genital warts

Summary Genital Warts

Genital warts are also known as condylomata acuminata or cockscombs, it is a disease caused by the papilloma virus (HPV), where the main symptomatology (the warts) appears in the genital area of ​​both men and women (vulva, urethra, penis, vagina or cervix).
HPV provokes the proliferation of attacked cells, causing tumors that can be benign genital and anal warts or malignant that can develop into cancer. There are more than 70 subtypes of HPV, subtypes 6 and 11 are the most frequent in cases of genital warts and are slightly carcinogenic. Fortunately subtypes 16 and 18, which have a higher risk of becoming malignant (causing cancer ), are rare. But all subtypes can cause cancer in the long term.

The main route of infection of genital warts is through direct skin-to-skin contact, especially during sexual intercourse (all types of sexual intercourse) , which is why it is a sexually transmitted disease (STD). It is not possible to get infected through objects such as toilet seats.

It should be noted that the symptoms are not always present, which makes sexual transmission even more problematic, as many times the person is a carrier of the virus and does not know it. Being asymptomatic, they do not think about protecting themselves and, therefore, about protecting their sexual partner. So when it comes to genital warts, the partner should also be examined. In addition, mechanical protection (condom) is not always sufficient, as warts may be present beyond the reach of the condom.

Treatments for genital warts act by slowly destroying them or causing the body to attack them, but they do not necessarily get rid of the HPV virus, which is why it is important to observe the appearance of new warts for up to 2 years after infection, after During this period the body usually expels the virus naturally.
There are several drug treatments in the form of solutions, lotions, gels or creams. In addition to conventional surgery, cryotherapy, electrical cautery or laser surgery, ultrasound surgery.
The best prevention is through the Gardasil® vaccine, which prevents HPV types 6, 11, 16 and 18 infections and is also used to prevent cervical cancer . This vaccine is recommended for people between 9 and 26 years old.

Definition

Genital warts, as the name suggests, are warts that appear on Organs genitals of both men and women. Examples of this occurrence are condylomata acuminata and cockscomb. These are warts whose cause is viral and are located on the genital mucosa. This virus has the property of causing an excessive growth of skin cells (epithelial cells), causing a thickening of the mucosa. The appearance of genital warts is characteristic in the form of “cauliflower” or “cockscomb”, hence their names.

The virus responsible for genital warts, the papillomavirus (HPV for Human Papillomavirus), has more than 70 subtypes, usually type 6 or 11, which are slightly carcinogenic. Rarely, the virus responsible for genital warts is subtype 16 or 18, which can become malignant, in  cervical cancer , after ten years.

Epidemiology

Genital warts are caused by the human papillomavirus (HPV). Type 6 and 11 viruses are the most commonly found in genital lesions and are considered low risk for cancer . Types 16, 18, 31, 33, 45, 58 and others are considered high risk and are constantly found in precancerous lesions.
Despite affecting both sexes, women apparently represent the majority (67%) among people who have symptoms. Its prevalence in sexually active women ranges from 10 to 50%. Currently, the incidence has increased, reaching about 50% of adolescents.

In Brazil, it is estimated that 36% of women have the DNA of the virus but without signs of infection. In men, the appearance of lesions is less frequent and there are few data on the incidence and prevalence of the disease. The most common locations in men are the foreskin (60-90% of cases) and the body of the penis (8-55% of cases).

The association of genital warts in men and penile cancer is much smaller and nowadays it is said that men are asymptomatic carriers of the virus.

Causes and transmission

Genital warts are caused by viruses in the human papillomavirus (HPV) family. There are about 70 types. Not all are pathogenic, i.e. cause disease. HPV attacks skin cells causing them to proliferate. This is known as a tumour. Depending on the subtype, we are dealing with so-called benign tumors (genital and anal warts), or malignant tumors that can develop into cancer. The prognosis is therefore different.

In general, HPV 6 and 11 are largely responsible for genital warts, which are of low carcinogenic risk (capable of transforming into cancer ), although the risk still exists in the long term. Subtypes 6 and 11 account for 90% of genital warts.

Be wary of HPV 16, 18, 31, 33 and 35 which carry a high carcinogenic risk. Therefore, it is important to start regular screening tests at the gynecologist. Types 16 and 18 account for 70% of cervical cancer cases.

Streaming

HPV is usually transmitted through sexual contact of infected regions with the genitals, characterizing itself as an STD ( sexually transmitted disease ). People who are immunocompromised by disease or medication are more vulnerable to the HPV virus and therefore more likely to develop genital warts. This is also the case when inflammatory genital diseases are present (leucorrhoea).

Groups of risk

Genital warts are an STD ( Dexually Transmitted Disease ) that mostly affect sexually active people. Also, people with multiple partners or who change frequently are more likely to develop genital warts. Among this group, women are the most affected. In this sense, people who do not use adequate protection during sexual intercourse (female or male condoms) are highly exposed to contracting the virus.
Genital warts develop more easily among people with low immunity due to illness or medication. This is the case, for example, of seropositive people ( HIV/AIDS🇧🇷 Genital warts also easily develop in inflamed areas when people suffer from inflammatory genital diseases (leucorrhoea, irritation).

Transplant recipients take drugs that reduce immunity so that their transplant is not rejected by the immune system. This also presents an opportunity for the appearance of genital warts. In immunocompromised patients, warts have a special shape: they are polymorphic and very abundant. This is a good tip for the doctor who can, for example, reduce the dose of immunosuppressive drugs for people who have had a transplant. It is really important to take care of these patients, as warts are usually benign, but they can develop into carcinomas. And in immunosuppressed people, the risk of transformation into carcinoma is high. For HIV-positive people, the viruses responsible for genital warts are often subtypes 16 or 18 (high-risk carcinogen).

Symptoms

Genital warts are called condylomas and are located in the genital and/or anal region. We can find them in the anus, vulva, urethra, penis, vagina or cervix. There are several appearances, warts, papules, subclinical, large and even asymptomatic. They are usually small, flesh colored or slightly pink. Most people have no symptoms other than the warts, but in some cases itching, burning, and tenderness may occur.

Since warts are caused by viruses, these are highly contagious and a big problem occurs when they are asymptomatic. Many people do not protect themselves during sexual intercourse when they do not know they are infected. Another problem lies in the transformation to carcinoma when the infection has been present for many years (usually more than 10 years).

In general, the incubation period for genital warts is 3 weeks to 6 months. Thus, after the first infection (usually through sexual contact) and after the incubation period, warts may begin to appear. On the contrary, its eventual transformation into cancer can take years. After the incubation period, the person passes on to transmit the virus, with or without the warts.

warts acuminata

This is the typical case of genital warts, in the classic form of a cockscomb. With a narrow base, they are covered by a pink plate (very vascularized), resembling a rooster’s comb. They are found in both men and women, in the genital and anal area; glans, vulva, vagina, urethra and cervix.

Flat condylomata

These warts have a smooth, white or pink appearance.

subclinical condylomata

These are barely visible warts. It will be detected with an application of a 5% acetic acid solution. With this solution the warts become white.

Buschke-Lowenstein condyloma

It is a giant condyloma, with an impressive appearance, despite its low malignancy.

Genital warts diagnosis

Genital warts are normally visible to the naked eye and their diagnosis is based on clinical evaluation: shape, appearance, color. However, some genital warts, although present, are not always visible (the incubation time is usually long, from three weeks to a few months), which is why the doctor must perform several tests: acetic acid test, and histology. The gynecologist regularly takes a sample from women to send to the laboratory to detect HPV by Pap smear, antigen test or PCR (Polymerase Chain Reaction).

Clinical Test

Genital warts are visible to the naked eye, have particular shapes and characteristics, allowing the doctor to categorize them.

Condylomata acuminata, also called cockscomb, are the best known type of genital warts. Its appearance resembles that of a cock’s comb, as it appears in the form of a pink plate (very vascularized) on a narrow base. They are found in both men and women. In men, genital warts are located on the glans or urethra. In women, genital warts are located at the level of the vulva, vagina or cervix.

In flat condyloma, genital warts are grouped together. These are papular and pigmented genital warts.

Buschke-Lowenstein condyloma (or giant condyloma) is a condyloma consisting of a proliferation of genital warts over the genital area. Despite being impressive, the “giant” condyloma is not malignant (cancerous). We are not going to treat Buschke-Lowenstein condyloma.

Acetic Acid Test

The acetic acid test consists of tamponade the area affected by genital warts with a 5% acetic acid solution. If genital warts are present, a whitish color will appear. The acetic acid test is used to confirm the presence of subclinical condylomas, since these are barely visible, almost invisible to the naked eye.

lab exams

The Pap test consists of a smear of cells made by the gynecologist. We can find infections and precancerous lesions. It is essential to perform this examination regularly. It is recommended that women of childbearing age have a gynecologist check up every two years. Women over 50 years old, in whom the risk of cervical cancer is higher, should see their gynecologist once a year.

The PCR (Polymerase Chain Reaction) is a test carried out in the laboratory that allows identifying the papillomavirus by its DNA. It is a very interesting test, as it allows you to determine the type of HPV.

Serology (blood test) allows the detection of antibodies produced by the body against different types of HPV. Antibodies are specific for viruses/bacteria.

Complications

Genital warts are usually benign forms of tumors. Although they are contagious, they invade but do not disturb the human body. Its proliferation is still limited, unlike the forms of malignant tumors, which, in turn, invade uncontrollably and compress other organs, which can cause pain and death of the affected individual.
However, it is sometimes possible for a prolonged infection, if left untreated, to develop into a carcinoma ( cancer), but there are vaccines to prevent and drugs for treatment. This is especially problematic among people with low immune systems (HIV positive, with immune disorders, transplant patients). In fact, in these people, genital warts, which are normally benign, tend to more easily turn into carcinoma, because the subtype responsible for genital warts is often HPV 16 or 18 (high-risk carcinogen).

Also note that among women with genital warts, only a minority will develop cervical cancer , and that after several years of infection. This is due to the intervention of several factors such as heredity, viral load, state of the immune system. Periodic examinations are recommended, especially among women. But it’s not just women who are at risk of developing some type of cancer from HPV, men can develop cancer in the penis, anus and oropharynx.

Genital warts are highly contagious by contact, talking about STDs ( Sexually Transmitted Diseases ). Contamination by sexual contact is a serious problem. It’s good to protect yourself while having sex with someone with genital warts. But the problem lies in the fact that these genital warts are not always visible and are sometimes asymptomatic. In this case, many do not even think about protecting themselves. So, according to statistics, 1 in 3 (sexually active) would be infected by HPV (Papilomavirus). It is estimated that today, more than 630 million people carry the virus.

Genital warts treatments

There are several treatments against genital warts, some work by slowly destroying the warts and others cause the body to attack them. The treatment does not necessarily rid the person of the HPV virus, some apparently normal areas can still be infected by the virus, so even after treatment it is possible for the warts to return in a few weeks or months. Although there is no treatment that gets rid of the virus completely, usually the body itself, through the immune system, expels the virus within 2 years.

Most treatments are in the form of solutions, lotions, gels or creams for external use, such as Podophyllum alcoholic solution or Imiquimod cream. These medications should be used with caution and only with a doctor’s prescription. All medications are used 1 or more times a week for several weeks until the warts disappear.

People who do not improve with drug treatment or who have very large warts or many warts can have them removed through conventional surgery (cuts the warts), cryotherapy (uses chemicals to freeze the warts), electrical cautery (uses electricity to burn the warts) or laser surgery (uses light to destroy warts), ultrasound surgery (uses sound waves to break up and remove warts). It is sometimes possible for genital warts to heal without treatment. Note also, that the concomitant treatment of the sexual partner, must be done.

Vaccine
It is also possible to prevent the appearance of genital warts with the vaccine against HPV. This vaccine was developed to prevent cervical cancer. As genital warts and cervical cancer are caused by certain types of HPV, this vaccine can also prevent genital warts.

Drug treatment Podophyllum alcoholic solution: Podophyllum is a plant from Texas and Mississippi. Its rhizome (false root) is where the resin is extracted from. It is precisely Podophyllum resin that will be used in the treatment of genital warts, as podophyllotoxin is cytotoxic (kills cells, preventing their proliferation). This treatment is not specific for genital warts. Therefore, it is important to rigorously apply the resin to the affected areas, without hitting the healthy area. That is why the application of this drug is done under strict medical supervision. In addition, the resin is highly toxic, the maximum treatable surface is 25 cm 2
🇧🇷The use of this drug is absolutely contraindicated during pregnancy, due to its toxicity to the fetus.

Imiquimod (in cream form): Imiquimod is an immunomodulatory molecule. In the form of a cream it will be used on external genital warts. Imiquimod is contraindicated for warts located in the urethra, vagina, cervix and rectum. Its use is reserved for adults.

Trichloroacetic acid : this type of treatment eliminates warts as it burns the lesions. It must be applied by a doctor.

Herbal medicine

Medicinal plants have been constantly studied in the treatment of genital warts. A plant that has shown promising results is the mimosa, used in the form of creams or ovules.

Another interesting medicinal plant is barbatimão (ointment). Researchers from the Federal University of Alagoas (UFAL) developed an ointment made from barbatimão bark, which proved to be 100% effective in the treatment of genital warts, with no side effects. The ointment acts by drying out the wart, leaving a thin film, which when removed does not leave marks. The study included 46 participants, among them: men, women, pregnant women, children, the elderly, people with AIDS and other immunosuppressed people.

Before the discovery of barbatimão bark ointment, treatments against genital warts had a cure rate of only 75%, in addition to many being invasive, leaving scars, among other side effects.

Other plants with interesting results in the fight against genital warts are thuja, rosewood and celandine .

However, before using any medicine, contact a doctor so that he can check if this type of product is the most suitable. Because of the potential for HPV lesions to cause cancer, treatment must be highly effective in eliminating the lesions.

Tips

Genital warts are treated using cytotoxic and non-wart-specific products, as these products are not per se antivirals. Thus, treatment of genital warts with Podophyllum solution or an Imiquimod cream should be done by applying them only to the warts. Indeed, by applying them around, you can also kill healthy skin.
Furthermore, these drugs should not be passed from one person to another, as they are strictly prescription drugs due to their high toxicity. The person concerned must first go to the doctor, who will diagnose the genital warts and will prescribe the appropriate medication. This is very important as both Imiquimod cream and Podophyllum solutioncannot be applied to all parts of the body. In fact, Imiquimod is contraindicated for genital warts on the urethra or cervix, for example.

During treatment, the correct application of the medication must be ensured. For Imiquimod-based cream, the following steps must be carefully followed:

– Wash hands;

– Apply the medicine only to the affected areas and let it act for 6 to 10 hours;

– Wash your hands after application.

Once the treatment has been completed, return to the pharmacy and return the medication bottle, as these medications are particularly toxic to the environment. The pharmacist will be responsible for disposal. After treatment, you will need to keep an eye on it for a few months to make sure the warts don’t come back.

Prevention

– Genital warts are sexually transmitted. Its transmission is through certain types of HPV. People most likely to get genital warts are sexually active people (especially people who have many sexual partners) who do not use adequate protection (female or male condoms).

– Warts are usually visible to the naked eye. However, this is not always the case. Protection is therefore difficult to predict, and it can spread more easily between different sexual partners. This is due to the shape of genital warts and their generally long incubation time from three weeks to several months.

– It is important for the prevention of genital warts to use a condom during sexual intercourse. But this also does not prevent 100%, as the virus can live in a place on the skin that the condom does not protect, such as the hands and oral cavity.

– The best prevention, for both women and men, is the HPV vaccine. This vaccine is not available on the public network, only privately. The Gardasil® vaccine helps prevent infections with HPV types 6, 11, 16 and 18. The Cervarix® vaccine is aimed at preventing infections with types 16 and 18 and may be effective against types 45 and 31. Both vaccines are given in 3 doses. The vaccine is recommended for people between 9 and 26 years old.

– In addition, it is strongly recommended to carry out preventive tests regularly. Women of childbearing age should see a gynecologist every two years. Among women over 50, it is recommended to visit a gynecologist at least once a year. In fact, genital warts are not very cancerous (with a risk of developing cancer ), but over the years, these warts can become cancerous and cause cervical cancer if left untreated.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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