Genital warts are the most common sexually-transmitted disease caused by a virus. Genital warts or venereal warts are the most easily recognized sign of genital human papillomavirus (HPV) infection. Many people, however, have a genital HPV infection without genital warts. Over 100 types of HPVs have been identified; about 40 of these types have the potential to infect the genital area.

• Around 90% of genital warts are caused by two specific types of the virus (HPV-6 and -11), and these HPV types are considered "low risk," having a low cancer-causing potential.
• Other HPV types have been strongly associated with premalignant changes and cervical cancers in women. HPV-16 is responsible for about 50% of cervical cancers, and types 16, 18, 31, and 45 together account for 80% of cancers.
• Common warts are not the same as genital warts and are caused by different HPV types that infect the skin.

Genital warts affect both men and women. In children younger than three years, genital warts are thought to be transmitted by nonsexual methods such as direct manual contact. Nevertheless, the presence of genital warts in children should raise the suspicion for sexual abuse.

Genital warts, sometimes referred to as condyloma acuminata, are:

• soft, moist flesh-colored or gray growths found in the genital area and anal region of both men and women which appear within weeks or months after infection.
• They sometimes appear in clusters that resemble cauliflower-like bumps, and are either raised or flat, small or large.
• The size may range from less than one millimeter across to several square centimeters when many warts join together.
   

How are they spread?

The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency period of months to years may occur.

The number of genital warts usually rises during pregnancy, which makes vaginal delivery difficult, because warts can bleed easily and infect the newborn, which poses the threat of contracting recurrent respiratory papillomatosis (RRP). This is a life-threatening disease of the respiratory tract. The papillomas or warts appear and spread quickly, sometimes dangerously blocking the child's airway.

Symptoms

• painless bumps, itching, and discharge.
• Rarely, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral opening (the opening where urine exits the body.)
• Warts in more than one area are common.
• There may be a history of previous or concurrent sexually transmitted diseases (STDs).
• In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals warrant a thorough examination of the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. Rarely, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.
• In men, genital warts can infect the urethra, penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many fingerlike projections (anal warts). Others may appear pearly, cauliflower-like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Infection with HPV may be dormant or undetectable, with some lesions hidden by hair or in the inner aspect of the uncircumcised foreskin in males.

Treatment

There is no single treatment that is effective in eliminating warts and preventing them from coming back.

• Cryotherapy: This technique freezes the wart using liquid nitrogen or a "cryoprobe."
• Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. The laser physically destroys the HPV-induced lesion. Disadvantages include high cost, increased healing time, scarring, and potentially infectious viral particles in the air caused by the laser plume.
• Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia. The resulting smoke plume may be infectious.
• Medications
• Surgery: Surgery may be performed as an office procedure with local anesthesia. It is usually done when the warts are small in size and number. Of all the treatment techniques, it has the highest success rate and lowest recurrence rate. Initial cure rates are 63%-91%.
• After treatment, patients should routinely visit their doctors for a check up, tests and new or alternative treatment.

Prevention

In 2006, an HPV vaccine (Gardasil) was approved by the FDA for use in girls and women, aged 9-26. This vaccine has been shown to be safe and 100% effective in preventing infection with the four most common HPV types (6, 11, 16, and 18) in women who have had no previous exposure to the virus. However, it is less effective in women who have already been infected with HPV, and it does not protect against all types of HPV infection.
Other tips on prevention include the common rules of prevention against any other STD:

• Abstinence
• Barrier contraception
• Limited number of partners or mutual monogamy
• Simple hygiene such as shower before and after sexual intercourse

How to stop the spread?

• Inform any recent partner(s)
• Use barrier contraception
• Cease sexual activity during time of treatment
• Remember that birth-control pills do not protect you from STDs, thus having multiple partners requires barrier contraception even if birth-control pills are taken
• Do not touch the warts since they are highly infectious
• Limit your number of partners or practice monogamy
• Take the necessary precautions to prevent trauma to the area, which can result in bleeding.
• Because the warts themselves are infectious, avoid touching them. Do not pick or squeeze the warts.