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Genetal Warts - Causes, Symptoms and Treatment

What is Genetal Warts?

Also called venereal warts and condylomata acuminata, genital warts consist of papillomas with fibrous tissue overgrowth from the dermis and thickened epithelial coverings. They are uncommon before puberty and after menopause. Certain types of human papillomavirus (HPV) infections have been strongly associated with genital dysplasia and, over a period of years, cervical neoplasia (depending on the viral strain).

What are the Causes of Genetal Warts

Infection with one of the more than 60 known strains of HPV causes genital warts. Transmission occurs through sexual contact. The warts grow rapidly in the presence of heavy perspiration, poor hygiene, and pregnancy and often accompany other genital infections.

What are the Signs and Symptoms of Genetal Warts?

After a 1 - to 6-month incubation period (usually 2 months), genital warts develop on moist surfaces: in men, on the subpreputial sac, within the urethral meatus and, less commonly, on the penile shaft; in women, on the vulva and on vaginal and cervical walls.

Genital warts can develop years after the first contact. In both sexes, papillomas spread to the perineum and the perianal area. These painless warts start as tiny red or pink swellings that grow (sometimes to 4" [10 cm]) and become pedunculated. Typically, multiple swellings give them a cauliflower-like appearance. If infected, the warts become malodorous. Most patients report no symptoms; a few complain of itching or pain.

Diagnosis for Genetal Warts

Dark-field examination of scrapings from wart cells reveals marked vascularization of epidermal cells, which helps to differentiate genital warts from condylomata lata, which are associated with second-stage syphilis. Histologic examinations of biopsies of warts are done for classification and to assess cancer risk. Applying 5% acetic acid (white vinegar) to the warts turns them white. In general, warts are easily diagnosed on visual inspection, with biopsy indicated only when neoplasia is strongly suspected.

The differential diagnoses include syphilis and vulvar/vaginal cancer (for example, verrucous carcinoma).

Treatment for Genetal Warts

Treatment is, for the most part, for cosmetic reasons and should be guided by patient preference. Topical drug therapy, such as trichloroacetic acid 85%, is applied weekly to external areas, or podophyllum resin may be applied topically to the wart, also weekly. (Podophyllum is contraindicated in pregnancy.) Warts that are larger than 1 " (2.5 cm) are generally removed by carbon dioxide laser treatment, cryo-surgery, or electrocautery. Treatment aims to remove exophytic warts and to ameliorate signs and symptoms. No therapy has proved effective in eradicating HPV. Relapse is common. Other treatments include interferon (intralesional), Podofilox (patient-applied), Imiquimod (patient-applied), and combined laser and interferon therapy.

Special Considerations and Prevention Tips for Genetal Warts

1. Use standard precautions.

2. Recommend that the patient abstain from sexual intercourse or use a condom until healing is complete.

3. Encourage the patient's sexual partners to be examined for HPV, human immunodeficiency virus, and other sexually transmitted diseases.

4. Encourage female patients to get annual Papanicolaou tests, and recommend that men be examined by a urologist because cancer of the penis can develop.

5. Recommend the use of condoms.

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