Introduction
Urethral warts are one of the common sexually transmitted diseases. It is caused by human papillomavirus types 6 and 11. Type 6 and 11 human papillomaviruses do not cause cancer. However, they can spread by skin contact, mostly during sexual intercourse. They present as clusters or separately in the genital or anal area. Treatment involves getting rid of urethral warts, but individuals can still transmit the human papillomavirus. Therefore, it is paramount to practice safe sex.
What Are Urethral Warts?
Urethral warts are sexually transmitted diseases caused by the human papillomavirus. Urethral warts are infectious and affect the rectal or genital area. Urethral warts are also called condyloma.
Urethral warts are seen in the following:
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The area between the skin and thighs (groin).
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Anus (inside or outside).
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Mouth, lips, tongue, or throat.
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Scrotum and penis.
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Vagina (involves the inside of the vagina), vaginal lips (labia majora and labia minora), vulva, and cervix.
What Is the Etiology of Urethral Warts?
Urethral warts are caused by the human papillomavirus, transmitted primarily through penetrative sexual intercourse. Urethral warts start to fade after four months and have a high recurrence rate even after therapy. Recurrence is affected by the following factors:
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Immunity status of the individual.
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General health.
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History of human papillomavirus vaccination.
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Certain human papillomavirus strains.
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Frequent sexual intercourse with an infected partner.
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Use of condoms.
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Viral load.
Genital or anal warts signify sexual abuse and can be transmitted during birth. Smoking increases the chances of getting urethral warts. Urethral warts develop within eight months of contact with an affected individual. Human papillomavirus is transmissible even during the latent period (the interval between infection and appearance of symptoms).
Are Urethral Warts Common?
Urethral warts, in many cases, are seen in the late teens and twenties. Human papillomavirus infections have a prevalence rate of 10 to 20 percent. Treatment resolves urethral warts but not the human papillomavirus infection. Studies conducted by authors have suggested that human papillomavirus may remain in the body for a lifetime. Human papillomavirus is the leading cause of cervical cancer, anal cancer, and vulvar cancer. Factors responsible for the persistence of human papillomavirus:
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Age.
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Immunosuppression.
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Concurrent infections with other human papillomaviruses.
CDC recommends human papillomavirus vaccination for adults between the ages of eleven to forty-five and may be started as early as nine years.
What Are the Symptoms of Urethral Warts?
The symptoms involve:
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Burning sensation.
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Discomfort.
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Itching or irritation of the genitals.
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Bleeding, which is usually mild.
Presentation:
Urethral warts appear as skin-colored (or darker), rough growths. They occur in clusters or separately, found in the genital or anal area, as small or large masses. They can be bumpy, cauliflower-like, or flat in texture. Urethral warts are painless.
What Are the Diagnostic Tests for Urethral Warts?
The tests performed are:
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Pelvic Exam: A Pap test may be performed as a part of the pelvic examination. The physician may also opt for a colposcopy to examine the cervix and the vagina. In addition, a pelvic exam helps in assessing the cervical changes caused due to urethral warts.
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Blood Tests: Done to check for other sexually transmitted infections, which are often seen in association with urethral warts. They include syphilis, gonorrhea, and chlamydia.
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Anal Exam: An anoscope is used to examine the anus and look for urethral warts.
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Biopsy: A biopsy may be taken when in doubt about the diagnosis.
What Is the Differential Diagnosis of Urethral Warts?
The differential diagnosis involves:
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Familial benign pemphigus.
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Condyloma lata of secondary syphilis.
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Herpes simplex infection.
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Benign nevi.
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Vulvar neurofibromatosis.
What Are the Complications of Urethral Warts?
The complications involve:
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Local disfigurement.
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Malignant transformation.
What Is the Treatment and Management of Urethral Warts?
There is no cure for human papillomavirus infection yet. Urethral warts can be resolved, but the affected individuals can still transmit the human papillomavirus infection. Therefore, surgery is preferred to treat urethral meatus warts, which may cause depigmentation, itching, pain, and scarring.
Topical Agents: They are very effective, less traumatic, and simple to use when compared to surgical modalities.
Podophyllotoxin: A Solution of 0.15 and 0.5 percent is applied in gel or cream and is not washed off. Podofilox is an antimitotic drug that is considered safer than Podophyllotoxin. Its mechanism of action is by the binding of microtubular subunits. The gel form is easier to use because of its consistency. Demerits of the gel are itching, pain, localized burning, and inflammation. Podophyllin has a high level of mutagens; hence it is no longer recommended. It is contraindicated during pregnancy.
Imiquimod: This topical cream has side effects such as fungal infections and flu-like symptoms. It works on increasing cytokines and enhancing the immune response. Five percent imiquimod gel is applied three times a week. Imiquimod 3.75 percent is equally effective with lesser side effects such as itching, pain, burning, and inflammation. Recurrence rates are lower when compared to Podophyllin therapy.
Sinecatechins: This is an ointment extracted from green tea. Sinecatechins have a higher clearance rate than Podophyllotoxin and Imimiquimod. In addition, 15% of sinecatechins have immunostimulatory, antiproliferative, and antitumor properties and mechanisms for reducing human papillomavirus gene products E7 and E6. Side effects of sinecatechins include pain, redness, and inflammation.
Isotretinoin: Commonly used for the treatment of acne. It reduces sebum, is anti-inflammatory, shrinks sebaceous glands, and provides antibacterial effects. In addition, it is effective in treating urethral warts in immunocompromised individuals with extensive condyloma or lesions resistant to initial therapy. The preferred dosage is 1.5 to 1 mg per kg per day. It is contraindicated during pregnancy as it may cause severe congenital disabilities. Isotretinoin has side effects such as chapped lips, dry skin, frequent nosebleeds, dry eyes, dry mouth, and sun sensitivity. Rare side effects include night blindness, hair thinning, arthralgias, muscle aches, rashes, stomach problems, and high cholesterol levels.
Surgical Removal:
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Simply removing warts under local anesthesia.
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Liquid nitrogen cryosurgery ablation.
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Electro cauterisation.
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Laser vaporization.
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Photodynamic therapy.
Patient Education:
Vaccination is proven effective for human papillomavirus types 6, 11, 16, and 18. However, vaccines are a preventive measure and not therapeutic.
Conclusion:
Urethral warts are sexually transmitted diseases caused by the human papillomavirus. Treatment resolves urethral warts but not the human papillomavirus infection. As the saying goes, prevention is better than cure; taking precautions and getting vaccinated is better.
