Genital Warts Diagnosis

  • Diagnosis

    Genital warts, also called human papillomavirus (HPV), is a group of 70 or more viruses that infect the skin and cause warts. HPV is a very common virus, and it is likely that you will probably be exposed to one more strains of it during your lifetime. However, not everyone who is exposed develops an infection, and many people who are infected don't develop symptoms.

    HPV can cause warts on the face, hands, feet, genitals, anus, or cervix, and other areas of the skin. Different strains of HPV tend to infect different parts of the body. The strains that cause common warts, flat warts, or plantar warts (warts on the bottom of the feet) are not the same strains that cause the sexually transmitted genital warts.

    Most strains of HPV cause harmless warts that eventually disappear by themselves. The most common complications of warts include itching and occasional bleeding. In rare cases, warts may become infected with bacteria or fungi.

    HPV infection of the cervix is associated with an increased risk of cervical cancer. A few strains of HPV cause a type of infection that can eventually lead to cervical cancer. Almost all cervical cancer cases are thought to be caused by HPV infection with these specific strains. The FDA recently approved a three-step vaccine against the HPV strains that can cause cervical cancer. This vaccine, called Gardasil, is indicated for girls, aged 12-13, who are not yet sexually active. Teenagers and young women up to age 26 should also be vaccinated with gardasil for improved immunity against the cancer-causing viral strains, because the vaccine was not availalbe when they were younger.

    HPV is usually spread by direct contact with a wart, but it can be spread through indirect contact as well. Warts on the skin can be spread from one part of the body to another fairly easily, usually by scratching and bringing the virus to a new location; however, nongenital warts are not very easily spread from one person to another.

    HPV can survive outside the body, and does not require bodily fluids for transmission. Therefore, it is possible to contract HPV from surfaces that carry the virus, such as locker room floors.

    HPV infection of the genitals, anus, vagina, or cervix is a sexually transmitted disease called condyloma acuminatum. Figure 01 Condyloma acuminatum is one of the most common sexually transmitted diseases in the U.S. It is caused by specific strains of HPV that are transmitted from person to person during oral, anal, or vaginal intercourse. Not everyone who is infected with HPV, however, develops genital warts. As many as 50% of people with genital infections show no symptoms, but can still transmit the virus to others.

    In rare cases, HPV can be passed from a mother to her child during birth. This potentially severe infection may cause warts to develop in a baby's throat. In some cases these warts can grow so quickly that they close off the airway, and may cause suffocation if a tracheotomy is not performed. The warts can be removed surgically or by laser, but recurrence is common. Oftentimes the warts disappear spontaneously at puberty.

    Click to enlarge: HPV-associated genital warts (condyloma acuminatum)

    Figure 01. HPV-associated genital warts (condyloma acuminatum)

    The symptoms of HPV infection depend on the location of the infection and the type of virus.Table 01 Common skin warts are flesh-colored, yellow, or brown. They are firm, dry, and rough, and are usually no longer than a half an inch in diameter. Plantar warts develop on the soles of the feet and may be quite painful. Instead of protruding outwards, plantar warts are flattened and pushed into the skin because of the weight of the body on the foot. Flat warts are common among children, and appear as smooth, yellow-brown spots primarily on the face; they may also develop on the neck, chest, arms, and legs.

    Table 1.  Characteristics of Warts Caused by HPV

    Common Warts Flesh-colored, yellow, or brown in color
    Firm, dry, and rough in texture
    Less than half an inch in diameter
    Flat Warts Smooth spots, yellow-brown in color
    Primarily located on the face, but also found on the neck, chest, or extremities
    Common in children, less common in adults
    Plantar Warts Flat, compressed warts on the soles of the feet
    Infiltrated with small blood vessels
    Often painful
    Genital Warts Generally flesh-colored, but may also be gray or pink
    Lesions may be small or large, flat or raised, single or clumped into a group that may look like a cauliflower.
    In women, found on the vulva, around the vagina or anus, on the cervix, or on the groin or thighs
    In men, normally found on the penis or scrotum

    Genital warts have a variety of appearances. Genital warts are flesh-colored and painless, but may also be gray or pink. They can be small or large, flat or raised, single or clumped into a group that may look like a cauliflower. In women, the warts appear on the vulva, in or around the vagina or anus, on the cervix, or on the groin or thighs. In men, genital warts normally develop on the penis or scrotum. The warts may also develop on the hands or mouth as a result of a virus that is transmitted during foreplay or oral sex. Many people with genital infections of HPV show no symptoms at all.

    HPV infection of the cervix usually has no physical symptoms unless cancer develops. The changes in the cells on the surface of the cervix caused by HPV can be detected by Pap tests (see below), but generally this infection has no physical symptoms unless cancer develops.

    Engaging in unsafe sexual practices increases the risk of contracting sexually transmitted HPV. Having unprotected sex increases your risk of contracting the virus. Having multiple sex partners also increases your risk of coming in contact with someone who is infected with the virus, as does having sex with someone who has sex with multiple partners. Having sex as a teenager increases a woman's risk of developing cervical cancer.

    A doctor will generally diagnose warts on the skin by physical appearance alone. Common warts and flat warts have a distinct physical appearance, and can easily be diagnosed by sight. Plantar warts can be distinguished from calluses by scraping off a small amount of the surface skin. Calluses will consist only of hardened skin, whereas plantar warts will have small blood vessels scattered throughout the wart.

    During your initial consultation for genital warts, your doctor will get a medical history and perform a physical examination. If you suspect you have genital warts, your doctor will start with a medical history, and may ask you questions about your sexual history as well as specific questions about how your symptoms developed. These questions are particularly important for women, as the answers will provide information about their risk for developing cervical cancer.

    The doctor may ask a woman if there is any chance she is pregnant, because some of the drugs used to treat genital warts (e.g., podophyllin) should not be used by pregnant women.

    After the history, your doctor will perform a physical examination to identify any genital warts. To check for warts inside the vagina or on the cervix, the doctor may use a colposcope, an instrument that magnifies areas of suspected abnormalities.

    Changes to the cervix caused by HPV are most commonly found during routine Pap tests. The Pap test, or Pap smear, is a routine part of the gynecological exam. During the exam, the doctor inserts an instrument called a speculum into the vagina to hold the vaginal walls apart so the cervix can be seen clearly. A cotton swab or brush is used to scrape a few cells from the mucus membranes where the cervix and vagina meet. The cells are placed on a glass slide and sent to a laboratory for examination. If the test comes back abnormal, your doctor may recommend further diagnostic tests. It is important to remember that Pap tests often yield false-positive results, so an abnormal result needs to be confirmed with additional tests.

    The risk of contracting genital warts can be reduced through safer sexual practices. For people who have sexual relationships, the risk of contracting HPV can be reduced through safer sexual practices, including using condoms. Gardasil, the new HPV vaccine, is very effective in preventing the type of HPV infections that can lead to cervical cancer.

    Having a monogamous sexual relationship—a relationship in which uninfected partners have sex exclusively with each other—can reduce your risk of contracting HPV.

    Consistent and proper use of condoms during sex can reduce the risk of contracting genital warts. Latex and polyurethane condoms provide an impenetrable barrier to HPV, and when used with every sexual encounter, they provide effective prevention against infection. Condoms should only be used before their expiration date, and when no obvious signs of defects or damage are visible. They should be worn before any sexual contact is made, and each condom should be used only once. Only water-based lubricants should be used with condoms; petroleum jelly, vegetable oil, or other oil-based lubricants can damage the condom and cause it to tear.

  • Prevention and Screening

    The risk of contracting genital warts can be reduced through safer sexual practices. For people who have sexual relationships, the risk of contracting HPV can be reduced through safer sexual practices, including using condoms. Gardasil, the new HPV vaccine, is very effective in preventing the type of HPV infections that can lead to cervical cancer.

    Having a monogamous sexual relationship—a relationship in which uninfected partners have sex exclusively with each other—can reduce your risk of contracting HPV.

    Consistent and proper use of condoms during sex can reduce the risk of contracting genital warts. Latex and polyurethane condoms provide an impenetrable barrier to HPV, and when used with every sexual encounter, they provide effective prevention against infection. Condoms should only be used before their expiration date, and when no obvious signs of defects or damage are visible. They should be worn before any sexual contact is made, and each condom should be used only once. Only water-based lubricants should be used with condoms; petroleum jelly, vegetable oil, or other oil-based lubricants can damage the condom and cause it to tear.

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