What are the symptoms?

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.