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Condyloma acuminatum

Genital warts (or condyloma, or condylomata acuminata) is a very contagious sexually transmitted disease. Caused by some variants of the Human papillomavirus, typically HPV 6 and HPV 11, it is spread during oral, genital, or anal sex with an infected partner. About two-thirds of people who have a single sexual contact with a partner with genital warts will develop warts, usually within three months of contact. more...

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In women the warts occur on the outside and inside of the vagina, on the opening (cervix) to the womb (uterus), or around the anus. While genital warts are approximately as prevalent in men, the symptoms of the disease may be less obvious. When present, they usually are seen on the tip of the penis. They also may be found on the shaft of the penis, on the scrotum, or around the anus. Rarely, genital warts also can develop in the mouth or throat of a person who has had oral sex with an infected person.

Genital warts often occur in clusters and can be very tiny or can spread into large masses in the genital or anal area.

Treatment

Genital warts often disappear even without treatment. In other cases, they eventually may develop a fleshy, small raised growth that looks like cauliflower. There is no way to predict whether the warts will grow or disappear. Therefore, if you suspect you have genital warts, you should be examined and treated, if necessary.

Depending on factors such as the size and location of the genital warts, a doctor will offer you one of several ways to treat them.

Imiquimod, (Aldara®) a topical immune response cream which you can apply to the affected area
A 20 percent podophyllin anti-mitotic solution, which you can apply to the affected area and later wash off
A 0.5 percent podofilox solution, applied to the affected area but shouldn’t be washed off
A 5 percent 5-fluorouracil cream
Trichloroacetic acid (TCA)
pulsed dye laser
liquid nitrogen cryosurgery

If you are pregnant, you should not use podophyllin or podofilox because they are absorbed by the skin and may cause birth defects in your baby. In addition, you should not use 5-fluorouracil cream if you are expecting.

If you have small warts, the doctor can remove them by freezing (cryosurgery), burning (electrocautery), or laser treatment. Occasionally, the doctor will have to use surgery to remove large warts that have not responded to other treatment.

Some doctors use the antiviral drug Alpha Interferon, which they inject directly into the warts, to treat warts that have returned after removal by traditional means. The drug is expensive, however, and does not reduce the rate that the genital warts return.

Although treatments can get rid of the warts, they do not get rid of the HPV virus, so warts can recur after treatment. However, the body's immune system typically clears the virus anywhere from 6 months to a year. There is even some suggestion that effective treatment of the wart may aid the body's immune response. An effective HPV vaccine is currently undergoing a phase III FDA trial and appears nearly 100% effective against the most common types.

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What you should know about genital warts
From American Family Physician, 12/15/04

What are genital warts?

Genital warts are small, skin-colored bumps that look like tiny cauliflowers. They can be on or inside the genitals. The genital area includes the vagina, vulva, cervix, urethra, penis, scrotum, and anus. These warts are not the same as warts you may find on other parts of your body.

Genital warts are caused by a virus called human papillomavirus (say: "pap-uh-lo-ma-vie-russ," or HPV). There are many kinds of HPV. Not all of them cause genital warts. People usually get genital warts by having sexual contact with someone who has them.

Who gets genital warts?

HPV infections are common, but most people do not know they have the virus. Studies have shown that up to three fourths of Americans between 15 and 49 years of age have been infected with HPV. But many people who have the infection do not get warts.

You can get HPV infection by having oral, vaginal, or anal sex with someone who is infected. HPV can live inside the body for weeks, months, or even years before warts appear.

How can I tell if I have genital warts?

Talk to your doctor if you see small, skin-colored bumps on your genital area. Your doctor will check you and decide if the bumps are warts. Genital warts usually do not hurt.

Sometimes an abnormal Pap smear is the first sign that a woman has an HPV infection. Pap smear is a simple test in which your doctor collects cells from the cervix. The cervix is part of your uterus (womb).

How are genital warts treated?

Genital warts must be treated by your doctor. Do not try to treat the warts yourself. Remember, genital warts are not the same as warts you may get on your hands and feet. Your genital area is sensitive, and you need special treatment that only a doctor can give you.

There are many ways to treat genital warts. Your doctor might freeze the warts with chemicals. Some chemicals make the area blister and cause the wart to fall off. This can hurt. Other chemicals can dissolve the warts. Your doctor might want you to use a special cream get rid of the warts.

Another way to remove genital warts is to burn them. Your doctor will numb the area before using heat on the warts. Your doctor also might use a laser to take off genital warts. This method is good for areas that are hard to reach, such as the cervix. Laser therapy also is good you have a lot of warts.

Even after the wart is taken off, HPV stays inside your body. This means warts can come back, and you might need to have them taken off again.

What if I do not get my genital warts treated?

Genital warts can grow if they are not treated. If this happens, warts will be harder to take off. You also risk infecting others if you have oral, vaginal, or anal sex and do not get treated for warts.

Certain kinds of HPV can cause abnormal cells to grow in the cervix. These cells can sometimes turn into cancer if they are not treated. Some kinds of HPV can cause cancer of the vulva, vagina, anus, and penis. But these kinds of cancer are much less common than cervical cancer.

What about HPV and cancer?

Certain kinds of HPV may increase a woman's risk of getting cervical cancer. Other things that increase this risk include having another sexually transmitted disease, having many different sex partners, having sex at an early age, or smoking. Pap smears can find changes of the cervix so that they can be treated early. This lowers the risk of getting cancer. Women should ask their doctor how often they should have Pap smears. HPV infection increases men's risk of getting cancer of the penis or anus.

What can I do to keep from getting genital warts?

The only sure way to prevent genital warts is to not have sex. If you are sexually active, having sex with only one person who has sex with only you also will lower your risk of getting genital warts. Use a condom every time you have sex to lower your risk.

If your doctor tells you that you have genital warts, your sex partner should be checked, too. Even if your partner does not have warts, he or she still may be infected with HPV.

Where can I get more information?

* Your doctor

* National Sexually Transmitted Disease Hotline Telephone: 1-800-277-8922 and 1-800-342-2437

* Centers for Disease Control and Prevention Web site: http://www.cdc.gov/std/HPV/STDFact-HPV.htm

* American Social Health Association Web site: http://www.ashastd.org

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