Genital warts are generally diagnosed by a physical examination of the warts, but in some cases, a biopsy or acetic acid test may be done (see below for details). If the warts are inside the vagina, you may not notice them, unless you experience pain, discomfort or bleeding during sex. Internal warts may be picked up during a pap smear or following an HPV test. If the warts are found on the cervix during a pap smear, a colposcopy (endoscopic camera inside the vagina) will be done to assess the extent of the disease and to take a biopsy, which can be used to check for cervical cancer. More details of specific testing methods used to diagnose genital warts are outlined below:
Acetic Acid Test
The acetic acid (vinegar is acetic acid) test makes the warts more visible and highlights the difference between normal and abnormal tissue. The test involves applying a 3-5% acetic acid–moistened gauze or cotton pad for 5-10 minutes on the areas suspected on the penis, cervix, labia, or perianal area. Areas with warts will temporarily ‘light up’ with acetic acid and any areas with more serious disease (cancer or precancerous lesions), will temporarily turn white (acetowhite).
A tissue biopsy of the warts may be done if the following situations apply:
- Women with a history of precancer of the vulvar
- Postmenopausal women
- When treatment fails
- When the lesions are difficult to identify without a microscope
HPV testing can let you know if you have been infected with the HPV virus. If you find that you are positive for HPV, you should get investigated for abnormalities of the cervix (including precancerous and cancerous cells) and genital warts. HPV testing can be done at home via a home test kit, or it can be done during a pap smear (cervical screening). Compared to pap smears, home test kits are 3.4 times better at detecting high risk or precancerous cervical cells and 4.2 times better at detecting invasive cancers.
Pap tests also known as smear tests or cervical screening, take a sample of the cells of the cervix. Pap tests do not look for genital warts specifically, but they are used to detect precancerous or cancerous lesions of the cervix which, like genital warts, can be caused by HPV. It is recommended that women should start having pap tests at the age of 21 and then they should have subsequent tests every 3 years until the age of 30. After this, women only need to have a pap test every 5 years, but it is recommended that you also get tested for HPV at the same time.