What are genital warts?
Genital warts (condylomata acuminata) are pink-red warts 1–2 mm in size that can sometimes merge into larger cauliflower-shaped warts. They develop on the penis, around the anus and vagina, and sometimes inside the vagina. They are transmitted by sexual contact. Other routes of transmission, such as the use of infected towels, are unlikely but cannot be entirely excluded.
What causes them?
Condylomata are caused by viruses from the human papilloma virus (HPV) family, which is very large. Genital warts are caused by HPV types 6, 11, 16 and 18.
Can genital warts cause cancer?
There is a link between infection with HPV-16 and HPV-18 and the development of cervical cancer. Women who have had a condylomata infection may have a greater chance of developing this cancer than women who have not; discuss a follow-up (screening) plan with your doctor or gynaecologist. An increased occurrence of anal cancer has also been described in patients with genital warts.
How is the diagnosis made?
External condylomata can generally be recognised quickly without further investigation. In women, the vagina is always examined with a speculum for condylomata. If an infection is suspected (for example because the partner has clear lesions), the “acetic acid” test can be done: 5% acetic acid is applied to the genitals, and small, flat warts turn white and so become visible. This test is not 100% reliable, however, as other conditions can also turn white.
How are genital warts treated?
- Podophyllin — this caustic substance is applied by the doctor with a cotton bud; the surrounding skin is first protected with petroleum jelly, and one hour after applying it is rinsed off with water. This can be repeated weekly.
- Imiquimod — a substance that influences the immune system and is effective against condylomata. The cream is applied 3 times a week and removed after 6–10 hours with soap and water.
- Green-tea extract (Camellia sinensis) — a cream applied 3 times a day to the warts for a maximum of about 16 weeks.
- Podophyllotoxin — a closely related substance (in cream) that the patient can apply themselves, repeated weekly for a few weeks according to the prescribing doctor’s instructions.
- Liquid nitrogen — freezing, especially effective when there are only a few condylomata.
- Coagulation — burning away, especially suitable for vaginal condylomata.
- Laser — for vaginal condylomata.
Vaccination against genital warts
It is possible to vaccinate against the viruses that cause genital warts. Vaccination should take place before the person has come into contact with the virus, so preferably before young adults become sexually active. In many Western countries children have been vaccinated for years, leading to a very strong decrease in the number of patients with genital warts.
When to see a doctor
See a doctor if you notice warts on or around the genitals or anus, for treatment and advice, and (for women who have had them) about cervical screening.