Hysteroscopy

Genital Warts

Genital warts, also called condylomata, is a common infection of the female
reproductive tract. There are a number of myths surrounding this complicated infection, and a discussion of genital warts, including the common symptoms, diagnostic tests available, and treatment options can help women gain the knowledge necessary to understand this condition.

We are unsure of how many women are infected with the virus, HPV, that causes genital warts. Some medical studies show that 1 out of every 10 women has HPV, while others reveal an incidence of up to 1 out of every 2 (50%)! HPV, short for Human Papilloma Virus, is a virus that can infect humans through sexual contact, or, less commonly, through prolonged exposure to such things as shared underwear or swimming clothes. There are over 70 different types of this virus.

Like most viruses HPV can infect someone without that person knowing it, and can "set up shop" inside their body for many years before causing symptoms. In some lucky individuals, HPV is present in their tissues but never causes symptoms. (In these people sophisticated and expensive diagnostic tests can sometimes reveal the presence of HPV). In others HPV causes abnormal Pap smears. This is the number one cause of highly abnormal Pap smears, although there are certainly other causes of abnormal Pap smears. Patients often have a difficult time understanding that HPV
can cause abnormal Pap smears without any warts being present. In fact, this is the most common situation, and in my experience most women with bad Pap smears have never had a genital wart.

HPV can also cause genital warts, which are usually small, wartlike growths that can develop anywhere on the female genital organs. Warts may develop in the vagina, on the labia (lips of the vagina), or around the anus. In men, warts may develop on the shaft of the penis, in the hair at the base of the penis, or on the "head" of the penis. Again, it is extremely important to remember that many, if not most, women who are infected with HPV will never develop genital warts or any other symptoms. Of course, it is impossible to predict who will or who will not develop genital warts.

Those women who get genital warts usually report one or more "bumps" on the vaginal lips or near the anus that are nontender and slightly raised. They look like warts that may occur elsewhere on the body. On some occasions the warts will brush against clothing and become irritated, causing bleeding or tenderness. While many women report only 1 or 2 warts, others will note numerous warts, or clusters of warts here and there. There are specific situations that may cause warts to grow to a large size, including during pregnancy or in women who have AIDS, leukemia, or
other immune system illnesses. In some patients there are no external warts, but rather internal (vaginal) warts.

Your physician or other health care provider will need to examine your pubic hair region, labia, anal area, and vagina. This is usually a painless exam. You may want to perform your own genital self examination with a mirror prior to visiting your health care provider, to help him or her locate all of the warts. In rare cases a biopsy, using novocaine and a small needle, will be necessary, but most health care providers who treat women are experienced at diagnosing this condition without a biopsy.

There are a number of treatment options for genital warts. HPV can probably never be completely removed from the body, since viruses are extremely difficult to eradicate. However, warts can be treated using medications applied to them, or special injections at the base of the warts, or by removal. In some cases a laser can be used to remove the warts. The best treatment will depend on the number of warts and their location. If possible, your health care provider will try to apply an acid solution (called TCA) or a brownish liquid (called podophyllin) to the warts to "melt"
them. This may take a few weeks of treatment. If this does not work, they can be frozen just like warts on other parts of the body. (Warts elsewhere on the body are usually caused by viruses other than HPV). Another alternative is to excise them using an electric wire or a pair of surgical scissors. The last two treatment options are more involved and more expensive. You doctor may choose to inject small doses of Interferon, a chemical that alters the immune system, into the base of each wart. This
is expensive and is usually not the first choice for treating genital warts. Laser is also expensive, but is very useful for removing warts within the vagina or anal canal, or for patients with a large number of warts. This is usually done in the operating room under anesthesia. None of these treatments are necessarily "better" than another, but each patient will find that one works best for her individual situation.

While warts can be treated, they may return in the future. If so, retreatment will take care of the problem. Women with genital warts require at least annual Pap smears and physical examinations. This will depend on your medical history and whether or not your Pap smears have been normal. As with most medical conditions, prevention is vitally important. Unfortunately, preventing genital warts is difficult. Latex condoms may prevent infection but are not guaranteed to do so. Choosing a monogamous partner is always a safe idea, and will certainly decrease the risk of xposure to HPV.

If you believe you have genital warts please make an appointment with your physician or other health care provider for an examination and to discuss treatment options. With appropriate treatment it is almost always possible to remove these troublesome warts. Afterwards, you will want to examine yourself every month or so to make sure there is no recurrence of the warts.

D. Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, Florida
407-897-1668