Genital Warts – Causes, Diagnosis and its Treatment
Condylomaacuminata or anogenital warts are the most commonly seen viral sexually transmitted disease cause by the Human Papilloma Virus (HPV)
Genital warts are caused by HPV which is family of highly infective DNA viruses. The most common way to acquire anogenital HPV is via sexual activity. Physical contact of infected areas is typically how the virus spreads.
In general there are three general classifications of HPV: low risk, moderate risk, and high risk. Moderate and high risk strains of HPV have increased rate of progression to cancer.
The risk of disease increases with the number of sexual partners. Additionally, men who have sex with men, HIV patients, and patients with other immunocompromising infections are also at risk for developing genital warts.
Patient symptoms will depend on the location and number of lesions present. Patients with few lesions may have no symptoms and those with several will likely develop symptoms of itching, bleeding, burning, discharge, or tenderness. The lesions may cause bleeding if they rupture.
It is possible to develop oral, laryngeal, and tracheal mucosal lesions particularly in patients who engage in oral sex.
Lesions may improve, stay unchanged, or progress.
The differential diagnosis for HPV warts include, secondary syphilis, squamous cell carcinoma, skin tags, and angiofibromas.
HPV is typically diagnosed by visual inspection of the infected area. Lesion appears skin-coloured or pink and range from a smooth flattened skin to large dome shaped masses. The extent of anogential lesions should be noted and will often require the use of anoscopy, or sigmoidoscopy. A biopsy can be considered when the diagnosis is uncertain or in patients who do not respond to therapy, are immunocompromised, or who have large or rapidly growing lesions.
Treatment for Genital Warts
Treatment for HPV depends on the location and number of lesions. Treatment can be classified into three broad categories: chemical/physical therapy, immunotherapy, or surgical therapy.
There is not data to suggest that one therapy is inherently superior to another
Chemical agents employed in treatment of HPV related warts include trichloroacetic acid, podophyllin, and 5-fluorouracil/epinephrine. These caustic agents physically destroy the external lesions and should only be considered after medical consultation.
Immunologic mediated therapy includes imiquimod, interferon alpha and again should only be considered after medical consultation.
Surgical therapeutic options include cryotherapy, laser therapy, and exisional surgical procedures.
HPV vaccination is described as an effective method of preventing HPV acquisition. It has been recommended for both men and women and particularly those with HIV and other such immunocompromising conditions. HPV vaccinations are typically given during adolescents up to the mid-20’s. Please discuss vaccination timing and merits with your physician.