What is genital wart? What is the relationship between genital warts and HPV?
Genital warts, also known as condyloma acuminata, can resemble cauliflower-like growths in the genital area of both men and women. They are caused by the human papillomavirus (HPV) infection of the superficial skin or mucous membranes. Genital warts typically develop in the genital and anal areas. For women, they usually appear on the labia, inner vulva, vaginal wall, cervix, perineum, or around the anus. For men, they can grow in the pubic hair area, scrotum, urethral opening, penis, or around the anus. In some cases, genital warts can also appear in the mouth and throat.
If a patient’s superficial skin or mucosal wound is infected with HPV, genital warts can take a few weeks to a few months to develop or be discovered. Some patients might not develop symptoms even if they are infected with HPV or have genital warts.
The progression of genital warts varies: some disappear on their own, some remain stationary, some spread to other areas, and some can cause cancer. HPV infections can lead to six types of cancers, including cervical, vaginal, vulvar, penile, anal, and oral/throat cancers.
Scientists have identified more than 200 types of HPVs. They can spread through vaginal, anal, or oral sex. HPV infections are categorized into two groups: low risk and high risk. High-risk HPV types are often found in cancer cells. The 12 high-risk HPV types are HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59, with HPV 16 and 18 being the most significant due to their association with most HPV-related cancers. Low-risk HPV types, including types 6, 11, 42, 43, and 44, rarely appear in cancer cells but can cause anal, genital, or oropharyngeal warts.
A 2010 study estimated the incidence of genital warts in the general adult population in Hong Kong to be about 203.7 cases per 100,000 person-years, which is higher than figures from other countries. According to the Hong Kong Department of Health in 2021, the number of men suffering from genital warts was 1,074, which is 3.3 times the number of women.
The September 2023 Lancet Global Health Journal reported a global prevalence of all types of HPV in adult men at 31%, with high-risk HPV prevailing in 21% of adult men. HPV-16 is the most common genotype, followed by HPV-6. HPV infection rates are higher among young adult men, peaking between the ages of 25 and 29, and this trend stabilizes or decreases slightly after the age of 30.
HPV vaccination is highly effective. The HPV vaccine can potentially prevent more than 90% of HPV-related cancers. Since the HPV vaccine was first recommended in 2006, infection rates with the HPV types that cause most HPV cancers and genital warts have dropped by 88% among teenage girls and by 81% among young adult women.
If you have not received the HPV vaccine, please discuss it with your doctor and consider getting vaccinated.
Cause
HPV infection is caused by close contact of HPV with superficial skin wounds or mucosal wounds of patients. Genital warts can be contracted through sexual contact (venereal disease). HPV infection can be spread by multiple sexual partners, sexual intercourse without condoms, oral sex, vaginal sex, and anal sex.
If you use a skin razor or shaver contaminated with the HPV virus, HPV may be transmitted to the small wounds caused when shaving your pubic hair, causing HPV infection.
If you use an HPV-contaminated (hotel or gym) towel to wipe the skin of the genital and anal area, the HPV virus may be transmitted to the small wounds caused by the abrasion, causing HPV infection.
If you have not received the HPV vaccine before, your wounds may be easily infected by HPV.
Symptoms
Patients with genital warts may notice some grey, brown, white, or pink tiny lumps, needle-pointed plaque, papillary nodules, or villous growths on the skin surface or mucosal surface of the following areas: pubic area, inner vulva, vulva, around the anus, scrotum, penis, mouth, and throat. Patients with genital warts usually feel minimal discomfort and rarely little pain in the wart-infected area. Genital warts that grow in the urethral opening may cause urethral obstruction and difficulty in passing urine. The genital warts may bleed after a minor scratch, sex, or vaginal delivery.
If you or your sexual partner has genital warts, is suspected of having genital warts, or is suspected of having an HPV infection, please see an experienced doctor for examination and seek advice as soon as possible.
Diagnosis
Patients who have developed genital warts or have a sexual partner diagnosed with genital warts should see a doctor for assessment. The methods to confirm the diagnosis include:
- Clinical examination: The doctor examines the patient's reproductive organs, private parts, anus, and mouth through visual inspection or magnified imaging.
- Anoscope
- Colposcope
- Biopsy (to confirm if warts, cancer, or other lesions are present)
- Human papillomavirus DNA swab test (to determine whether it is a high-risk or low-risk HPV infection)
- Female Pap smear cytology (to determine whether there is cervical cancer or precancerous lesions)
- People with genital warts are advised to consider screening for other sexually transmitted diseases, such as HIV and syphilis blood tests
Treatment
If genital warts are not treated soon, they may grow in size, spread to other areas, or be passed on to your partner. It may cause symptoms such as pain, bleeding, or itching. In rare cases, HPV infection or genital warts can develop into cancer. Removing the wart tissue will reduce the risk of HPV infecting other body parts, your sexual partner, and people living with you. If you have warts, you may need to consider the following treatments:
Chemical Therapy
Applying caustic chemicals over the skin lesion causes superficial tissue necrosis. The depth and width of the chemical-induced tissue necrosis need careful control. Please consult your doctor for advice.
Cryotherapy
Using liquid nitrogen spray over the skin lesion induces frostbite and subsequent superficial tissue necrosis. The depth and width of the cryotherapy-induced tissue necrosis need careful control. It usually takes several treatment sessions to cure. Please consult your doctor for advice.
Laser Surgical Therapy
Using carbon dioxide laser to vaporize and destroy the warts. The depth of tissue destruction needs careful control. Please consult your doctor for advice.
Surgical Excision
Surgical removal is the fastest way to reduce the chance of the virus spreading.
- Method (1): Excise the genital warts and suture the wound. Remove the sutures two to three weeks after surgery. Please consult your doctor for advice.
- Method (2): Remove genital warts and cauterize the wound. The wound will heal slowly after daily cleaning. Please consult your doctor for advice.
Patients with poor immunity may have recurrence after curative treatment. Studies have shown that injections of the human papillomavirus (HPV) vaccine could prevent genital warts.
Prevention
Research has found that HPV vaccination with GARDASIL 9 helps to protect men and women, aged 9 to 45 years, from the following diseases:
- Cervical cancer
- Vaginal and vulvar cancer in women
- Anal cancer
- Certain head and neck cancers (such as throat and oral cancer)
- Genital warts (male or female)
These diseases are caused by the most common nine types (6, 11, 16, 18, 31, 33, 45, 52, and 58) of HPV. Globally, Gardasil-9 vaccination prevents approximately 90% of HPV-related cervical cancer cases in women and 80-95% of HPV-related anal and genital cancers (in both men and women).
GARDASIL 9 may not completely protect everyone, and it may not prevent diseases caused by other HPV types or diseases caused by non-HPVs. GARDASIL 9 does not prevent all types of cervical, vulvar, vaginal, anal, or head and neck cancers. HPV vaccination does not eliminate the need for recommended screening for these cancers, and it is important for women to continue routine cervical cancer screening.
GARDASIL 9 does not treat cancer or genital warts. If you already have genital warts, the HPV vaccine cannot treat them. However, the vaccine can still protect you against other types of HPV to which you have not been previously exposed.
If the patient's immunity is reduced, genital warts may recur. It is recommended that patients consider HPV vaccination to protect themselves.
Frequently Asked Questions
A: You should keep the affected area dry and wear soft cotton underwear to protect the diseased area, prevent tissue damage around the infected area, and prevent the disease from spreading to the surrounding area. You should seek medical advice as soon as possible.
A: HPV vaccination can prevent genital warts. Avoid promiscuity. Use condoms during sexual activity. As condoms do not cover the entire penis or around the pubis, it is not 100% effective. Patients who have treated their genital warts should consider HPV vaccination to protect themselves. Please seek medical advice.
A: Your sexual partner being diagnosed to have genital warts should receive treatment as soon as possible. If your sexual partner has genital warts, you may have been infected with HPV, or carrying obscure genital warts. Please find a doctor for assessment and consider the HPV vaccination to fight against HPV.
