Genital warts in women

In the past, doctors attributed genital warts to syphilis or gonorrhea. However, now we know that they’re caused by HPV, or human papillomavirus. Specifically, types 6 and 11.

The key takeaways are:

• They’re not harmful themselves
• If you see new warts, especially ones that look like little bits of cauliflower, tell your doctor.
• They can be easily removed if you find them distressing.

The warts themselves affect approximately 1% of the sexually active population. Having unprotected sex with someone who has genital warts comes with a 75% chance of contracting the virus. Therefore this is high risk and you should use a condom and avoid any skin-to-skin contact with the warts.

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Some one in ten patients can develop warts that stay, due to their bodies failing to properly clear the infection. This can lead to cancers such as invasive carcinoma. Possibly even more concerning is the ultra rare chance of developing giant condyloma acuminatum — in layman’s terms, genital warts that are very big. These are when the warts have grown down into the underlying tissue, and can be quite distressing and potentially dangerous.

The reason why spotting genital warts quickly is important to women is that genital warts and HPV have a very strong link to cervical cancer. More than 99% of cervical cancer patients also have an HPV infection.

However, the warts themselves aren’t very harmful.

There are four types of genital warts to look out for

• Condylomata  acuminata (kon-die-low-mata ack-yew-min-ata), which look like little bits of cauliflower
• Papular warts, which look like acne
• Keratotic warts, which are “granny warts”, or the dark splotches you sometimes see on elderly people.
• Flat-topped papules, which have a different colour to the skin around them and are slightly raised.

If you spot “new” warts, you should go talk to your doctor.

Fortunately, there’s several therapy options for genital warts. These include

• Laser therapy
• Potassium hydroxide (aka potash lye) topical solution
• Cryotherapy (freezing off the warts)
• Imiquimod and podophyllotoxin, creams to put on yourself at home
• Surgery
• Hospital chemical treatments, like trichloroacetic acid

References

1. Winer RL, Koutsky LA: Genital Human Papillomavirus Infection  In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit J, Corey L, et al., editors. Sexually transmitted diseases. 4th ed. New York: McGraw-Hill Education; 2007
2. Lopaschuk CC. New approach to managing genital warts. Can Fam Physician. 2013;59(7):731-6.
3. Park IU, Introcaso C, Dunne EF. Human papillomavirus and genital warts: a review of the evidence for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis. 2015;61( Suppl 8):S849–855
4. Niazy F, Rostami K, Motabar AR. Giant Condyloma Acuminatum of Vulva Frustrating Treatment Challenge. World J Plast Surg. 2015;4(2):159-62.
5. Asadi N, Hemmati E, Namazi G, et al. A Comparative Study of Potassium Hydroxide versus CO2 Laser Vaporization in The Treatment of Female Genital Warts: A Controlled Clinical Trial. Int J Community Based Nurs Midwifery. 2016;4(3):274-82.
6. Yanofsky VR, Patel RV, Goldenberg G. Genital warts: a comprehensive review. J Clin Aesthet Dermatol. 2012;5(6):25-36.

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