Genital Warts

Key Points
Sexually transmitted infection caused by the human papillomavirus (HPV)
Consists of round bumps of varying size, flesh colored, which can be smooth, flat, or cauliflower shaped

Genital Warts are a sexually transmitted infection caused by human papillomavirus (HPV). It consists of round flesh colored bumps of varying size. Bumps may be smooth, flat, or cauliflower in shape. Bumps may form on the labia, vagina, penis, scrotum, anus and urethra. Infection can only be spread by skin to skin contact, but does not require intercourse to do so. Many affected persons will not present with symptoms, and the infection will resolve spontaneously. In many patients, however, the infection becomes chronic. In this population, the infection is still transmittable, even without visible symptoms. Use of condoms will reduce the risk of infection, but not eliminate it completely. While there are over 100 types of HPV, two subtypes (6 and 11) are responsible for most infections. These types are classified as low risk, as they are not accompanied by a heightened risk of cancer.
Carrier rates of HPV vary from study to study but 10-20% of the population is a fairly reasonable estimate with higher rates in some subgroups such as sexually active 20-30 year olds. Risky sexual behavior or having your first sexual experience at an early age can heighten a person?s chances of contracting the condition.

Differential Diagnosis (Other conditions with similar appearance)
Condyloma Lata (Secondary Syphilis)
Seborrheic keratosis
Darier disease
Hailey-Hailey disease
Nevi
Pearly penile papules

Diagnosis
Key Points
Diagnosis based on appearance of the affected area
Biopsy can be performed to formally establish diagnosis if necessary
Pap smears and other tests may also detect the condition in women

Diagnosis of genital warts is generally accomplished based on the appearance of the affected area, though in women who do not show symptoms, pap smears may indicate an HPV infection.

Treatment
Goal of treatment is to remove visible lesion and reduce risk of spreading the condition
Many treatments exist, but multiple treatment sessions are often needed
Cryotherapy (freezing)
Topical imiquimod
Surgical excision

In some cases, especially in those affected persons with healthy immune systems, the visible Warts may resolve spontaneously without treatment. However, such resolution will not occur immediately, and any visible symptoms should be treated by health care professionals.
Treatment goals consist of removing visible symptoms and reducing the risk of passing on the disease. While many treatment methods exist, none are completely effective. In some cases, treatments may be prescribed which are applied by the affected person, including Imiquimod cream, which encourages the immune system to kill the infection, and podofilox solution. Treatments that must be administered by health care professionals include the application of podophyllin resin, trichloroacetic acid, cryotherapy, surgical excision, and carbon dioxide laser therapies. In most therapies, multiple treatments are generally required. It is also possible to vaccinate for this condition now, and parents should be encouraged to consider the vaccine for their children prior to their years of sexual activity. Routine vaccination is likely to reduce the incidence of cervical cancer due to high risk HPV serotypes, and can reduce the likelihood of genital warts due to any of the serotypes.