By Dr Alfred Murage
Genital warts are common and usually cause no symptoms. But most women find them disfiguring and annoying. They may sometimes be painful or itchy, but rarely interfere with childbirth.
They are usually flat and papular growths on the external genital region, or inside the vagina and on the penis. Genital warts can also occur at other sites such as the cervix, the urethra and around the anus.
Most genital warts are caused by strains of the Human Papilloma Virus (HPV) types six or eleven. These HPV types are not associated with cancer of the cervix, but cause conjunctival, nasal, oral, and laryngeal warts. Other HPV types (16, 18, 31, 33 and 35) may be found occasionally in visible genital warts. They are associated with changes of the cervix that may be associated with cancer of the cervix.
Diagnosis of genital warts is usually made by visual inspection. A biopsy may be done if the diagnosis is uncertain or if there is no response to treatment. The main reason for treating genital warts is to relieve symptoms and for cosmetic purposes. If left untreated, genital warts can resolve spontaneously, remain unchanged, or increase in size or number.
Available treatments for genital warts likely reduce, but probably do not eradicate HPV infectivity. There are various treatment choices and none is superior to the other or ideal for all patients or all warts. Because of uncertainty regarding the effect of treatment on future transmission of HPV and the possibility of spontaneous resolution, an alternative is to forego treatment and await spontaneous resolution.
Treatment modalities include applications of solutions, gels, creams or ointments on the warts. Some of these may damage adjacent normal skin and must be applied by a trained health worker.
Other treatment methods are use of cold energy (cryotherapy), heat energy or even surgical removal of the warts. Most warts will respond within three months of treatment, but recurrence is also common.
In pregnancy, the warts may be left alone until after delivery. Majority of women will have a normal delivery, but any concerns must be discussed with their obstetrician.
Two HPV vaccines are available, both of which offer protection against the HPV types that cause cervical cancers and one that protects against the types that cause genital warts. These vaccines are most effective when administered before sexual contact and are recommended for 11-12 year old girls and for females aged 13–26 who didn’t receive the vaccine when they were younger.
One of the vaccines can be used in males aged nine to 26 years to prevent genital warts. Women should get regular pap smears as recommended, regardless of vaccination or genital wart history.