Genital warts are sexually transmitted infections caused by certain types of human papillomavirus (HPV). They are generally pink and the project is out of the skin surface. Usually they cause some symptoms, but sometimes it can be painful. Usually they appear one to eight months after exposure. Warts are the most recognizable symptom of genital HPV infection.
HPV types 6 and 11 are the typical causes of genital warts. It is spread by direct skin-to-skin contact, usually during oral, genital, or anal sex with an infected partner. Diagnosis is generally based on symptoms and can be confirmed by biopsy. The type of HPV that causes cancer is not the same as that which causes warts.
Some HPV vaccines can prevent genital warts as well as condoms. Treatment options include creams such as podophyllin, imiquimod, and trichloroacetic acid. Cryotherapy or surgery can also be an option. After treatment, the warts often heal within 6 months. Without treatment, up to one-third of cases recover themselves.
About 1% of people in the United States have genital warts. Many people, however, are infected and have no symptoms. Without vaccinations, almost anyone who is sexually active will get HPV at one point in their lives. This disease has been known at least since the time of Hippocrates in 300 BC.
Video Genital wart
Signs and symptoms
Genital warts can occur singly but are more commonly found in groups. They can be found anywhere in the anal or genital area, and are often found on the outer surface of the body, including the shaft of the penis, the scrotum, or the labia majora vagina. They can also occur on internal surfaces such as opening to the urethra, inside the vagina, in the cervix, or in the anus.
They can be as small as 1-5mm in diameter, but can also grow or spread to large masses in the genital or rectal area. In some cases they look like small rods. They may be hard ("keratin") or soft. The colors can vary, and can sometimes bleed.
In many cases, there are no symptoms of HPV infection other than the wart itself. Sometimes warts can cause itching, redness, or discomfort, especially when they occur around the anus. Although they are usually without other physical symptoms, genital wart outbreaks can cause psychological distress, such as anxiety, in some people.
Maps Genital wart
Cause
Transmission
HPV is most often transmitted through penetrative sex. While HPV can also be transmitted through non-penetrative sexual activity, it is less likely to be transmitted than through sex penetration. There is conflicting evidence about the effect of condoms on low-risk HPV transmission. Some studies suggest that they are effective in reducing transmission. Other studies have shown that condoms are not effective at preventing transmission of low-risk HPV variants that cause genital warts. The effect of condoms on HPV transmission may also depend on sex; there is some evidence that condoms are more effective in preventing infection in men than in women.
The type of HPV that causes warts is very easily transmitted. Approximately three out of four couples were not affected by patients with warts developing it within eight months. Another study of partner concordance shows that the presence of visible warts may be an indicator of increased infectivity; HPV concurrency rates are higher in couples where one partner has visible warts.
Latency and looping
Although 90% of HPV infections are cleansed by the body within two years of infection, it is possible for infected cells to undergo a latent period, with the first occurrence or recurrence of symptoms occurring several months or years later. Latent HPV, even without external symptoms, is still transmitted to sexual partners. If an individual has unprotected sex with an infected partner, there is a 70% chance that he or she will also be infected.
In individuals with a previous history of HPV infection, the appearance of new warts may result from new exposure to HPV, or from previous infection relapse. As many as a third of people with warts will experience a relapse.
Children
Anal warts or genitals can be transmitted during birth. The presence of lesions such as warts on the genitals of young children has been suggested as an indicator of sexual harassment. However, genital warts can sometimes be caused by autoinoculated by warts elsewhere in the body, such as from the hands. It has also been reported from sharing swimwear, underwear, or bath towels, and from non-sexual touch during routine care such as changing diapers. Genital warts in children are less likely to be caused by HPV 6 and 11 subtypes than adults, and are more likely to be caused by the type of HPV that causes warts elsewhere on the body ("skin type"). Child pediatrician child abuse surveys show that in children younger than 4 years, there is no consensus as to whether the emergence of new anal or genital warts can, by itself, be considered an indicator of sexual harassment.
Diagnosis
The diagnosis of genital warts is most often made visually, but may require confirmation by biopsy in some cases. Smaller warts are sometimes confused with molluscum contagiosum. Genital warts, histopathologically, typically rise above the skin surface due to papilla dermal enlargement, have parakeratosis and typical nuclear changes typical of HPV infection (nuclear enlargement with perinuclear clearance). DNA testing is available for diagnosis of high-risk HPV infection. Because genital warts are caused by low-risk HPV types, DNA testing can not be used for the diagnosis of genital warts or low-risk HPV infection.
Some practitioners use acetic acid solution to identify smaller warts ("subclinical lesions"), but this practice is controversial. Since the diagnosis made with acetic acid will not necessarily affect the course of the disease, and can not be verified with more specific tests, the 2007 UK guideline advises against use.
Prevention
Gardasil (sold by Merck & Co.) is a vaccine that protects against human papillomavirus types 6, 11, 16 and 18. Types 6 and 11 cause genital warts, while 16 and 18 cause cervical cancer. This vaccine is preventive, not therapeutic, and should be given before exposure to the virus type to be effective, ideally before the onset of sexual activity. The vaccine is approved by the US Food and Drug Administration for use in men and women as early as 9 years.
In the UK, Gardasil replaces Cervarix in September 2012 for reasons unrelated to safety. Cervarix has been used routinely in young women from its introduction in 2008, but is only effective against high-risk 16 and 18 HPV types, none of which usually cause warts.
Management
There is no cure for HPV. The existing treatments are focused on visible wart removal, but these can also regress on their own without any therapy. There is no evidence to suggest that removing visible warts reduces transmission of underlying HPV infection. As many as 80% of people with HPV will clear the infection within 18 months.
A health practitioner may offer one of several ways to treat warts, depending on the number, size, location, or other factors. All treatments have the potential to cause depigmentation, itching, pain, or scarring.
Treatment can be classified as a physical or topical ablative agent. Physical ablative therapy is considered more effective at early wart removal, but like all treatments has a significant recurrence rate.
Many therapies, including traditional medicine, have been suggested to treat genital warts, some of which have little evidence to suggest they are effective or safe. Listed herein is mentioned in national or international practice guidelines have evidence base for its use.
Physical ablation
Physical ablation methods are more likely to be effective on keratin warts. They are also most appropriate for patients with relatively smaller numbers of warts.
- Simple excisions, such as with scissors under local anesthesia, are very effective.
- liquid nitrogen cryosurgery is usually done on a visit to the office, at weekly intervals. It's effective, cheap, safe for pregnancy, and usually does not cause scarring.
- Electrocauterization (sometimes called "electrical excision procedure loops" or LEEP) is a procedure with a longer history of use, and is considered effective.
- Laser ablation has less evidence to suggest its use. This may be less effective than other ablation methods. This is very expensive, and is often used as a last resort.
- A formal surgical procedure, performed by a specialist under general anesthesia, may be required for larger or larger warts, intra-anal warts, or warts in children. This carries a greater risk of scarring than other methods.
Topical agents
- 0.15-0.5% podofilotoxin solution (also called podofilox) in gel or cream. This can be applied by the patient to the affected area and not cleared. It is the purified active ingredient and standard of podophyllin (see below). Podofilox is safer and more effective than podophyllin. Skin erosion and pain are more frequently reported than with imiquimod and sinecatechins. Its use is cycling (2 times per day for 3 days then 4-7 days off); one review stated that it should only be used for four cycles.
- Imiquimod is a topical immune response cream, applied to the affected area. This causes less local irritation than podofilox but can cause fungal infections (11% in packet insertion) and flu-like symptoms (less than 5% expressed in packet inserts).
- Sinecatechin is a catechin ointment (55% epigallocatechin gallate) extracted from green tea and other components. Action mode not specified. It appears to have a higher clearance rate than podophyllotoxin and imiquimod and causes less local irritation, but permission takes longer than imiquimod.
- Trichloroacetic acid (TCA) is less effective than cryosurgery, and is not recommended for use in the vagina, cervix, or urinary meatus.
- Interferon can be used; it is effective, but also expensive and the effect is inconsistent.
- Stopped
- 5% 5-fluorouracil cream (5-FU) is used, but is no longer considered an acceptable treatment because of side effects.
Podophyllin, podofilox and isotretinoin should not be used during pregnancy, as it can cause birth defects in the fetus.
Epidemiology
Genital HPV infection has an estimated prevalence in the US 10-20% and clinical manifestation in 1% of the sexually active adult population. The incidence of US HPV infection has increased between 1975 and 2006. About 80% of those infected are aged between 17-33. Although treatment can remove warts, they do not remove HPV, so the warts can recur after treatment (about 50-73% of the time). Warts can also spontaneously withdraw (with or without treatment).
Traditional theory postulates that the virus remains in the body for a lifetime. However, research using sensitive DNA techniques has shown that through the immunologic response the virus can be cleaned or pressed to levels below what can be measured by a polymerase chain reaction (PCR) test. One study examining genital skin for subclinical HPV using PCR found a prevalence of 10%.
Etymology
A condyloma acuminatum is a single genital wart, and condylomata acuminata is some genital warts. The root word means "sharp warts" (from Greek ????????, "knuckles", Greek - ??? -oma , "disease," and Latin > acuminatum "points"). Although named the same, it is not the same as the latum condioma, which is a complication of secondary syphilis.
References
External links
- Human Papilloma Virus in Curlie (based on DMOZ)
Source of the article : Wikipedia
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