Published on Jan 05, 2017 and last reviewed on Mar 09, 2023 - 5 min read
Abstract
Current evidence suggests that over 50% of sexually active adults (15 to 25 years of age) have been infected with one or more human papillomavirus (HPV) infections. The underlying HPV infection may increase the evidence and prevalence of genital warts. Read this article to know more.
Introduction:
Condyloma, a Greek word with the meaning of round tumor, has been recognized as a distinct entity since ancient times. Mucosal HPV infections are regarded to be the most common sexually transmitted infections (STIs). It can occur in the anogenital region, oral mucosa, or skin. HPV present in the birth canal can be transmitted to a newborn during vaginal delivery, and it may persist for years in a dormant state and become infectious intermittently. Most commonly, people of the young and sexually active age group are affected.
The causative organism is the human papillomavirus. The most common subtypes are 6, 11, 16, and 18. Less common subtypes are 31, 33, 35, 39, and 51 to 59.
Genital HPV infectionsare transmitted chiefly through sexual contact such as genital to genital, oral to genital, or genital to anal, but digital and perinatal transmission can also occur. The incubation period is several weeks to months.
The risk of developing genital HPV infection increases with,
Increased number of sex partners.
History of chlamydia and gonorrhea.
Indulging in sex at an early age.
The most common sites affected are the frenulum, coronal sulcus, the inner surface of the prepuce, urethral meatus, cervix, vagina, and vulva. It can also affect the anal region of homosexuals. It is usually asymptomatic, single or multiple, soft, pink or whitish, sessile tumor (immobile) with fine papillary projections. It may bleed on friction or slight trauma. These lesions may either subside, progress, or prevail in the same condition. There may be abnormal discharge, and pruritus may also be present. Some experience bleeding with sex and during pregnancy.
Two-third of the population having sex with sex partners having HPV-induced genital warts are known to acquire the infection within three months of exposure.
Small papular.
Cauliflower like floret.
Sessile.
Flat-topped papules or plaques.
Giant condyloma (Buschke-Lowenstein tumor).
It may enlarge to an enormous size and hamper the physiological function.
Sometimes, there will be bleeding, ulceration, and secondary infection.
Local malignancy (oncogenic - type 16 and 18) is associated with oncogenic atypia and less frequently with invasive carcinoma in HIV.
Anogenital warts flourish in pregnancy. The size, as well as the number, will increase, maybe due to the influence of increased hormone levels, vascularity, and immune deficiency.
Genital warts in children may result from the perinatal route (mother to newborn during delivery) or autoinoculation from finger warts and non-sexual transmission from a family member or through sexual abuse. Genital warts present at delivery are associated with a risk of juvenile laryngeal papilloma.
Clinical examination is sufficient to diagnose most of the external genital warts. Sometimes to visualize warts clearly, a specialized instrument called a colposcopy can also be used, which helps view warts in a magnified version. Laboratory examinations are also used in a few cases. They are as follows:
Acetowhite test for subclinical genital HPV (5% acetic acid for 5 minutes).
Pap smear.
Skin biopsy for koilocytes, mature squamous cells with a large clear perinuclear zone, and smudged nuclei.
Detection of HPV DNA.
Serology test.
In people with HPV genital infection, additional tests to look for the presence of other sexually transmitted infections like syphilis, gonorrhea, chlamydia, HIV/AIDS, etc., are also done.
Sebaceous cysts.
Buschke-Lowenstein tumor.
Lichen planus.
Condyloma lata.
Spontaneous regression may happen in 10% to 15% cases.
20% Podophyllin (a resin extracted from Podophyllum peltatum) in alcohol or tincture Benzoin is applied to the lesion with an applicator, covering the surrounding area with petroleum jelly. It is left on the surface for 4 to 6 hours and then cleaned. It may be repeated every third day till lesions are completely cured. This is contraindicated in pregnancy as it can lead to fetal death and abortion.
Trichloroacetic acid of 50% to 70% can be used.
Podophyllotoxin cream 0.5% solution or 0.15% cream twice daily for three days followed by a four days gap. This has to be given for three cycles.
5% 5-Fluorouracil cream applied locally to the lesion for three to seven days.
Immunomodulator: Treatment with 5% Imiquimod cream three times per week every other night for a maximum of 16 weeks will help.
Surgical methods such as cauterization, excision under local anesthesia, cryocautery or carbon dioxide laser, electrodessication, and curettage are also beneficial.
Prophylactic and therapeutic vaccines are available. Gardasil and Cervarix three doses over six months.
Counseling:
Clear information and counseling must be given to accomplish proper management. Female individuals, who have an HPV infection, should get counseling about regular participation in cervical cytology screening programs. He or she should be encouraged to use barrier protection with new sexual contacts until successful treatment has been completed.
20 to 30% of the time, genital warts due to HPV infection can recur even after successful treatment. They also have the ability to become cancerous. Hence follow up with your treating doctor is necessary. Keep a close look on your affected regions and look for signs of bleeding, pigmentation, and ulceration, which indicate malignant transformation.
Conclusion:
If you are suspected or confirmed with HPV infection, inform your sexual partners regarding it and refrain from having sex until you successfully get treated. Otherwise, it unnecessarily gets transmitted to your partners. Condom usage can prevent the transmission of such sexually transmitted diseases; hence if you plan to have sex other than for getting pregnant, condoms are worth using.
Human Papillomavirus (HPV) infections cause genital warts, and most of the HPV infections will go away on their own, from a few months to years. Even when genital warts disappear on their own without treatment, the virus will still be present. But, when left untreated, they grow large in big clusters.
Genital warts look like,
- Skin-colored whitish bumps.
- Little pieces of cauliflower.
- Can have just one wart or a bunch of them.
- It can be big or small.
They can be itchy, but mostly, they do not hurt and show up on the vulva, vagina, cervix, penis, scrotum, or anus.
Genital warts can be cured and removed, but the virus, which is the causative factor for genital warts, cannot be cured. Prevention is better than cure, so prevent genital warts by using condoms and dental dams for sex.
Genital warts can be mistaken for,
- Pimples.
- Chickenpox.
- Molluscum contagiosum.
- Even skin cancer.
It can be a single wart or a cluster of warts caused by the human papillomavirus (HPV), a common sexually transmitted infection (STI).
Genital warts can be examined by,
- Biopsy - A sample of the wart is taken to detect genital warts.
- Blood sample - A blood sample is drawn to test for HIV and syphilis.
Depending on the results, the patient will be referred to a specialist for further treatment.
Most people infected with Human Papillomavirus (HPV) do not show symptoms. But when they start showing symptoms, they are mild so that they do not know they are infected. It usually starts with the symptoms such as,
- Pain.
- Bleeding.
- Itching.
If the person experiences the symptoms, they will acquire the infection within two to three months, but if they do not show up the infection after having symptoms for 2 months to three years, then genital warts will appear after only active infection, but there is a possibility of spreading the virus even if warts do not appear.
When genital warts are untreated, they can spread to other areas of the body and increase in size and number. It should be soon evaluated by the doctor as genital warts do not go away on their own.
Warts occur when the virus comes in contact with the skin, and they develop on broken skin as the virus can enter into the top layer of cuts or scratched skin due to,
- Picked hangnails.
- Nicked by shaving.
Increased risk of warts are a sign of weakened immune systems in some people. People who have weakened immune systems like the human immunodeficiency virus (HIV) are at increased risk of warts.
In order to prevent warts from spreading:
- Do not scratch warts.
- Keep warts dry.
- Avoid shaving on your warts.
- Wash hands regularly.
- Try to disinfect the wounds.
- Cover warts.
- Do not share towels with other people.
- Do not touch other people's warts.
Condyloma acuminata is the medical term for genital warts and is commonly associated with low-risk Human Papillomavirus (HPV) 6 and 11. They cause about 90% of genital warts, and they rarely develop into cancer. Warts show up after months of having sex with the infected partner.
Human Papilloma Virus and its isotypes cause condyloma acuminata. They usually do not cause cancer, are not precancerous and do not progress to form invasive carcinomas.
Last reviewed at:
09 Mar 2023 - 5 min read
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