed with this condition, he or she may be a victim of sexual abuse. |
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| Complications |
| Genital warts may be considered a silent disease. Many patients are unaware that they are infected simply because they don’t feel anything. Unfortunately, this sexually transmitted infection may pose several complications, which is why regular medical consultations are necessary, especially if risk factors are present. |
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| Cancer. Most genital warts are benign, but some strains of human papilloma viruses can lead to the big C. In females, cancer of the cervix is most commonly associated with HPV types 16 and 18. A Pap smear is a very important diagnostic tool in the early detection of this specific type of cancer. Other less common carcinomas involve the vulva, anus and the penis. |
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| Pregnancy and Childbirth. Women infected with vaginal warts may have difficulties in giving birth since the lesions may decrease the elasticity of the vagina or cause obstruction during delivery. This is especially true if the warts are large. |
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| In rare cases, infants born to infected mothers may develop respiratory papillomatosis or warts in the throat. This can cause difficulties in breathing or infant respiratory distress. |
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| Treatment |
| Some warts disappear without treatment. However, there is no way to predict whether they will vanish or stay and grow. Several over the counter medications are available for warts, but it is highly recommended that genital warts be managed by a doctor. This is because different kinds of warts are treated differently; thus, what may work for a wart on the face will not work for a wart on the genital area. |
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| Depending on the size and location of the genital warts, several therapeutic options may be offered by the doctor. |
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| Trichloroacetic acid (TCA) and bichloroacetic acid (BCA) are widely used to treat external genital warts. These caustic
agents physically destroy the warts. However, they can damage surrounding normal tissue when used excessively.
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| Topical preparations like imiquimod cream or podofilox solution/gel may be prescribed for lesions not exceeding 10 square centimetres in size. The former is a topically active immune enhancer while the latter is an antimitotic drug that destroys the warts. Irritation and redness are commonly observed after application. |
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| Removal has the advantage of getting rid of the warts within a single medical visit. Options include electrocautery or burning of the lesion, laser treatment, and surgical excision. Choice is dependent on the size, location, and even severity of the infection. |
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| A less frequently used method is injection of interferon, an immunostimulant, directly into the wart. This is not a primary modality since it is difficult to administer, requires frequent clinic visits and is associated with a high incidence of adverse reactions. |
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| An unfortunate fact in the treatment of genital warts or any type of warts is that therapy can make the lesion disappear without eliminating the virus. Thus, it is still possible that the warts will come back despite medical and/or surgical management. |
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| Prevention |
| Since the main route of getting the infection is through sexual intercourse, abstinence is therefore advised until it is sure that both partners are free from genital warts. Use of condoms is also recommended to prevent spread of the disease. Although this does not fully protect a person from contracting the infection since there might be areas not covered by the rubber, it is nonetheless advised to be used during sexual contact. Avoiding multiple sexual partners is also essential. This not only decreases the possibility of getting genital warts but also lessens the spread of other sexually transmitted infections, including HIV. |
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| Recently, a vaccine for prevention of genital warts was approved by the Food and Drug Administration. It is designed to combat HPV 16 and 18 which are regarded as high risk, cancercausing types. Thus, it not only prevents genital warts but also prevents cancer that may arise from this condition. However, this vaccine is only for females 9-26 years old. |
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| Regular medical check-up also proves beneficial. The likelihood of detecting the infection is increased when regular medical consults are done. For females, a Pap smear proves highly valuable in early detection of complications like cervical cancer. |
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| In any illness, it is said that prevention is far better than cure…and genital warts are definitely not an exception. |
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| SOURCES: |
www.cdc.gov/STD/treatment/2006/genital-warts  |
| www.nlm.nih.gov/medlineplus/genitalwarts |
| Kodner CM. Management of genital warts. Am Fam Physician. 2004; 70(12): 2335-42. |
| US Food and Drug Administration. FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus. Rockville, MD: National Press Office; June 8, 2006. P06-77. |