The human papillornavirus (HPV), also known as genital warts, has more than 100 strains, some of which are harmless; others are transmitted through sexual contact. Genital warts are most often caused by subtypes six or 11 of HPV. Other high-risk HPV subtypes are associated with cervical cancer. They typically present as multiple lesions on the external genitalia, including the vulva, penis, perineum, perianal skin, or scrotum. Occasionally, there may only be a solitary lesion present. They can also occur internally on the mucous membranes of the vagina, anus, urethra, cervix, or mouth. The appearance of genital warts ranges from flesh-colored, cauliflower-like lesions to red or brown dome-shaped, smooth lesions.
Most patients do not experience any symptoms. Occasionally, men or women with external genital warts may experience itching. When internal warts are present, they typically do not cause symptoms unless they are large. Symptoms of internal warts in women include vaginal pain, vaginal bleeding, and pain with intercourse.
Diagnosis is usually made based on the appearance of the lesions. A biopsy may be performed if there is a question regarding the diagnosis, or if there is a poor response to therapy.
Treatment of genital warts is based on the location, number, and size of the lesions. Treatment response rate for genital warts in men and women ranges from 40 to 90 percent. depending on the type of therapy used.
Treatment options for women include:
• cryotherapy with liquid nitrogen,
• imiquimod topical therapy,
• trichioroacetic acid,
• surgical removal, and
• laser therapy.
If there is no response to medical therapy after three cycles, the diagnosis should be confirmed with biopsy and the treatment changed.
Genital warts can be prevented by limiting the number of lifetime sexual partners, avoiding direct contact with sexual partners who are infected, and using condoms. Using condoms, however, does not always prevent transmission of the virus.