Genital Warts

Genital warts are a type of sexually transmitted disease caused by the HPV virus. There are approximately 40 different strains of the HPV virus that can cause genital warts and if you have unprotected sex with someone with genital warts, there is a 66% chance that you will also get infected. HPV is passed on from both skin-to-skin contact and from the exchange of sexual fluids. Therefore, condoms do not completely protect you from genital warts and you should be aware of this to avoid being infected or infecting anyone else. If you do become infected, there is no cure for genital warts, however the warts can be removed and you can use immune-modifying creams and lotions to help prevent more warts from appearing.

There are approximately 40 types of HPV that can cause genital warts [11], but genital warts are primarily caused by HPV types 6 and 11. HPV types 16 and 18 are primarily associated with cervical lesions known as dysplasia or squamous intraepithelial lesions.

HPV is contracted through sexual contact with an infected partner. Skin-to-skin contact and the exchange of genital fluids transmits the virus from one person to another. Condoms can be protective against the transmission of HPV through sexual fluids, but they do not always protect against HPV which can be transmitted via skin-to-skin contact.

The signs and symptoms of genital warts are:

• Small flesh-coloured or grayish bumps on the skin around the genitals
• A cluster of several warts together
• Pain, itching or discomfort during sex
• Bleeding during sex

In women, genital warts can be found on the:

• Vulva
• Walls of the vagina
• Cervix
• Perineum (the area between the vulva and the anus)
• Anus
• Inside the anal canal
• Mouth or throat (following anal sex with an infected person)

If the walls appear internally, you may not notice them. They can be picked up by a HPV test, during a cervical screening (pap smear) or if you have symptoms such as pain, discomfort or bleeding during sex.

In men, genital warts can be found on the:

• Head of the penis
• Shaft of the penis
• Scrotum
• Anus
• Anal canal
• Mouth or throat (following anal sex with an infected person)

Genital warts is 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 a 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).

Tissue biopsy

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

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 [12].

Pap Testing

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.

Risk factors for genital warts:

• Younger age
• Having more sexual partners
• Not using condoms
• Previous infection with chlaymdia, herpes or trachomatis https://www.ncbi.nlm.nih.gov/pubmed/10616354

Risk factors for cervical cancer:

• HPV infection - HPV alone does not always lead to cancer, but other factors, such as smoking, can increase your risk.
• Starting to have sex at a younger age
• Having more sexual partners
• Having anal sex (increases risk for both men and women)
• Using tobacco products, especially cigarettes
• Taking birth control pills for more than 5 years - it is not known whether the contraceptive pills themselves leads to the increased risk, or if using birth control pills also correlates with not using condoms and an increased number of sexual partners, which would consequently increase your risk.
• Chewing Indian betel quid - this is related to oral cancer which is associated with HPV infection.  
• Having high-risk precancerous lesions on the cervix

There is no cure for genital warts or HPV [13], most treatments focus on reducing your symptoms. If you have a cancerous or precancerous condition caused by HPV, treatments or surgery may be used to cure that condition or to prevent progression.

Aldara Cream
Aldara cream is a popular treatment for genital warts. It works by boosting your immune system’s response to the warts, to help your body to get rid of them.

Wart Removal

Warts can also be frozen off (cryotherapy) or removed with lasers or surgery.

How does smoking relate to cervical cancer?

Nicotine and other carcinogens accumulate in the cervical mucus in women who smoke. This puts smokers at higher risk of their genital warts progressing to cancer, especially cervical cancer.

What is the HPV vaccine?

The HPV vaccine protects against 90% of the strains of HPV that cause genital warts. Two types of HPV Vaccines are recommended for both girls and boys in adolescence to prevent the most common (6,11) and high-risk types of HPV (16, 18).