Are genital warts sexually transmitted?
A penile wart, or a genital wart, is a common sexually transmitted infection caused by the human papillomavirus (HPV).
There are more than 100 types of HPV, and at least 40 of these can infect the genital area.
The types of HPV infections that cause genital warts are mainly types 6 and 11, which account for 90% of all genital warts. However, other HPV can develop genital warts.
It is important to note that the wart virus is transmitted from oral sexual contact and skin-to-skin contact.
What are the causes and risk factors?
The risk factors for contracting HPV and developing genital warts include;
- Having unprotected sex with an infected sexual partner.
- Having multiple sexual partners.
- Having a weakened immune system.
- General risks include smoking, poor nutrition, and stress.
How are genital warts transmitted?
Genital warts are highly contagious and can be transmitted through sexual or genital contact with an infected person, including vaginal, anal or oral sex.
The virus can also be spread through skin-to-skin contact with the affected area, even if there are no visible warts.
What are the symptoms of genital warts?
It is a small, flesh-coloured or grey bump that appears around any part of the genital area and may have a cauliflower-like appearance.
Genital warts are usually painless but can cause itching, discomfort and bleeding during sexual activity.
Physical examination and diagnostic tests
During a physical examination, the healthcare provider will visually inspect the genital area for the presence of warts. They may also ask about symptoms such as itching, burning, or pain.
If warts are present, the provider may perform a biopsy, which involves removing a small tissue sample from the affected area for laboratory analysis. The biopsy can confirm the presence of HPV in the tissue sample, diagnose warts and help rule out other conditions, such as cancer.
Differential diagnosis
Other conditions that can present similarly to penile warts include:
Molluscum contagiosum: It can appear as small, smooth, pearly or flesh-coloured bumps with a central dimple or indentation. These bumps can be spread through sexual contact and may appear on other body parts. The Molluscum contagiosum virus is what causes this viral skin infection.
Pearly penile papules: These are small, harmless, dome-shaped bumps that can appear around the rim of the head of the penis. They are not sexually transmitted infections but somewhat normal variants of the anatomy of the penis.
Sebaceous glands: These are small, harmless, white or yellow bumps that can appear on the shaft of the penis. They are not sexually transmitted infections; rather, overactive sebaceous glands that produce an oily substance are the cause.
Fordyce spots: These are small, harmless, raised, yellow or white spots that can appear on the shaft or head of the penis. Enlarged oil glands cause them and are not a sexually transmitted infection.
What are the medical treatments available?
Topical treatment for genital warts
Topical treatments are a standard and effective option for treating penile warts caused by human papillomavirus (HPV). These medications are applied directly to treat genital warts and work by destroying the infected tissue. Several topical treatments are available for genital warts, including immunomodulators, keratolytic, and cytotoxic agents.
1. Immunomodulators
Imiquimod is an immunomodulating cream that is used to treat genital warts. It stimulates the immune system to produce cytokines, which activate immune cells to attack and destroy the HPV virus.
Instructions for safely using Imiquimod cream:
Before and after using the cream, wash your hands thoroughly with soap and water.
Gently apply a thin layer of the cream to the affected skin area just before going to bed.
Leave the cream on the treated skin for 6 to 10 hours (for genital warts) without getting the area wet by bathing, swimming, or other means.
After the recommended time has passed, wash the treated area with mild soap and water.
If treating genital warts under the foreskin, uncircumcised men should clean the area daily by retracting the foreskin.
Any unused cream from a single-dose packet should be discarded.
It's important to avoid using other products containing imiquimod in the same treatment area, as this may increase the risk of serious side effects.
Do not use it inside the penile urethra or back passage.
Dosage and frequency:
Imiquimod cream should be applied topically to the affected area three times a week for up to 16 weeks (Aldara) or daily for up to eight weeks (Zyclara). While generally well-tolerated, typical side effects include redness, itching, and irritation.
2. Keratolytics
Podophyllotoxin is a keratolytic agent that is used to treat genital warts. It works by breaking down the structure of the wart cells, causing them to die and slough off.
Podophyllotoxin can cause local skin irritation and should not be used in pregnant women.
How to use Podophyllotoxin ?
Wash hands and affected area with mild soap and water before use.
Apply podophyllotoxin cream or solution twice daily for three consecutive days.
Allow four days without treatment.
Repeat the cycle until the warts have gone (usually 4-5 weeks).
If using the solution, use the applicator to touch the wart only and allow it to dry. If using cream, apply with a fingertip and wash hands after use.
Avoid using on raw, bleeding or healthy skin surrounding warts.
Do not use it inside the penile urethra or back passage. Be careful not to get into eyes accidentally. If cream or solution gets on healthy skin, wash with water.
Trichloroacetic acid (TCA) is another keratolytic agent used to treat genital warts. It destroys the infected tissue, causing the wart cells to break down and slough off. TCA is applied topically to the affected area once a week for up to six weeks. TCA can cause local skin irritation and should be used cautiously in patients with sensitive skin.
3. Cytotoxic agents
Bleomycin is a cytotoxic agent that is used to treat genital warts. It works by disrupting the DNA of the HPV virus, causing the infected cells to die. Bleomycin is injected directly into the wart tissue once a week for up to six weeks. Local skin irritation is common, and more severe side effects, such as systemic allergic reactions, are rare.
4. Interferon
Interferon is a medication that can stimulate the immune system to fight off viruses and other infections. In the treatment of genital warts, interferon is used to trigger an immune response that can help to clear or get genital warts back.
Interferon injections are the most effective way to administer medication for genital warts. A healthcare professional usually gives the injection in a clinic or hospital setting.
The frequency of injections can vary, but typically, interferon injections are given two or three times a week for up to three months. The number of injections required may depend on the severity of warts and how well the patient responds to the treatment.
One potential downside of interferon injections is that they can be painful. Some patients report experiencing pain, swelling, and redness at the injection site. However, the pain is usually mild and short-lived. Other common side effects of interferon include fatigue, flu-like symptoms, headaches, and fever. In some cases, interferon can cause more severe side effects, such as depression, anxiety, or liver damage.
5. Sinecatechins
Sinecatechins (e.g., Veregen) is an effective botanical product for treating penile warts. The exact mechanism of action of catechins is unknown, but they have both antioxidant and immune-enhancing activity. The ointment is self-administered and placed on each external wart three times daily for up to 16 weeks.
However, it is essential to note that Sinecatechins should not be used on warts inside the penile urethra or back passage. It should also not be used in immunocompromised individuals or individuals with active herpes.
Before sexual contact, the ointment should be washed off the skin to avoid irritation.
Additionally, Sinecatechins can weaken the latex in condoms and diaphragms, so it is recommended to use alternative forms of contraception during treatment.
Surgical procedures to remove warts
Some surgical treatments can be performed in a medical office, while others require an operating room. However, surgical treatments for genital warts are generally considered safe.
Surgical treatments may be recommended when:
· Warts are unresponsive to medical therapy.
· Large areas of warts are present, as medical therapy alone may not be sufficient.
· Warts are located in the urethra or back passage.
· Areas have precancerous changes in addition to warts.
Cryotherapy:
Cryotherapy is a standard surgical treatment for warts. The procedure involves applying liquid nitrogen or another chemical to the wart, freeing and destroying the wart tissue. Cryotherapy can be performed in the doctor's office or theatre and usually does not require anaesthesia. However, the procedure can be painful, and some patients may experience skin irritation, swelling, blistering, and ulceration after the treatment.
Electrocautery:
Electrocautery is another surgical treatment for warts. This procedure involves using electrical energy to burn away the wart. The treatment for genital warts is usually performed in the doctor's office or theatre using local anaesthesia to prevent pain. Electrocautery is effective in removing warts, but it can be painful and may cause scarring. Some patients may experience bleeding or infection after the procedure.
Excision:
Excision involves using surgery to remove the wart from the skin physically. This procedure typically uses local or general anaesthesia to prevent pain in an operating room, or if done under local anaesthetic, it can be performed in a doctor’s office. Excision is often recommended for warts that do not respond to other treatments, particularly large or deep ones. However, excision removal of genital warts can be painful, and some patients may experience scarring or infection after the procedure.
Laser treatment:
Laser treatment involves using a high-intensity beam of light to destroy the wart. This procedure usually uses local anaesthesia to prevent pain in an operating room. This wart treatment is typically reserved for warts that have not responded to other treatments or for particularly large or deep warts. This is effective in removing warts, but it requires specialised equipment and training to perform. Some patients may experience scarring, bleeding, or infection after the procedure.
How to deal with warts that come back
Even though most genital warts treatment are effective in some patients, they recur. This causes great distress.
If you are sexually active and have warts that come back;
- Ask the sexually active people or partners you are involved with to get checked at the many sexual health clinics available. Using a condom is not enough, as genital warts spread through oral sex, anal sex and genital contact.
- Try a different treatment. If you have been treating your wart with the same medication or method, it may be worth trying a different treatment option.
How to stop genital warts from being passed on.
HPV vaccine
HPV types 6 and 11 cause around 90% of genital warts.
The quadrivalent (Gardasil) and 9-valent (Gardasil 9) HPV vaccinations are available for preventing genital warts. The Gardasil HPV vaccine targets four types of HPV, while Gardasil 9 HPV vaccine adds five additional types.
However, the vaccines do not treat an HPV infection or warts that have already occurred.
There is a role for HPV vaccination of boys and young adult men. This not only lowers the risk to pass HPV, decreases the risk to develop genital warts, and lowers the risk of genital skin cancer. Discuss vaccination in boys and young males with your doctor.
Safe sex practices to prevent genital warts
To reduce the risk of becoming infected with HPV, avoid sexual contact with sexual partners with genital warts or HPV. However, many people are infected with HPV and do not have visible genital warts, making it difficult to avoid. In addition, small external genital warts may be difficult to see. If you have an active sexual lifestyle, regularly visit a sexual and reproductive health clinic to get screened is a safe practice.
Condoms are not foolproof protection against warts or genital HPV infection, as areas not covered by the condom can still spread the virus from one person to another.
If you use sex toys and you have been diagnosed with genital warts, once you remove genital warts, make sure that the sex toys should be cleaned properly after each use.
If you doubt you have HPV or genital warts, visit a sexual health clinic.
Genital warts and cancer
In females, HPV infection can lead to cervical cancer. Similarly, in males, HPV infection or genital warts increases the risk of penile cancer.
Having genital warts does increase the risk of developing penile cancer, but the overall risk is still relatively low. According to the American Cancer Society (ACS), only a tiny percentage of men with genital warts will develop penile cancer.
If you have a history of genital warts or HPV infection, it is recommended to screen yourself regularly.
