Frequently Asked Questions About Genital Warts Treatment

They appear as small growths or a group of growths in the genital area. They can be raised or flat, single or multiple or small or large, and may join together to grow like cauliflower. They often are hard to see clearly and sometimes dampening the area with a vinegar solution makes them clearer to see.

Warts can appear anywhere in the genital area in both men and women including the vagina, cervix, vulva (area outside of the vagina), penis, scrotum, and the area around the anus. Inside the anus, warts may occur which cannot be seen or felt. They will often be painful and cause bleeding during and after sexual intercourse, and cause itching or discomfort.

Genital warts are a type of sexually transmitted infection (STI). They are caused by the human papilloma virus (HPV). There are more than 100 strains of HPV, but only a few can cause genital warts. Strain 6 and 11 are the typical strains which cause genital warts. Genital warts are a common infection, and frequent occurrence is seen in young people in their late teens and early 20s. A lot of infections have no symptoms and you can pass the infection on to others without realizing it.

With its immediate heat, genital-skin-to-genital-skin contact is the most common way to transmit HPV, the virus that causes genital warts. This can be as minimal as 5 seconds of contact, and the virus can be shed from areas not covered by a condom, so it is still possible to get HPV from safe sex practices. If the infected skin comes into contact with an area of skin not affected, there is a high chance that the virus will be passed on. This also applies if the infected skin comes into contact with the mucosal skin - the moist skin on the genitals, the skin in and around the anus, and the female cervix. Any of these types of skin-to-skin contact can transmit HPV. An additional way to pass on the virus through skin-to-skin contact is through digital manipulation, where an infected area is touched and then touches an unaffected area, or if the hands are the infected area and come into contact with genital and anal areas. Coming into contact with bedding or towels that have been used by a person who has genital warts can also transmit the virus, though this is rare.

Auto-inoculation can occur if a person uses the same towel to dry two different areas of the body, or scratches an infected area and immediately touches another area of skin. This is because HPV lives in the top layer of skin and once an area has been cleared of warts, it is still possible to spread the virus from that area. This method of transmission is also how children can get warts. Finally, genital warts can be transmitted from mother to baby during childbirth, which can cause juvenile-onset respiratory papillomatosis (JORP), a potentially severe condition where warts grow in the child's throat.

The second way to transmit genital warts is through fomite transmission, where the virus is passed on an inanimate object.

Common symptoms of genital warts include:

• Small swellings on the genital area.
• These may be tiny or large, raised or flat, or shaped like a cauliflower. They may be difficult to detect with the human eye.
• Itching or discomfort in the genital area.
• This may be accompanied by a general feeling of discomfort and flu-like symptoms. These symptoms may be difficult to link to genital warts.
• Bleeding during intercourse.
• This is uncommon and fairly rare. Women sometimes experience bleeding following intercourse due to a wart located on the cervix.
• Vaginal discharge.
• Women with warts inside the vagina or on the cervix may notice vaginal discharge.
• Sometimes there are no symptoms.
• In fact, many people who have HPV may not have visible warts or know that they are infected.
• The time from the moment of infection to the time the warts appear can range from a few weeks up to several months, or not at all. This makes it difficult for the infected person to know who gave them the HPV.

Because it is possible to have more than one sexually transmitted disease at the same time, it is possible that your doctor will recommend tests for other sexually transmitted diseases. There is no test to find out a person's "HPV status". These tests may include Pap smears, and tests for chlamydia, gonorrhea, syphilis, or HIV. If you are female and have been diagnosed with genital warts, it is important to have a Pap smear to check for abnormalities of the cervix.

If you think that you have genital warts, it is important to consult a doctor to confirm the diagnosis. Genital warts are diagnosed through a visual examination of the genital area, or the cervical area in women. Some healthcare providers apply a mild acetic solution to the genitals that causes the warts to turn white, making them more visible. If visual examination is inconclusive, extensive tissue sampling may be necessary to rule out a serious condition such as cervical dysplasia. This could include colposcopy (a magnification of the cervix), biopsy of the warts, and in rare cases, removal of the warts and examination under a microscope.

Diagnosis of genital warts is essential, as this condition can be mistaken for other skin diseases or skin changes, which may potentially prove to be more serious. There are a number of diseases and conditions which mimic the appearance of genital warts, and correct diagnosis is important. Visual examination of the genital skin is often not sufficient to decide upon a diagnosis. Some lesions are flat and skin colored, making them difficult to see with the naked eye. An additional aid to diagnosis can be an acetic acid wash, which makes any flat lesions more visible, turning them white. More recently, a method known as high power magnification or videotoscopy has become available at some clinics, offering a highly magnified view of lesions. If a clinical diagnosis remains uncertain, the patient should be referred to a specialist for further assessment.

If it becomes necessary to confirm a diagnosis where there are no visible lesions, viral testing may be useful. A smear of cells from the suspected area is taken and tested for the presence of HPV DNA by molecular tests such as PV testing or Hybrid Capture 2. Although viral testing can be used to detect the virus in either men or women, testing methods differ between the sexes and no test currently available to the public has been approved for HPV testing in men. In both sexes it is uncertain how useful viral testing is compared to simply relying on clinical diagnosis.

Trichloroacetic acid (TCA) and bichloroacetic acid (BCA) are caustic agents that can be applied to the warts. This is a provider-applied therapy. Liquid nitrogen has also been used to destroy warts. Both of these methods can be used for internal warts. However, these methods can be painful and they can cause irritation of the surrounding skin. This and other provider-applied therapies are discussed further below.

Sinecatechins (Veregen) can be used to treat genital warts. This is an FDA-approved topical treatment that can help stimulate the immune response in the area and thus help combat the virus. This medication has been shown to be both safe and effective. It can be used for both the initial warts and recurrences.

Podofilox (Condylox) is a self-applied treatment which is done at home. Imiquimod (Aldara) is another self-applied treatment that is used in the privacy of your home. Both of these treatments are more convenient, but they can irritate the skin in the genital area.

There are several different ways to treat genital warts. The best treatment for you will depend on the size and location of the warts, and other factors. You should discuss treatment options with your healthcare provider. Do not use over-the-counter treatments for warts near the genital area (see below).

No one therapy has been proven to be superior to the others based on the rate of wart clearance or the frequency of recurrence. Nonetheless, the clearance rates are generally higher for therapies applied by the provider than for those applied by the patient.

New and recurrent infections after various therapies are common, and no therapy is completely effective in eliminating warts and preventing their recurrence. Data is also limited regarding the effect of the various treatments on subclinical HPV and the subsequent transmission rate. The most common modalities used are provider-administered therapy such as cryotherapy, trichloroacetic acid (TCA) or bichloroacetic acid (BCA), and surgical removal. Patient-applied therapies include imiquimod, podophylotoxin, and sinecatechins. Data on the safety and efficacy of these medications during pregnancy is limited, and consideration should be given to delaying treatment until after the pregnancy.

The treatment of genital warts is aimed at removing the visible warts and decreasing the risk of intralesional and anogenital cancer. The choice of therapy is based on the location, size, and morphology of the lesions as well as the patient's preference, convenience, and cost. The available treatment modalities include patient-applied therapy, provider-administered therapy, and surgical treatment. No definitive evidence exists to support fully the superiority of any of the specific treatment modalities for external genital warts.

Genital warts can be treated but not cured through any modality. Spontaneous clearance rates for genital warts vary from 20% to 30%, even without treatment, in the first 3 months after infection. Recurrence after treatment is common. Even though the warts may clear, the virus may still be active in the area and transmission may occur in the absence of any visible lesions.

It is noted that all of these remedies should be used for at least 4-6 weeks or until the wart disappears. However, individual results and reactions to some of the above remedies may vary. Some individuals may find that they are allergic to tea tree oil and experience skin irritation. It is advised to seek professional confirmation before resorting to home remedies to ensure that your self-diagnosis is correct.

• Tea tree oil: Apply to the infected area three times a day.
• Garlic: Eat one raw garlic clove and/or place a slice of garlic in the infected area. Replace the garlic every 3-4 hours. This is effective for both internal and external genital warts.
• Vitamin E oil: Break a Vitamin E capsule and apply the oil to the infected area. Tape a small piece of banana skin to the wart on top of the oil and leave it on overnight. This allows the Vitamin E oil to be absorbed directly into the wart.
• Aloe: Break off a leaf from an aloe plant and apply the juice onto the affected area. Leave it to dry. Repeat 4-5 times a day.
• Thuja oil/homeopathic thuja treatment: Apply directly to the affected area twice daily.

There are plenty of home remedies currently available to help cure genital warts. It is estimated that 65% of sufferers who use these remedies will have positive results.

Using condoms can reduce the risk of transmitting the HPV virus to a partner, but HPV can be spread by contact with an area that is not covered by the condom. No research has been published on the effect of condoms in preventing the spread of HPV, but it is logical for sexually active persons to use condoms as a means of prevention. Keep in mind that condoms do break, and so safe sex means getting vaccinated and using condoms.

The recommended vaccines for genital warts are Cervarix and Gardasil. Both vaccines are close to 100% effective in preventing infections with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers and an even higher percentage of some of the rarer genital cancers. Gardasil is also close to 100% effective in preventing diseases caused by HPV types 6 and 11, the two low-risk types that cause 90% of genital warts. These vaccines are preventive and will not treat existing HPV infections or diseases caused by HPV, so it is best to get them before becoming sexually active. They are given in three shots over a six-month period.

Prevention of the spread of genital warts is an important topic. It is much easier to prevent the spread of the virus than it is to treat the warts that may develop from a previous infection. The virus that causes genital warts is spread very easily to others and to other areas of your own body. Even if you have been treated for genital warts, you may still be contagious. There are several things you can do to prevent spread of the virus to yourself and to others.

• Find out if your partner has had genital warts. Remember that most people (70%) who have been infected with HPV do not know it. This is because they have no signs of infection. But they still can pass the virus to others.
• Get the HPV vaccine. The vaccines Cervarix, Gardasil, and Gardasil 9 protect against infection with HPV types 16 and 18. HPV types 16 and 18 cause about 70% of cervical cancers and about 90% of anal cancers. The vaccines are approved for boys and girls. They can be given as early as age 9. The Centers for Disease Control and Prevention (CDC) recommends the vaccine for all girls and boys at age 11 or 12. The vaccine is also recommended for males through age 21 if they have not been vaccinated earlier or have not completed the vaccine series, and for females through age 26 if they have not been vaccinated earlier or have not completed the vaccine series. The vaccines are most effective if they are given long before a person is exposed to HPV. So they are given at an earlier age than the age when most people become sexually active. But the vaccines can also help prevent HPV infection in people who have already become sexually active. The recommended ages for the vaccine may be revised over time. Check the latest CDC recommendations. (Cervarix is no longer available in the United States.).

You can reduce your risk of getting genital warts by not having sex or by having sex only with a long-term partner who is not infected with HPV.

There are two vaccines available in many countries as of August 2011, which can prevent genital warts. They are 'Gardasil' and 'Cervarix'. Both vaccines are delivered as three doses over a six-month period and have been shown to be close to 100% effective in preventing cervical cancer caused by HPV types 16 and 18. Gardasil has also been shown to be over 95% effective in the prevention of low and high-grade lesions on the cervix, vulva, and vagina caused by HPV types 6, 11, 16, and 18, in women who had no previous exposure to the relevant HPV types. In terms of the prevention of recurrent genital warts, early research on Gardasil indicates it is over 90% effective in the prevention of these lesions in males, in females who have had a previous history of genital warts. Cervarix has no therapeutic effects. The impact of vaccination on public health, in regard to genital warts, has the potential to be significant. It has great promise to reduce the incidence of genital warts in both males and females and therefore have an impact on decreasing transmission of sexually transmitted HPV and reducing costs associated with the treatment of recurrent disease.

Safe sex is the most reliable way to prevent the spread of infection, but whilst HPV is mainly spread through genital skin-to-skin contact, using condoms and dental dams might not entirely prevent transmission as the virus can infect areas not covered by the barrier. So condoms cannot give complete protection against HPV, but they do reduce the risk.

Studies also show that the use of condoms protects against persistent HPV infection, in some cases reducing the risk by as much as 70 percent. A randomized controlled trial (RCT) involving over 82,000 women showed that condom use reduced the rate of HPV-related diseases, such as abnormal smear tests and cervical pre-cancer, by around 70 percent in women aged 35 and over.

However, consistent use of condoms drastically decreases the chances of HPV being transmitted, says the Health Protection Agency (HPA). One study showed that in women whose partners used condoms every time they had sex, the rate of genital HPV infection over a 15-month period was 28 percent lower than in women whose partners used condoms less than 5 percent of the time.

Genital warts can be particularly stressful for people who are single and dating, because the burden of keeping potentially contagious skin changes secret. Some people decide to be very upfront with new partners about the risks of HPV, while others feel that this information is too personal to share early in a relationship. The emotional impact of genital warts should not be underestimated. Data from a study of women with gynecological warts showed that two-thirds of the participants experienced feelings of depression during the previous month, and half had considered suicide since their diagnosis. This is a serious issue and requires adequate emotional and psychological support.

Genital warts can be a distressing condition. The emotional impact of having a sexually transmitted infection which is visible and which can recur may cause a variety of feelings. Many people feel 'dirty' or 'spoilt', regretful about the circumstances which led to the infection, angry about unfairness of life, anxious about the effect on future relationships or guilty about having unwittingly passed the infection on to others. Some people may feel stigmatized by the condition and judged by others as being promiscuous or irresponsible. All of these feelings are normal reactions to an unwelcome infection but they are negative and unhelpful and it is important not to get stuck in these ways of thinking. Professional help can be obtained from general practitioners and genitourinary medicine or sexual health clinic staff and may involve accessing counseling services.

Genital warts could have a substantial impact on establishing and maintaining close relationships. This happens through the transmission of HPV to a partner, and the emotional effects which are played out in different forms of behavior. Studies have shown that the most frequent behavioral change is abstention from sex compared to uninfected partners or less regular sexual intercourse. A smaller study showed that individuals with visible genital warts were less likely to have sex than uninfected individuals with HPV with no visible warts. When considering starting a new relationship, the thought of having to discuss the HPV infection is a concern for many individuals. Data from individuals with anogenital HPV infection shows they have concerns about long-term relationships and marriage. In a study of Australian adolescents aged 12 to 16, 20% of females and 10% of males said they would break off a relationship with a partner who had genital warts.

An uninfected partner may show unintentional displays of avoidance or rejection, and in some instances the relationship ends because the stress and upset becomes too much for the infected individual. HPV is also a frequent scapegoat for relationship problems as it is an easily blamed sexually transmitted infection. Studies have shown the rate of recurrence of HPV is higher in partnerships where 1 partner was infected at the beginning of the relationship, compared to those where infections were acquired around the same time. This is attributed to the fact that the infected partner is more likely to eradicate the virus and any visible warts if reinfection from the partner occurs.

Similar support groups may be available in other countries, and people can ask their local genitourinary medicine clinic whether there is a group in their area. If there is no group, individuals can still benefit from speaking to others who have the virus. This may be possible by contacting a local helpline or by finding health care providers who are aware of HPV and can take the time to listen to their patients' concerns.

Counseling for people with genital warts is often provided by the same health care provider who treats the warts. It may involve educating the patient about the virus and its effects, giving the patient an opportunity to express feelings about having the virus, and helping the patient find ways to cope with the issues the virus raises. POSITIVE is a patient-led support organization established in 1996 to provide support and information for persons affected by HPV. (In this context, the term "persons affected by HPV" includes anyone with an HPV infection or HPV-related disease and their loved ones.) Support group meetings are held in various cities in the UK and are confidential and informal. They provide an opportunity to share experiences in a safe and understanding environment. The meetings promote self-help and the exchange of information on medical and alternative treatments. In addition to meetings, the POSITIVE Support Line provides support and information via a telephone answering service and a confidential callback facility. Information literature is also available to all members.

Support and counseling for genital warts are becoming more widely available. This is because many doctors are coming to recognize that the physical effects of genital warts are only part of the burden the disease places on people. Many individuals with genital warts become depressed and feel "dirty" or ashamed. Some feel that they have let down their partners, and a few have experienced rejection from a loved one. It is common for people to feel angry or upset about having a disease that affects their private or sensual lives. For some, the knowledge that they have a virus that can be spread to others is one of the most difficult parts of the diagnosis. Treatment and prevention can be stressful because it may involve facing the reasons the patient became infected and taking steps to avoid re-infection.