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active  Topic # 68

11/09/2016 @ 7:20 PM
by NHS_UK

Anonymous

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Introduction 

Genital warts are small fleshy growths, bumps or skin changes that appear on or around the genital or anal area.

Genital warts are very common. In England, they are the second most common type of sexually transmitted infection (STI) after chlamydia.

Genital warts are the result of a viral skin infection caused by the human papilloma virus (HPV). They are usually painless and do not pose a serious threat to health.

But they can be unpleasant to look at and cause psychological distress.

There is no evidence that your fertility will be affected by genital warts.

Symptoms of genital warts 

Most people who have an HPV infection will not develop any visible warts. If genital warts do appear, it can be several weeks, months or even years after you first came into contact with the virus.

The warts may appear as small, fleshy growths, bumps or skin changes anywhere on the genitals or around the anus. In some cases, the warts are so small they are difficult to notice.

A person can have a single wart or clusters of multiple warts that grow together to form a kind of "cauliflower" appearance.

Warts in women

The most common places for genital warts to develop in women are:

  • around the vulva (the opening of the vagina)
  • on the cervix (the neck of the womb)
  • inside the vagina
  • around or inside the anus
  • on the upper thighs

Warts in men

The most common places for genital warts to develop in men are:

  • anywhere on the penis
  • on the scrotum
  • inside the urethra (tube where urine comes out)
  • around or inside the anus
  • on the upper thighs

Other symptoms

Warts are usually painless, although on some people they can become itchy and inflamed. If a wart becomes inflamed, it may lead to bleeding from the urethra, vagina or anus.

The urethra is the tube connected to the bladder, which urine passes through. Warts that develop near or inside the urethra can also disrupt the normal flow of urine.

Treating genital warts 

Treatment for genital warts depends on the type of warts you have and where they are located. You do not need treatment if there are no visible warts.

There are two main types of treatment for genital warts:

  • applying a cream, lotion or chemical to the warts (topical treatment)
  • destroying the tissue of the warts by freezing, heating or removing them (physical ablation)

Most topical treatments tend to work better on softer warts, and physical ablation tends to work better on harder and rougher-feeling warts. Sometimes, a combination of topical treatments is recommended.

For some people, treatment can take several months to remove the warts, so it is important to persevere.

You may be advised to avoid perfumed soap, bath bubbles or lotions while you are having treatment for warts as these can sometimes irritate the skin.

Topical treatment

There are several topical treatments that can be used to treat genital warts. Some creams can weaken latex condoms, diaphragms and caps. Remember to check this with the doctor or nurse, who can advise you.

Topical treatments are described below.

Podophyllotoxin

Podophyllotoxin is usually recommended to treat clusters of small warts. It comes in liquid form and works by having a toxic (poisonous) effect on the cells of the warts.

A special application stick is used to draw up the correct dosage of the liquid, which is then dripped on to the wart.

You may experience some mild irritation when you apply the liquid or cream to the wart. Cream is usually advised for areas where applying liquid is difficult.

Treatment with podophyllotoxin is based on cycles. The first treatment cycle involves applying the medication twice a day for three days.

This is then followed by a rest cycle where you have four days without treatment. Most people require four to five treatment cycles separated by rest cycles.

Podophyllotoxin should not be used if you are pregnant.

Imiquimod

Imiquimod is a type of cream usually recommended to treat larger warts.

It works by helping stimulate your immune system into attacking the warts. You apply the cream to the warts and then wash it off after 6 to 10 hours. This should be done three times a week.

You may experience skin irritation after you apply the cream. Usually this is mild, but contact the doctor or clinic if it does not improve.

It can often take several weeks of treatment before you notice an improvement in your warts.

Imiquimod is not usually used if you are pregnant.

Trichloroacetic acid

Trichloroacetic acid (TCA) may be recommended to treat small warts that are very hard. 

It works by destroying the proteins inside the cells of the wart. But if it is not applied correctly, TCA can damage healthy skin.

TCA is thought to be safe to use during pregnancy.

It is not recommended that you apply TCA yourself. Instead, you will be asked to visit your local GUM clinic once a week so a doctor or nurse can apply the medication.

After TCA is applied, some people experience an intense burning sensation for around 5 to 10 minutes.

Physical ablation

There are four main methods used in the physical ablation of genital warts. They are:

  • cryotherapy
  • excision
  • electrosurgery
  • laser surgery

These treatments are performed by a trained doctor or nurse.

Cryotherapy

Cryotherapy involves freezing the wart using liquid nitrogen and is usually recommended to treat multiple small warts, particularly those that develop on the shaft of the penis or on, or near, the vulva.

During cryotherapy treatment, you will experience a mild to moderate burning sensation.

Once the treatment has finished you may develop skin irritation, blistering and pain at the site of the wart. Your skin will take between one and three weeks to heal.

Avoid having sex until the area of skin around the wart has fully healed.

Excision

Excision, where warts are cut away, is sometimes recommended to treat small hardened warts, particularly where this is a combination of smaller warts that have joined together to form a sort of cauliflower shape.

At the start of the procedure, you will be given a local anaesthetic to numb the area of skin around the wart. The wart will then be cut away with a surgical scalpel and the remaining incision sealed with stitches.

Excision can cause scarring, so it may not be suitable for very large warts. The area of skin where the wart was removed will be sore and tender for around one to three weeks.

You should avoid having sex until the area of skin around the wart has fully healed.

Electrosurgery

Electrosurgery is a specialist treatment. It is often combined with excision to treat large warts that develop around the anus or vulva that have failed to respond to topical treatments.

Excision is first used to remove the outer bulk of the wart. A metal loop is then pressed against the wart. An electric current is passed through the loop to burn away the remaining part of the wart.

Removing a large number of warts in this way can be quite painful, so you may be given a regional anaesthetic (where everything below your spine is numbed, similar to an epidural during pregnancy) or even a general anaesthetic.

Laser surgery

Laser surgery is also a specialist treatment. It may be recommended to treat large genital warts that cannot be treated using other methods of physical ablation because they are difficult to access, such as warts deep inside your anus or urethra (the tube that connects the bladder to the penis or vulva, which urine passes through).

During the procedure, a surgeon will use a laser to burn away the warts. Depending on the number and size of the warts, laser surgery can be performed under either a local or general anaesthetic.

As with other types of ablation treatment, you should expect soreness and irritation at the site where the warts were removed. This should heal within two to four weeks.

Genital warts and sex

It is recommended you do not have sex, including anal and oral sex, until your genital warts have fully healed.

This will help prevent you passing the infection on to others. It will also help your recovery, as the skin friction that occurs during sex can cause treated skin to become irritated and inflamed.

Even after the warts have gone, there may still be traces of human papilloma virus (HPV) in your skin cells. It is therefore recommended you use a condom during sex for the first three months after the warts have cleared up.

Smoking

For reasons that are still unclear, many treatments discussed on this page are more effective in non-smokers than in smokers.

If you are a smoker, quitting smoking may help speed up the healing process after treatment for genital warts.

Quitting smoking will also bring a range of other important health benefits, such as significantly reducing your risk of developing lung cancer and heart disease.

The NHS Smokefree website provides support and advice for people who want to stop smoking. Your GP will also be able to prescribe medication that can help you quit.

See treatment for quitting smoking for more information.

When to seek medical advice

You should always seek medical advice if you suspect you have genital warts, or a recent or current sexual partner develops genital warts.

Even if no warts have developed, you can be given advice on how to check yourself and what to do if they appear. 

Treatments are only available with a prescription and may need to be applied by a nurse or doctor. It is also important to get a proper diagnosis in case the growth is not a genital wart.

If you do need a prescription treatment for warts, these are free from sexual health and genitourinary medicine (GUM) clinics.

Find sexual health services near you, including sexual health and GUM clinics.

Read more information about diagnosing genital warts.

It is recommended you avoid having sex until your genital warts are fully healed.

The human papilloma virus (HPV)

The HPV is not a single virus, but a family of more than 100 different strains of viruses. Different strains usually affect different parts of the body, including the hands or feet.

Although around 30 different types of HPV can affect the genital skin, most cases of infection with HPV cause no visible symptoms. Around 90% of all cases of genital warts are caused by two strains of the virus – type 6 and type 11.

The types of HPV that cause visible genital warts do not cause genital cancer. Other strains of HPV can cause cervical cancer.

How do they spread?

Genital warts can be spread during vaginal or anal sex, and by sharing sex toys. But you don't need to have penetrative sex to pass the infection on because HPV is spread by skin-to-skin contact.

Read more about the causes of genital warts.

It can take months, or even years, for warts to develop after infection with HPV. So if you're in a relationship and you get genital warts, it does not necessarily mean your partner has been having sex with other people.

HPV is most likely to be transmitted to others when warts are present, although it is still possible to pass the virus on before the warts have developed and after they have disappeared.

Condoms do not provide complete protection because it is possible for the skin around your genital area not covered by the condom to become infected.

Read more about preventing genital warts.

Treating genital warts

If you think you have genital warts, see a health professional as they may need to be treated. It is possible to have more than one STI at a time, so if you think you have warts, it is a good idea to have a check-up.

You can make an appointment at your local sexual health or genitourinary medicine (GUM) clinic.

You can go to a sexual health clinic whatever age you are. If you're under 16, the service is still confidential and the clinic won't tell your parents. Find your local sexual health or GUM clinic.

The treatment for genital warts depends on how many warts you have and where they are. Several treatments are available, such as liquids or creams and freezing the warts (cryotherapy).

You should not use wart creams that are available over the counter because they are designed to only treat warts on the hands or verrucas.

If you are diagnosed with genital warts, it is recommended you do not have sex, including anal and oral sex, until your genital warts have fully healed. This will help prevent you passing the infection on to others. It will also help speed up your recovery.

Learn more in treating genital warts.

Will the warts come back?

Some people only ever get one episode of genital warts. For many others, the warts will come back weeks, months or years later.

If you do develop a new wart, it is not possible to say if these are a result of the original infection or a new infection with HPV.

Who is affected?

Both men and women can be affected by genital warts. According to Public Health England, in 2012 there were 73,893 new cases of genital warts diagnosed by GUM clinics in England. This compares with 206,912 new cases of chlamydia in 2012.

Genital warts are most common in sexually active teenagers and young adults. The highest rates of genital warts occur in men aged 20 to 24 years and women aged 16 to 19 years.

HPV vaccinations

HPV vaccines in the UK are offered to all girls in year 8 (aged 12 to 13 years).

Since September 2012, the vaccine Gardasil has been used and can help protect against HPV types 6 and 11, which cause around 90% of genital warts. It also protects against types 16 and 18, which are linked to more than 70% of cases of cervical cancer in the UK.

Before September 2012, a different vaccine called Cervarix was used to protect against HPV types 16 and 18.

HPV vaccines cannot protect against all types of HPV. If you are a woman and have received HPV vaccinations, you should still attend cervical screening (smear tests) as the vaccines do not guarantee that you will not develop cervical cancer in the future.

Read more about cervical screening.

Web site NHS_UK
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