Genital Warts

Condyloma

Genital Warts are warts that develop on the skin and mucous membranes in the genital area. Also called condylomata acuminata, these warts or papillomas are usually spread by skin-to-skin contact during sexual intimacy.

Symptoms

Genital warts are typically flesh-coloured and soft to the touch, resembling tiny cauliflower florets. Often flat and small, they generally affect the tender, moist tissues of the genital area. In women, this means outside and inside the vagina, on the cervix (opening to the uterus), around the anus. In men, they tend to occur on the tip or the shaft of the penis, on the scrotum, and/or around the anus. Rarely, genital warts develop in the mouth or throat of a person who has had oral sex with an infected person.

Genital warts may itch or bleed and may be difficult to keep clean. Sometimes, depending on location and size, they can interfere with bowel movements and urination, or with sexual intimacy.

Genital warts usually appear from 1 to 6 months after exposure. They can, however, take much longer - even years - to appear.

Causes

Genital warts are caused by certain types of the human papillomaviruses (HPV).

More than 100 different HPVs have been identified and most of them are harmless. Some cause skin warts like the ones you see on hands or feet. More than 30 types of HPV are sprea d by genital, anal, or (rarely) oral sex, and some of them - especially types 6 and 11, - cause genital warts.

Genital HPVs are among the most common sexually transmitted infections (STI). Some are associated with cervical cancer and other genital cancers, but not HPV-6 and HPV-11, which are the types of HPV that generally cause genital warts. HPV-6 and HPV-11 are low-risk viruses and rarely develop into cancer.

Most people who have an HPV infection may never develop warts. They are, however, still able to pass HPV to their partners, who may or may not develop warts.

Diagnosis

If you notice unusual growths of any kind in your genital area, visit your doctor, whose experienced eyes will usually recognize what they are. If in doubt, your doctor may perform a biopsy.

Important: Do not try to diagnose your genital warts yourself; there are a variety of conditions that can look like genital warts and need to be treated differently. Go to your doctor or clinic for diagnosis and treatment.

Women without visible genital warts but who have genital HPV are often diagnosed during an HPV test or a Pap smear, the test used by gynecologists to check the health of the cervix. Sometimes the infection will go away on its own.

If you are diagnosed with HPV, with or without the presence of genital warts, make sure you are monitored by your health provider to keep track of any developments.

Treatment

So far there is no sure-fire cure for genital warts that works for everyone all the time. Current treatments can usually eradicate the warts themselves, but cannot destroy the virus (HPV) that causes them. Recurrences are possible following any treatment, especially if the person smokes cigarettes.

Important: Never use over-the-counter treatments on warts in the genital area.

The goal of treatment is to remove the visible genital warts. Thus the doctor treats the consequences (i.e., the wart) but not the cause (i.e. the virus). Removing the wart(s), however, does help reduce the risk of transmission. In time, many people eventually rid themselves of HPV and stop getting warts.

When deciding on the best treatment for you, your doctor will consider the size, number, and location of the warts, as well as convenience, adverse effects, any changes in the warts, and your preference.

Topical treatments that you can apply at home include:

• Imiquimod cream (e.g., Aldara): safe, effective, and easy to use on external genital warts; boosts the immune system locally.

Treatments that are currently being carried out in clinics or doctors' offices include:

• Application of trichloroacetic acid or bichloroacetic acid: the results of this popular treatment may be seen after just 1 or 2 treatments.
• Cryotherapy, which freezes off the warts with liquid nitrogen.
• Electrocautery, which burns off the warts with an electrical current.
• Laser therapy, which uses an intense light to destroy warts.

Don't hesitate to discuss the recommended treatment with your doctor or pharmacist, who will help clarify what's involved.

People at risk

As with other STIs, people who have numerous sexual partners, infected partners, or sexual partners who've had numerous sexual partners are most at risk - as are people whose immune systems have been weakened (such as people being treated for cancer or suffering from HIV-AIDS).

Rates of genital warts and human papillomavirus

The highest rates of genital warts are recorded among men and women aged 20 to 24, although sexually active people of any age can be infected. Women are more likely to have a genital HPV infection.

Prevention

The only way to guarantee complete protection from genital warts (or any other genital HPV) is to abstain from sexual contact. There are two other things you can do, however, which will reduce your risk of catching genital warts:

• Only have sex with one partner who only has sex with you.
• If you or your partner has genital warts, do not have sexual activity until the warts are removed.

While practising safe sex and using a condom can prevent the spread of many STIs, they don't necessarily in the case of genital warts, because the warts affect areas - scrotum, anus, perineum, vulva - that are not protected by condom use.

Important: the virus that causes genital warts is spread by skin-to-skin contact only. You cannot catch genital warts from toilet seats or from sharing baths or towels or eating utensils.

Vaccine

Vaccines against certain types of HPVs that are known to cause genital warts or cervical and anal cancers are available. These vaccines, known by the names Gardasil and Cervarix, can prevent HPV infection but are not a cure. Vaccination against HPV is optimal if it takes place before the onset of sexual activity but can also be initiated later in life. Ask your health professionnal to find out if vaccination is appropriate for you.

If you develop genital warts

You may feel ashamed, angry, and afraid. This is a normal reaction; many people react to having genital warts that way. The HPV virus doesn't discriminate: Some reports estimate that about 15 percent of the population has genital warts and 90 percent have one type of HPV or another (not necessarily a genital HPV).With time and the proper treatment, you can once again have a normal sexual life.

For more information:

• Sex & U