I know for most this is a weird topic to talk about, some of us have never even heard of genital warts; the thought of even having warts on your genitals is…… PAINFUL!! But yes people, it exists and is caused by one of the most common sexually transmitted infections (STIs), HPV –Human Papillomavirus.

At least 70% of sexually active men and women will have a HPV infection in their lifetime but thanks to our immune system the majority of us will never even know they were infected!! Many might not have symptoms and the infection usually resolves itself without treatment; approximately 90% of HPV infections clear through the host’s immune system. The virus is transferred primarily through skin-to-skin contact. To date, over 100 types have been identified and more than 40 known HPVs   infect the genital tract. These types are transmitted through skin to skin contact during sexual activity, including vaginal, anal or oral sex. So where do genital warts come in?

There are two types of HPV:-

1) High Risk HPV types- Just like the name suggests, they are deadly. These types can lead to cancer, persistent infection with high risk HPV has been established as a necessary cause of cancer. They may cause abnormal change in the cell that can lead to various cancers such as anal, penile, vulvar, cervical, head and neck cancer.  An example is HPV types 16 and 18 which can cause cervical cancer.

2) Low risk HPV types-Do not cause cancer but can lead to other health problems such as genital warts, skin warts, Recurrent  Respiratory Papillamotosis ( RPP).RRP is a rare disorder characterized by recurrent wart-like growths (papillomas) in the upper respiratory tract.  Types 6 and 11 – which are linked to about 90% of genital warts, are the most common.

The types of HPV that cause cancer are not the same with the ones that cause warts.

The medical term for genital warts is condyloma acuminatum. They are highly infectious and approximately 65% of people who have sex with an infected partner will develop warts themselves. Diagnosis is generally based on symptoms and can be confirmed by biopsy (a medical test where they take a small amount of your tissue or sample of cells from your body)

Transmission- How is it spread?

Nearly all cases of genital warts are caused by HPV which is spread by having skin-to-skin contact with someone who’s infected, often during vaginal, anal and oral sex. Most of the time they are spread through vaginal and anal sex, it is rare (but not impossible) for genital warts to be passed on by oral sex.Genital warts can spread without penetrative sex as long as there is skin to skin contact. Transmission can happen even when you don’t have any visible warts or other symptoms, though that’s less common. It can take several weeks, months, or even years after you have sexual contact with someone who has genital warts for them to show up. So knowing when you contacted the infection and by whom (in some cases) might be challenging.

Another transmission route is from an infected mother to the baby during vaginal delivery.

Genital warts are different from warts you might get elsewhere on your body. So you can’t get genital warts by touching yourself (or a partner) with a skin wart that’s on your foot or hand. Also you can get the virus and never actually get warts, so you could be infected and not have any symptoms.

Symptoms of genital warts?

Genital warts show up on the skin around your genitals and anus. When I say genitals in the case of women the warts occur in or around the vulva, vagina, on the cervix or groin area. For men it can be on the penis, scrotum or groin area. The common characteristic symptom is a small bump or a group of bumps on these areas. The warts usually kind of look like little pieces of cauliflower. You can have just one wart or a bunch of them, and they can be big or small. They might be itchy, but most of the time they don’t hurt. Some people might experience itchiness around the area , skin burning sensation or bleeding.

We have to be careful not to assume all bumps are genital warts; it can be a mole, skin tag, pearly penile papule, hemorrhoid, or other skin condition, that’s why you should seek medical attention. My personal opinion is when it comes to conditions that involve down there; don’t do over the counter medication, if you can try and see a doctor. You never know, you might end up giving yourself burns in areas you would never even want to talk about.

Most people with HPV warts don’t have any symptoms besides the warts themselves.

Risk factors 

A risk factor is any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease. But having a risk factor or even several does not mean that you will get the disease. Genital risk factors are mainly behavioral based, meaning one’s lifestyle plays a huge role  in acquisition of this condition. To name a few:-

a) Multiple sexual partners

b) Unprotected sex

c) Alcohol and drug abuse

Diagnosis-How do I know I have genital warts?

Genital warts are diagnosed by an examination; a biopsy can be done. You may also need to be examined internally (in the vagina), or around or inside the anal area, depending on where the warts are.

Treatment 

There is no cure for HPV infection but there are treatments available for genital warts. Some people choose not to treat genital warts. If left untreated, genital warts may go away, stay the same, or grow in size and number. They will not progress to be cancerous.. The current treatment options are largely centered upon removal of the warts rather than elimination of the underlying viral infection. Choice of treatment can be dependent on many factors, including size, number, and location of warts; patient preference; patient compliance; cost; side-effect profile; and provider experience and preference

External genital warts are usually treated one in two ways:

1) Topical treatments: applied directly to the warts, usually in the form of a cream, liquid, or lotion. This is usually used on soft warts

2) Removal of the warts: can be done in various ways, usually used for hard warts. They include:-

• Cryotherapy

Liquid nitrogen is used to rapidly freeze the affected area.

• Surgical excision.

 The warts are surgically removed while the patient is under a local anesthetic.

• Electrocautery

Involves using electric current to burn the warts off the skin with an electrical device. A person may require a local or general anesthetic..

• Laser surgery

In this procedure, a specialist uses a powerful beam of light to destroy the warts.

Treatments for Internal Warts

If you have vaginal or cervical warts, the recommended treatments are:

• Surgical removal

• Cryotherapy /liquid nitrogen

• Acid solution

Most common warts can be treated by topical products but it’s advisable to seek medical attention when one has genital warts.

Prevention

1) Vaccination

Was developed primarily to prevent cervical cancer but now there are HPV vaccines available for most of the strains of HPV that cause genital warts and cancer. These vaccines are most effective when administered before a person becomes sexually active and are recommended for both boys and girls. HPV vaccine is recommended for routine vaccination at age 11 or 12 years but vaccination can be started at age 9. There are two commercial vaccines that can protect one from HPV type 6 and 11 (they are linked to about 90% of genital warts)

a) Gardasil®       b) Gardasil®9

2) Practice  safe sex

Can include practices such as:-

a) Limit your number of sex partners. Your risk of acquiring STIs goes up with the number of partners you have.

b) Use condoms the correct way every time you have sex. This can lower your chances of getting  all STIs, including HPV. However, HPV can infect areas that are not covered by a condom, so condoms may not give full protection against getting HPV.

3) Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

4) Avoid vaginal douching- Douching is washing or cleaning out the vagina with water or other mixtures of fluids with the aim of getting  rid of vaginal odor or other vaginal problems like discharge, pain, itching, or burning. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs; young women who regularly douche have 84% increased risk of STIs.

The above prevention steps work best when used together. No single step can protect you from every single type of STI or genital warts.

It is crucial that we talk about genital warts especially in this era we are living in, with more young people becoming sexually active at a younger age. This should be a topic of discussion in sex education. The interesting bit is that there are more discoveries being made in research and some studies show possible  non-sexual modes of HPV infection and transmission via fomites such as sex toys. Let’s be on the loop as it seems like there is still more to learn, for the time being let’s try and stay genital warts free.