Genital Warts - Human Papilloma Virus

Genital warts otherwise known as Venereal warts or Condylomas are soft eruptions on the skin and mucosal regions of the anogenital region. Genital warts are basically papillary lesions caused by Human Papilloma Virus, which appear as skin or grey coloured growths that when colonize, look like a cauliflower.

These warts are common in men and women specially between the ages of 17 and 35 years. As the virus is highly contagious, even a single sexual contact with an infected person is a great risk. Of the many sexually Transmitted Diseases (STDs), genital warts happen to be the most common. Also, a person with genital warts is likely to have another Sexually Transmitted Disease along. About 20% of the population with genital warts is also diagnosed with other STDs. Genital warts appear as first symptoms of acquiring the infection usually within three months from the time of sexual contact. Use of birth control pills by women and subsequent sexual acts without barrier protection, sex with multiple partners and early age sex, seems to be the indirect causative factor for the spread of genital warts.

Image Credit: inviTRA

Image Source – What is Human Papilloma Virus?

Causes and Transmission of Genital Warts

Vaginal/Anal sex and sharing of sex toys are the common ways of spreading genital warts from person to person. Penetrative sex, like in sexual intercourse is not strictly the way the infection is spread. Even skin to skin contact of the genital regions of sexual partners can spread the virus from one to another.

Genital warts are caused by Human Papilloma Virus (HPV) that infect the genital organs. There are over 100 HPV strains out of which 40 are identified as affecting genital organs and specific HPV strains 6 and 11 cause genital warts. The infected partner transfers the HPV to the healthy partner through Vaginal, Anal or Oral sexual contact. Genital regions exposed to injury during sexual contact are prone for HPV warts.

Fine exfoliating flakes of HPV warts from the infected partner carry the virus which gets in to the blood stream of the healthy partner through miniscule abrasions in the mucosa of anogenital areas caused by sexual activity. Once infected, the virus has a dormant period widely ranging from few months to a year or so. The HPV in the blood changes the natural process of tissue growth in genital regions resulting in manifestation of genital warts. Genital warts are not symptomatic in many HPV infected people. People with weakened immune system are more symptomatic of HPV and genital warts

How Genital Warts appear / look in Men?

Genital warts appear on the urethra, penis, scrotum and rectal areas in men. More often, they are seen on the head of the penis and foreskin as compared to the penile shaft, scrotum or the anal area. The warts can be either smooth, soft, raised masses or rough, finger like projections. Some others may look pearly, cauliflower-like or rugged with a mild dark surface. The skin surface is usually raised, but some warts may have flat surfaces. Some warts may be hidden by hair or in the inner folds of the uncircumcised foreskin of the penis. Though most genital warts are painless, they may cause discomfort depending on their location, size, itchiness, while urinating or may splash urine stream.

1. The wart may be as small as one millimeter or several square centimeters when many warts merge together.
2. Condylomas are often painless bumps with itching and discharge.
3. Rarely, initial problems come up only with either bleeding or urinary obstruction when the wart presents in the penile opening.
4. It is common to see genital warts in more than one anogenital areas

Complications caused by HPV Infection

1. Injured warts may need medical attention when bleeding cannot be controlled with direct pressure.
2. Warts may obstruct the urethral opening and not allow urination.
3. Though cancer of the genitals are rare in men, some of the types of HPV associated with genital cancers can lead to cancer of the anus or penis, especially in men with a healthy immune system. Most cancers that are found in the back of the throat, base of the tongue and in the tonsils are HPV related. In fact, these are the most common HPV-related cancers found in men.
4. Condylomas may get infected and discharge with unpleasant odour.
5. While visible genital warts can be controlled or removed, HPV still proliferates in the skin cells. There may be several recurrent outbreaks in due course.
6. Often interferes with sexual activity
7. Causes psychological distress

Treatment of Genital Warts

Genital warts that do not interfere with daily activities and are not increasingly becoming uncomfortable, may not need treatment. But, if infected wartscause itching, burning and pain or if visible warts are causing emotional distress, treatment can help overcome an outbreak alongside a regular systemic antiviral therapy. However, the lesions are likely to come back after treatment. There is no treatment to kill the HPV itself. If there is a sign of genital warts, see a health-care professional and discuss treatment options to avoid possible complications. Advanced warts that bleed or obstruct penile/anal opening need to be treated on an emergency.

Treatment for genital warts are usually only to relieve itchy, secreting symptoms or to minimize their appearance. However, genital warts are not safe to, be cured with over-the-counter (OTC) wart removers or treatments. These medications are not intended for use in the moist, mucosal tissues of the genital area. Using over-the-counter or unlabelled medications on genital warts can cause even more pain and irritation. The doctor may prescribe topical wart treatments in the form of creams/ointments that either appears to boost the immune system’s ability to fight genital warts or destroys warts chemically. Injections of specific drugs in to the areas with warts to destroy them may also be considered.

If visible warts do not disappear for long, if the warts are too large or if warts do not respond to medications, surgical removal may be necessary. Warts may be removed through:

1. Electrocautery– Procedure involves burning off warts with electric currents.
2. Cryosurgery– Liquid Nitrogen may be used for freezing of warts – works by causing a blister to form around the wart. As the skin heals, the lesions slough off, allowing new skin to appear.
3. Laser treatments – This approach uses an intense beam of light to destroy warts and is usually very effective for treating very extensive and difficult warts.
4. Surgical excision – Special tools such as scalpel, radio knife etcare used to manually cut off warts under anaesthesia.

These treatments do not get rid of the HPV infection. A person who has been treated can still spread the infection, even if the warts are no longer visible. It is important to discuss with a health care specialist, preferably in venereal diseases or in sexology to discuss the best treatment option suitable.

As genital warts are caused by transmission of HPV, managing symptoms of HPV is important to avoid transmitting the virus to others. In addition, it is important to discuss this with the sexual partner. This can help protect the partner from also getting an HPV infection and genital warts. The safest and only measure to avoid spread of HPV and genital warts is to practice condom protected sex other than being celibate which means, not having sex. HPV vaccines for young men and women before they engage in active sex is a welcome measure to curtail the spread of HPV infection and symptomatic genital warts