Genital Warts Treatment

Genital warts (GW) are sexually transmitted disease caused by human papillomaviruses (HPV). Usually they are asymptomatic but, depending on the size and location, may be painful or itchy. If left untreated, visible genital warts can resolve on their own, remain unchanged, or increase in size or number. Before the treatment is started, the physician should fully assess the entire lower genital tract, including performing a Pap smear, to rule out the presence of a cervical lesion (carcinoma).

There are many modalities for treating genital warts, depending on the morphology, number and distribution of warts and patient preference. However, none of them provide 100% chance of clearance or 0% chance of recurrence. Also, there is no clear evidence that any one treatment is superior to the others.

Therapy may be applied by the patient or by the provider. A treatment response is usually seen within 3months.

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HPV vaccines have been touted as vaccines that would put an end to cervical cancer. But what are they, are they safe, why were they ‘fast-tracked’ by the FDA, and why is vaccination against this rare cancer being pushed by doctors and governmental agencies?

HPV stands for Human Papillomavirus, which is a virus that establishes infections through the skin and mucous membranes. There are about 200 strains of HPV, many of which cause no symptoms at all in humans. Some, however, are known to cause warts, including genital warts, and infections that can lead to cervical and other cancers.

Around 40 HPV strains can be transmitted via sexual contact and certain ‘high-risk’ HPV viruses are thought to be the main cause of cervical cancer in women. They may also cause other genital cancers such as penile, vulvar, vaginal, anal, and cancers of the head and neck. Most infections with these viruses do not, however, lead to serious disease.

Due to intervention of the immune system, 70% of infections by the HPV virus resolve by themselves within one year and 90% resolve within two years. In about 5-10% of infected women, the infection can lead to precancerous lesions or invasive cancer of the cervix. This process is a very slow one, thought to take at least 5-15 years for detectable changes to develop in the cervix.

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Genital warts is a health subject that those who are (or who are about to become) sexually active should be familiar with. Genital warts are caused by certain types of Human Papillomavirus (HPV). HPV is a virus that can be contracted by direct genital contact such as vaginal and/or anal sex. The Centers for Disease Control and Prevention (CDC) reports that at least 50% of sexually active people will get genital HPV

The types of HPV that are associated with the visible skin changes known as genital warts fall into the low risk category. This means that genital warts do not put a person at increased risk for cancer. Genital warts are visible growths or bumps that can be raised or flat, small or large, and singular or multiple in number. External warts can be found on the penis, vulva, scrotum, and surrounding skin tissues. Internal warts can be found on the cervix, vagina, urethra, and anus. Often genital warts go unnoticed, but they can be painful, itchy, and bleed easily.

Genital warts can be prevented by abstinence (not having sex). A vaccine is available for women aged 9-26 that prevents certain types of HPV thus reducing the risk of having genital warts. The risk of contracting genital warts can further be reduced by using condoms, and keeping the number of sexual partners you have in your lifetime to a minimum (the partner you select should also have had minimal partners).

While Genital warts may go away on their own, a number of treatment options are available to remove them. When considering the option of having genital warts removed it is important to remember that removal of the wart or warts does not eliminate the HPV infection. Removal also does not prevent the transmission of HPV.

Two self applied treatments that are available are Podofilox and Imiquimod. These medications are well studied and considered easy to use. Podofilox is applied to the warts twice a day for three days followed by 4 days of no medication. This weekly cycle is repeated for up to a month. Imiquimod is applied to warts once a day, three times a week, for up to 16 weeks. Both of these medications can cause local skin irritation and redness with mild to moderate pain during their use. Prior to using these medications a healthcare provider will need to give instructions on their proper application. Alternative provider administered treatments to remove genital warts include cryotherapy, the application of topical medications, interferon therapy, and surgery.

There is a newer third option for self treatment called Wartrol. Wartrol is an alternative treatment  based on homeopathic philosophy. Some studies have shown a positive response from this treatment. More information can be found here.

Cryotherapy is completed with liquid nitrogen or a cryo-probe. Often repeat visits are needed every 1-2 weeks. With cryotherapy over or under treatment is possible. Temporary side effects of this type of therapy include pain, blistering, and an area of blackened dead skin. Cryo-probe use for vaginal warts is not recommended due to the potential for serious complications.

Topical medications a provider can apply to genital warts include Podophyllin resin, Trichloroacetic acid (TCA) and Bichloroacetic acid (BCA). These three topical medications all require weekly applications by the clinician. TCA and BCA are both widely used, but have not been thoroughly studied.

Interferon therapy to remove genital warts has been attempted. Systemic interferon therapy is not recommended as its effectiveness is poor. However, interferon injections directly into the wart itself have proven to be effective. The use of interferon injections requires numerous office visits and is associated with several systemic side effects.

Surgery to remove genital warts can be completed in numerous ways (including via laser) by a skilled healthcare provider. Surgery can be an ideal option for patients with numerous or large warts. Surgery is also the only treatment option that can generally remove a wart with only one visit.

Whatever treatment option is selected follow-up consultation after three months to evaluate effectiveness and assess for reoccurrence is recommended. Genital warts and HPV may not be a subject you feel comfortable discussing, but it is a subject you should educate yourself on. An open discussion with your healthcare provider can help you decide if you want to attempt treatment and which treatment might be best for you.

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