"WARTS!!! Down there??! That’s disgusting."

Not an unusual reaction to a diagnosis of genital warts (sometimes called venereal warts), a sexually transmitted infection caused by the human papilloma virus (HPV). And, unfortunately, not an uncommon occurance. Some estimates place HPV infection in the US as high 40 million with up to 750,000 new infections each year.

WHAT IS IT?

HPV is a large family of viruses that infect the skin, often causing irregular cell growth which may resulting in fleshy bumps known as condylomata or warts. However, not all HPV infection causes visible warts. Approximately 30 varieties of HPV can infect the genital area (penis, vagina, anus, and perineum). Warts can grow in the throat, but this is rare. Warts that occur on the hands, feet or other parts of the body aren’t transmitted to the genital area. Some types of HPV can cause cervical cancer in women.

TRANSMISSION

HPV is transmitted through contact with infected skin during sexual activity. Infants born to infected mothers may become infected, usually in the mouth or throat. Visible warts may appear 2-3 months or more after infection and in some cases warts may not develop at all. However, because the virus is present in the skin, transmission is possible even though there are no visible signs of infection.

SYMPTOMS

Genital warts range from soft, fleshy, cauliflower-like growths that are easily seen to small round or flat bumps that are barely visible. They are painless, but may bleed easily or itch. They occur on the vulva, in or around the vagina or anus and on the penis, scrotum, groin or thigh. Quite often are no visible signs of infection. This is known as "subclinical" or inapparent infection. A person can pass the infection to their sexual partners whether there are visible warts or not, which is one reason why HPV infection is so common.

PREGNANCY

An infected mother can pass the infection to her infant during birth. Infected babies most often have warts in the throat or mouth.

DIAGNOSIS

A health care provider can determine if warts or abnormal tissue growth are present, but since HPV infection is often subclinical or without symptoms, people may not seek treatment. A Pap smear, in which cells are scraped from the surface of the cervix or rectum and examined with a microscope, can detect abnormal cell growth caused by subclinical HPV infection in those areas. Subclincal infection of the cervix or rectum can cause cervical or anal cancer. Women who are sexually active or who have had a diagnosis of HPV infection should have an annual pelvic exam and Pap smear. Cervical cancer can be effectively treated when detected early. Men or women who have had anal sex should be checked for HPV infection and signs of cancer in the rectum.

TREATMENT

Visible warts can be removed in several ways, but the viral infection persists and warts may come back, requiring repeat treatment. A clinician can remove warts by freezing them with liquid nitrogen or by burning them with electorcautery. There are topical medicines that can be applied by the patient. However, all treatments for genital warts require a prescription; over-the-counter wart treatments should never be used on genital warts.

PREVENTION

HPV infection is often subclinical so people don’t know they are infected. Also, it is not clear whether, or how long, people remain infectious after warts have been removed. Over time the virus probably becomes inactive, although the infection remains. However, following these guidelines will reduce your risk of acquiring or transmitting HPV infection.

• Abstinence from sexual activity is the surest way to avoid acquiring or transmitting HPV infection.
• The next surest way is to limit sexual contact to one uninfected partner who only has sex with you.
• For those choosing to be sexually active, condoms used correctly and consistently can reduce the risk of transmission, but because HPV is transmitted through skin to skin contact, they are less effective than for other STDs.
• Avoid sexual contact if warts or suspicious symptoms are present. If you suspect that you have genital warts (or any sexually transmitted disease), seek immediate care at a local STD clinic, hospital, or medical practitioner.
• Before having sex, talk with your partner(s) about HPV and other sexually transmitted diseases. Negotiate a risk reduction strategy with them that feels comfortable to both of you. If the STD status for you or your partner is unknown, go together to get screened at a local STD clinic, hospital, or medical practitioner.
• If you have HPV (or any sexually transmitted disease), notify all sex partners so that they can also seek and obtain treatment.

Information courtesy of Seattle and King County Public Health
at (http://www.metrokc.gov/health/)

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