The Ugly Truth about Genital Warts

Early in my career, I treated a patient population with a lot of genital warts. It was a long time ago (longer than I like to admit) and the treatment methods back then were limited and painful--I had more than a few nightmares about those poor ladies.

Fortunately, we’ve advanced a little since those days and I rest a bit easier! If you have genital warts, you should know the facts so that you can get the treatment you need.

What causes genital warts?

The human papillomavirus (HPV) causes genital warts. This same virus causes cervical cancer. The HPV virus has many different subtypes but, fortunately, the primary subtypes that cause visible genital warts do not cause cervical cancer.

About 90 percent of genital warts are caused by HPV subtypes 6 and 11, which happen to be 2 of the subtypes that can be vaccinated against with the Gardasil vaccine. Occasionally, a subtype of HPV that's high risk for cancer can be found inside a visible wart, but usually the cancer-associated HPV turns out to be part of a co-infection with subtypes 6 and 11. This is more common is those with HIV as well.

What do genital warts look like?

Genital warts often look like warts anywhere else--except that they are found in the genital area. They usually don’t cause problems but they can be painful and itchy, depending on their size and location.

What about treatment?

Genital warts cannot be cured in the medical sense because the HPV virus cannot be eliminated by medical means. The body’s immune system, however, can clear the virus in many individuals; others, unfortunately, must carry it dormant, or active, all their lives. But treatments have been developed that can get rid of all visible signs of the warts. Treatment is usually aimed at relief of symptoms and cosmetic improvement. Treatment can be done either at home by the individual or at the health care provider’s office by the provider. Treatment options include:

At home

• Podofilox (Condylox®) is applied twice a day for 3 days and then not at all for 4 days. This treatment is repeated until the warts are gone. The warts are desiccated externally.
• Imiquimod (Aldara®) is applied once daily 3 times a week for up to 16 weeks. This drug stimulates the body's immune system to create an immune response against the warts.
• Sinecatechins (Veregen®). Applied 3 times a day for up to 16 weeks, this drug (which is an extract of green tea) is the newest on the market and its treatment mechanism is not completely understood. It may stain clothing.

In the health care provider's office

• Cryotherapy. This treatment consists of freezing the warts using liquid nitrogen or a very cold "cryo gun." The procedure must be repeated every 1 to 2 weeks until warts resolve.
• Podophyllin is a resinous powder that also desiccates genital warts. A liquid form of the drug is applied weekly until the warts resolve. The podophyllin liquid should be allowed to dry thoroughly before covering it with clothing. It must then be washed off in 4 hours.
• Trichloroacetic acid (TCA) or bichloracetic acid (BCA). These acids are applied to the warts weekly until warts resolve. Both of these caustic agents destroy the warts. This is tough stuff!
• Surgical removal is usually done in the operating room with lasers, cautery, scalpels, or scissors. The greatest benefit of surgery is that it eliminates all the warts in a single visit.

Points to remember

• Most sexually active adults will contract HPV at some point in their lives. Some of these infections will progress to genital warts.
• Treatments for genital warts will get rid of the warts but not the HPV virus.
• Condoms are not fully protective but can help lower the risk of contracting HPV.
• One should refrain from sexual activity until genital warts are resolved.
• Recurrence of warts is common--particularly in the first 3 months after treatment.

The best thing a person can do is to have the Gardasil vaccine long before any sexual activity is initiated, but of course this is not always an option. Always use condoms to help prevent sexually transmitted diseases--including HPV. If you have genital warts, see your health care provider for treatment. These days, there are lots of options and genital warts are easy to take care of!