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Causes of genital warts and how to treat them

In the United States, about 1.4 million people have genital warts at any given time and about 360,000 cases of genital warts each year. In the United States, there are about 14 cases of sexually transmitted HPV each year. By age 50, about 80% of sexually active women have at least one genital HPV infection.

Most HPV infections clear up on their own within 1 to 2 years, but some persist.

I. Cause

There are about >100 known types of HPV. Some cause skin warts. Some damage mainly the skin and mucous membranes of the genital area.

Important manifestations of genital HPV include

Genital warts (genital warts)
Carcinoma and cancer of the cervix, anus, or penis
Bladder cancer and oral cancer
Bowenoid papulosis

Genital warts are the most common benign genital warts caused by HPV types 6 and 11. Endothelial cancer and low-grade and high-grade carcinomas can be caused by HPV. Almost all cervical cancers are caused by HPV; about 70% are due to types 16 and 18, and the majority to types 31, 33, 35, and 39. HPV types that affect mainly the genital area can be transmitted to the oropharynx by contact genital; Type 16 seems to be responsible for many cases of oropharyngeal cancer. HPV types 16 and 18 can also cause cancer in other areas, including the vulva, vagina, and penis.

HPV is transmitted from lesions during skin-to-skin contact. Types affecting the genital area are usually sexually transmitted or vaginally penetrating anal passages, but may involve digital, oral, and nonpenetrative genital exposure.

Genital warts are more common in immunocompromised patients. Growth rates vary, but pregnancy, immunosuppression, or damage to the skin can accelerate the growth and spread of warts.

II. Signs and symptoms

Warts appear after an incubation period of 1 to 6 months.

Visible genital warts are usually soft, moist, less pink or gray (growing lesions)


  • Can become stalked
  • Has a rough surface
  • Can form clusters

Warts are usually asymptomatic, but some patients have itching, burning, or discomfort.

In men, warts occur most commonly under the foreskin, on the cervical fissure, in the urethra, and on the shaft of the penis. They can occur around the anus and rectum, especially in homosexual men.

In women, warts most commonly occur on the vulva, vaginal wall, cervix, and perineum; The urethra and anus may be affected.

HPV types 16 and 18 often cause flat anal or endometrial warts that are difficult to see and diagnose clinically.

III. Treatment

Mechanical removal (eg, by cryotherapy, electrocautery, laser, or surgical excision)
Topical treatment (eg, with antibiotics, caustics, or interferon stimulants)
No treatment for anal warts is completely satisfactory, and recurrences are frequent and require re-treatment. In immunocompromised individuals, genital warts may resolve without treatment. In immunocompromised patients, warts may be less responsive to treatment.

Because no treatment is clearly more effective than other treatments, treatment of genital warts should be guided by other considerations, primarily the size, number, and anatomical location; patient preference; treatment costs; convenient; side effects; and practitioner experience (see Centers for Disease Control and Prevention (CDC) 2015 STDs Treatment Guidelines: Anogenital Warts).

Genital warts can be removed by cryotherapy, electrocautery, laser, or surgical excision; Local or general anesthesia is used depending on the size and amount to be cut. Endoscopic excision may be the most effective treatment; a general anesthetic is used.

Local antineoplastics (eg, podophyllotoxin, podophyllin, 5-fluorouracil), caustics (eg, trichloroacetic acid), interferon anesthetics (eg, imiquimod), and sinecatechins (a newer botanical product of unknown mechanism) ) is widely used but often requires weeks of use and is often ineffective. Before topical treatments can be applied, surrounding tissues need to be protected with coagulants. Patients should be warned that after treatment, the area may be painful.

Interferon alfa (interferon alfa-2b, interferon alfa-n3), intralesional or intramuscularly, clears incurable skin and genital lesions, but with optimal use and long-lasting effects length is not clear. In addition, in some patients with neuroblastoma (caused by HPV type 16), the initial lesion disappeared after treatment with interferon alfa but reappeared as invasive cancer.

For lesions in the urethra, thiotepa (an alkylating drug), injected into the urethra, is effective. In men, using 5-fluorouracil two to three times daily is highly effective for urethral lesions, but rarely, it causes swelling, leading to urethral obstruction.

Cervical lesions should not be treated until the results of the Papanicolaou (Pap) test rule out other cervical abnormalities (eg, dysplasia, cancer) that may require additional treatment.

By removing the moist surface under the foreskin, circumcision can prevent recurrence in uncircumcised men.

Sex partners of women with cervical warts and patients with bowen's cyst should be counseled and screened regularly for HPV-associated lesions. The same approach can be used for HPV in the rectum.

Current sexual partners of someone with genital warts should be tested, and if infected, treated.

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