Symptoms
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
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
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,
• interferon,
• trichioroacetic acid,
• podophyllin,
• podofilox,
• 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.

Prevention
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.

Genital Warts

Human papillomavirus (HPV) infection is the most common sexually transmitted viral infection of the lower genital tract. There are many subtypes of this virus, and infections by different varieties lead to disparate clinical conditions. These include genital warts (condylomata acuminata), sub-clinical infection, abnormal growth of epithelial cells (intraepithelial neoplasia), and/or carcinoma of the vulva, vagina, and cervix. In fact, more than 60 subtypes of HPV have been identified, but only a few cause infections of the genital tract. Subtypes 6 and 11 are more often associated with genital warts (overt condylomata acuminata), hut subtypes 16 and 18 are more likely to promote progression to premalignancies or malignancies. HPV infection is widespread. As many as 60% of women tested for HPV DNA with sensitive molecular biology techniques (polymerase chain reaction, or PCR) are positive. Although the majority who test positive are asymptomatic, there is always the risk of reactivation, with subsequent serious consequences, because this virus remains in a woman’s system for life once she is infected.

Health care providers diagnose warts by their typical appearance on physical examination. They can be flat or raised; pink, white, or other pigments; large or small; and they can appear singly or in clusters. Pap smears provide an important screening test to determine the presence of warts. One diagnostic method involves applying 5% acetic acid to the affected area and then examining it microscopically. A colposcopic examination offers a more definitive diagnosis. The surgical excision or biopsy of suspicious tissue and examination of it by a pathologist are often required. Symptoms include occasional itching or bleeding but usually not much pain, in pregnancy, if the wart becomes large it can interfere with a vaginal delivery. Although rare, the vocal cords of vaginally delivered infants have become infected. The most appropriate treatment depends on the location of the lesion, its extent, the severity of the disease, and whether the patient is pregnant. There are several chemical treatments (podophyllin, bichloroacetic acid, trichloroacetic acid, and 5-fluorouracil [5-FLJ]). Physical treatments include freezing the lesion (cryotherapy), laser therapy, electrotherapy, and surgical excision. Immunotherapy also is used in severe cases. Although each of these methods has a success rate that approaches 95% in properly selected patients, recurrences are common. We need research to develop agents that would confer immunity, eradicate latent infection, improve the treatment of overt infection, and further clarify the association between this virus and malignancy.

Human Papillomavirus (HPV)

 The warts are often painless (though they may occasionally itch, burn, or bleed), and in most cases they won’t pose any problems for mother or baby. They do tend to grow during pregnancy, though, possibly from the extra vaginal discharge that provides the virus with a moist growing environment. In certain cases, your practitioner may offer to remove them with a mild acid solution. But unless your warts are so large or numerous that they block your birth canal or there’s a concern that they’ll bleed excessively, you can still have a normal vaginal birth whether they’re treated or not. (What’s more, they often improve on their own or even disappear altogether after delivery.) Though HPV can be transmitted to your baby during birth and lead to a serious condition characterized by warts on his vocal cords and other areas, this is extremely rare. Having a c-section doesn’t seem to offer a baby complete protection from the virus, anyway, so your birth won’t be managed any differently than it would have been if you ware HPV-free.

Human Papillomavirus (HPV)

Genital warts (Condylomata acuminata) are not painful, unlike the sores of herpes infection, but some of the viruses that cause this STI are associated with the development of cervical cancer. This association with cancer and the possible transmission of this disease to the respiratory tract of infants during birth are the gravest concerns of this disease. Warts are noncancerous skin tumors, masses of cells that result from uncontrolled cell growth. All warts are called papillomas and are caused by the human papillomavirus (PAP-ih-LOW-mah-vigh-rus) (HPV). However, there are over 60 types of papillomaviruses (named HPV-l, HPV-2, and so on); each affects only certain areas of the body. More than 20 types of HPV can infect the genital tract, but visible genital warts are usually caused by HPV-6 and HPV-11. These viruses cause warts particularly in the cervical, vaginal, and vulvar areas in women and various parts of the penis in men. They can also infect the urethra and anal areas in both sexes. The HPV types that infect the genital area
but do not result in the growth of warts cause tissue changes that a health care provider usually can see by using special techniques. Some of these viruses, particularly HPV-16 and HPV-18, are associated with cancer of the cervix and less often with cancer of the vulva and penis. The American Cancer Society recommends that women have regular Papanicolaou tests (Pap smears) to detect atypical, precancerous or cancerous cells within the cervix and that men consider having any abnormal tissue growth in the genital area microscopically examined for the presence of cancer. Health care professionals are not required to report cases of genital warts to CDC, so only estimates of prevalence are available. More Americans have herpes then genital warts. The incidence of warts fell from 1987 to 1997 but has been rising since then.

Although genital warts may go away on their own, the virus particles may remain in the tissue, and can reactivate and infect others. These warts may also persist, grow larger and spread. The removal of genital warts involves applying medications to the skin that break down the wart tissue, freezing them with liquid nitrogen, cauterizing (burning) them, or treating them with carbon dioxide lasers. Treatment for hard-to-remove warts involves the injection of the antiviral agent alpha-interferon directly into the tumorous growths. If you contract genital warts, you may want to discuss the benefits and drawbacks of various treatments with your health care provider. Many treatments are far more painful than the warts, interferon treatments can be costly, and medical researchers are unsure whether treatment to remove warts reduces the risk of transmission. Efforts to develop a vaccine to protect against HPV infection or to use in its treatment have proved fruitless, primarily because the virus is extremely difficult to culture in the laboratory.

Genital Warts

Another virus that is sexually transmitted is the human papillomavirus (HPV), which causes genital warts, also called condylomata acuminala. These genital warts may occur in the urogenital, perineal, or anal areas, and may be either external or internal. The population at risk seems to be teenage girls or young women in their twenties. In the United States, it is estimated that there are approximately 1 million new cases of genital warts identified every year, and as many as 24 million already infected with HPV (NIAID and NIH, July 1998b). The incubation period for genital warts appears to be approximawly 1 to 2 months, but may be up to 6 months. Unlike genital herpes, genital warts are usually painless, soft fleshy growths appearing most commonly in the genital area. Sometimes many warts may grow together to form a large cauliflower-shaped growth. The greatest health threat that HPV poses to a female client is the predisposition to the development of cervical cancer. Although there are over 60 different types of HPV, only 6 of those have been associated with the development of cervical cancer. Cigarette smoking has been linked to the development of cancerous cervical changes in women with HPV. Women who have HPV should be advised not to smoke. HPV appears to play a role in the development of cervical cancer, along with many other factors. An abnormal Pap test may be the first indication of HPV. Genital warts are less common in men. If seen, they are usually on the lip of the penis.

Medical—Surgical Management
Since genital warts are caused by a virus, there is no cure for the disease. The focus is on preventing the spread of the disease to sexual partners, and reducing the possibility of cancer. Use of a condom during sexual intercourse may provide some protection. Once the genital warts disappear, the disease may lie dormant for many years until there is a recurrence of the outbreak.

Surgical
The warts may be removed under local anesthesia. This is especially recommended if the warts have formed a large fleshy cauliflower-like growth. Freezing the warts off with cryosurgery, or surgical use of extreme cold, is the treatment of choice for small warts. The warts may also be removed with laser surgery, or cauterized. Whatever treatment is recommended, it mu.st be remembered that the treatment will not cure HPV, but only provide a palliative effect. The warts may recur after any treatment.

Pharmacological
A topical solution of podophyllum resin (Poddoen) may be applied to the genital warts. It is only recommended for treatment of I or 2 lesions at a time, since it can be toxic if applied to too large an area at one time. Most people report experiencing a good deal of pain from the treatment. After the solution has been in contact with the genital warts for a period of 4 to 6 hours, it is then washed off with soap and water. If not thoroughly washed off, podophyllum may cause
chemical burns that 1w-al very slowly and are very painful. This therapy must not be used on a diabetic client, a client with poor circulation, or a pregnant client.

Human Papillomavirus (HPV)

Genital Wart Oil:

This oil is potent—which it must be to destroy warts—so use it carefully.

1/2  teaspoon Castor oil

1/4  teaspoon thuja essential oil

1/4  teaspoon tea tree essential oil

800 IU vitamin E oil (2 opened 400 IU capsules)

Combine all of the ingredients. Protect the skin around the wart with salve, leaving only the wart exposed. Carefully apply the mixture to the wart with a cotton swab two to four times per day for no more than one week. Caution:
Do not take essential oils internally.

  These strains are transmitted by skin-to-skin contact, usually during intercourse. Four weeks to nine months after exposure, blistery and perhaps itchy sores with a red base appear first on the genitals, then the anus and buttocks. The warts may stay the same, grow larger, or completely disappear, but the virus remains in the body and may recur months or even years later. Risk factors for genital warts include multiple sex partners, cigarette smoking, and immune weakness. If you are female and test p0sitive for a genital warts virus, be sure to get regular Pap smears and pelvic exams to keep an eye on the health of your cervix. This is especially important if you also have genital herpes, another risk factor for cervical dysplasia.

Genital warts are a condition you do not want to treat on your own. Be sure to consult your doctor, who can give you more information about risk factors and treatment options. It’s especially important for your doctor to monitor the progress of the condition.

DRUG TREATMENT
No known drugs can eliminate the human papillomavirus. The warts themselves can be removed by freezing, surgery, laser or electric burning, or toxic chemicals. And they recur in up to 75 percent of cases.

HERBAL REMEDIES
Garlic (Allium sativiun), Amazing garlic not only fights viruses but also is good for the heart and treats bacterial
infections. Allicin, a sulfurous compound in garlic, appears to encourage healing. Typical dosage one or more fresh cloves, raw or only slightly cooked, per day; or up to three 500- to 600-miligram capsules per day (look for at least 5.000 micrograms of allicin per day).

St.-John’s-Wort (Hypericum perforatum)
Well-known for its usefulness in treating mild to moderate depression, this herb is also antiviral. Its known to help in cases of herpes, so it’s worth a try with genital warts. Typical dosage 450 milligrams in capsules two times per day for three days, then skip a day, repeating for nine months or longer; or 3/4 teaspoon of tincture two times per day for the
same time period.

Genital Warts

Genital warts in women can appear on the labia, inside the vagina, and on the cervix (opening to the uterus), as well as
around the anal area. In men they generally appear on the head or shaft of the penis, and sometimes on the scrotum or around the anus. The warts start as pink, tan, or red swellings about the size of rice grains but often merge to resemble small cauliflowers. Some warts are so minute and painless that they are unnoticeable. Others are over 3 inches around and interfere with the ability to sit or to walk. Sometimes the warts itch or bum, and scratching them can cause irritation. It can take between 1 and 6 months for warts to appear after infection.

How are genital warts treated?

 
Because genital warts often recur and are so easily spread, eradicating them can be frustrating. Part of the treatment
involves evaluating the woman’s partner as well as discussing techniques to prevent the spread of the warts, since obviously it is pointless to remove warts in a woman who continues to have sexual contact with an infected partner. For small warts, self-treatment with the prescription cream imiquimod (Aldara) is sometimes successful, although it can irritate surrounding skin. The cream is applied 3 times a week until the warts dissolve. Larger or persistent warts can be dissolved with a topical agent such as podophyllin or trichloracetic acid applied directly. Because these medicines (especially podophyllin) can cause chemical burns if used incorrectly, women should not try to apply them at home. Podophyllin must be removed several hours after it is applied and usually needs to be reapplied several times at weekly intervals. It should not be used by women who are pregnant because it can cause birth defects. A topical cream, podofilox, which a woman can apply herself for 3 days a week up to 3 weeks, is also available by prescription and is effective. If warts persist or return after this treatment, the clinician will make sure they are not cancerous by doing a biopsy, if necessary using a topical or local anesthetic. Once cancer has been ruled out, the clinician may try burning or freezing off the warts using electrocautery (see entry) or liquid nitrogen (see cryosurgery). These techniques are sometimes used instead of topical agents when warts are extensive or occur in particularly sensitive locations. Some investigators have also had success removing a small number of warts by injecting them with alpha interferon several times a week for about 3 weeks. Though less likely to cause pain and scarring than other treatments, alpha interferon makes some women feel as though they have the flu and is not safe for use during pregnancy. Injection of Interferon B into the muscle of the arm or buttocks appears to be an effective and less painful treatment, but it is not yet available in the United States. There is some psychological research to suggest that warts may respond to hypnosis in some individuals for whom medical treatments fall, as a last resort for extensive or persistent infections, laser surgery may be used. Though quite effective in eradicating warts, laser surgery usually requires regional or general anesthesia, and many women experience incapacitating pain in the perineum (the skin between the vulva and the anus) after surgery, as well as persistent vulvar pain. Because it is hard to tell it all warts have been removed, a woman should be rechecked by her clinician after about 6 months. Sometimes additional treatment may be necessary. Th make sure no cancerous changes have occurred, a Pap test every 6 months thereafter for at least a few years is a good idea.

How can genital warts be prevented?
Preventing the spread of genital warts involves the same safer sex practices required to prevent the spread of any sexually transmitted disease. Because abstinence from sexual activity while the warts are contagious is often impractical, condom use is important until all warts have been eradicated. Male condoms, however, do not provide total protection, since a mans scrotum can harbor the wart virus.

Genital Warts

 
Genital warts are benign growths in the genital and anal area. A common form of sexually transmitted disease, they are caused by one of various forms of the human papillomavirus (HPV), other forms of which cause plantar warts of the foot and common warts of the skin. Also called venereal warts or condylomata acuminata. genital warts usually result from sexual contact with an infected partner, although they occasionally are spread by touching the genitals with wart infected hands. In rare Instances genital warts are spread from an Infected mother to a newborn during delivery. Although they are easily spread and hard to eradicate, genital warts are generally no more than an annoyance. Warts caused by certain types of the HIV, however, have been associated with cervical cancer. Treatment can be important for pregnant women because occasionally a large mass of warts on the vaginal waits can physically obstruct labor. In rare cases, untreated warts on the cervix, vagina, or anal area may necessitate a cesarean section so that they do not break open and bleed excessively during delivery.

Who is likely to develop genital warts?

Genital warts can develop in any person whose genital area has been directly touched by another wart. Because these
warts thrive in warm, moist environments, they are likely to proliferate In women who are pregnant or who have vaginal infections (see vaginitis) because at these times vaginal secretions tend to increase. Some investigators believe that warts are particularly likely to grow in people with compromised immune systems, including those who are infected with the human immunodeficiency virus (HIV), which causes AIDS.

How is the condition evaluated?
Some women (especially those with warts on the cervix) do not find out they have genital warts until they have an abnormal Pap test. Others may notice suspicious swellings on the vulva and consult a clinician. Since the naked eye can miss many warts, most clinicians use a magnifying glass or a colposcope (a special type of microscope used to examine the genital area) for a more thorough Inspection. Often a vinegar-like (acetic acid solution is applied to the affected area first to turn cells white and improve visibility. If warts are found, the clinician may do a biopsy (tissue sample to make sure that there have been no cancerous changes in any surrounding cells. In some cases a blood test may be recommended as well to check for the presence of HIV, which seems to accelerate the growth and spread of the warts.

Genital Warts

Genital warts are caused by the Human Papilloma Virus (HPV). The warts vary in appearance from tiny bumps to large, spreading masses which can appear on the penis, the labia, around the anus, in the vagina and on the cervix. The disease spreads through sexual contact with warts on the genitalia of an infected person. HPVs are now associated with cancer of the cervix, as well as tumours of vulva, vagina, anus and penis.

Human Papillomavirus (HPV)

The best mode of treating the none vascular wart is  by excision. Whatever substitute is tried, the surgeon most commonly resorts to this at last. The ligature is quite as painful, or more so, and certainly much less efficient. Whether excision or the ligature be adopted, the surface that is exposed should be touched with caustic. With this precaution, the wart very often re-appears —without it, we may generally count on its doing so. When discharges co-exist with wart, proper means for arresting them should always be employed. Improvement of the secretions is desirable also–and for this, aperients, with the warm bath, and regulated diet are of service. When warts of the glans, or of the inner prepuce its angle, have occasioned phymosis, or those other can- sequences to which I have fully alluded, it becomes indispensable to divide the prepuce, or even to remove it. Indeed, if a patient with a prepuce naturally long, evinces a disposition to warts, which is not effectually prevented by cleanliness and the constant application of lint, I should strongly recommend the operation of division of the prepuce, or even that for the removal of some portion of it. I have performed both several times on this account, and the warts have subquentty ceased to appear. When adhesion’s have occurred between the inner prepuce and the warts, and ulcerated openings have formed in various parts of the prepuce, removal of a portion.

Genital Warts