They are common and can affect you at any age but are most common in young people in their early 20s.
What causes genital warts?
Genital warts are caused by the human papillomavirus (HPV), specifically the low-risk genotypes 6 and 11. This is different to the high-risk strain of HPV which is commonly associated with cervical cancer.
Even though they are benign and very unlikely to cause severe diseases, their location in intimate areas and the way they grow and spread can lead to a lot of discomfort, embarrassment and distress.
They are commonly spread by sexual contact and can be caught by anal, oral or vaginal sex with someone who has genital warts. You may also get them from sharing sex toys.
Sometimes they can also be spread from warts on your partner’s hands; or from a mum to the baby during a vaginal delivery.
Diagnosing genital warts
Genital warts are commonly diagnosed by a physical examination where they can be seen on the skin. They:
- May occur singularly or in clusters.
- Occur in high friction areas where skin or clothing may rub.
- Can look different depending on where they are: soft and fleshy in moist, hairless areas or firm in dry, hairier areas.
- Can look the same as your skin tone or, in some cases, appear lighter or darker.
- May grow close to the skin with a broad base or have a slight stalk connecting them to the skin.
It is important to have them checked out because there are similar-looking lesions which may need to be biopsied and tested. You may also be tested for other sexually transmitted infections at the same time to allow you to receive the most appropriate treatment.
Genital warts treatment
There are a number of treatments for genital warts.
Do nothing
The first option is doing nothing and leave the warts alone. Although this may not feel like the best approach, 30% of warts that you can see disappear within six months.
However, that is a long time to wait and, as it can be a highly contagious infection, it can affect your sexual relationships and body image whilst you wait for them to clear up.
Topical (skin) preparations
There are a few skin preparations applied including creams, ointments or liquids that can be put on your skin. These include Podophyllotoxin, Imiquimod or Catephen.
Podophyllotoxin
Podophyllotoxin has a few different brand names and used for genital warts in women and men if they have large warts.
It must be used with medical supervision because, your healthcare professional can help you with the precise location of the warts and where to apply the treatments yourself.
It comes as a cream or liquid, and treatment usually happens for three days every week for as many weeks as your doctor recommends. This depends on the nature and extent of your lesions.
You might experience some skin irritation within a couple of days of starting treatment. Irritation is mostly mild and goes away if you stop using the cream.
Sometimes, podophyllotoxin can cause very severe skin irritation or ulcers may develop. Be careful not to apply the cream on open wounds and avoid it near your eyes.
Also, watch the amount you are using – thin application is best, as excessive amounts don’t make it get better quicker but can lead to complications like bowel or kidney damage and more.
Pregnant and breastfeeding women should not use this medicine.
Imiquimod
Next is Imiquimod cream, which may also have different brand names.
The duration of treatment is lengthy, up to four months and using the cream three times a week. It is best applied at night.
You apply the cream directly on the warts only (not on normal skin), rubbing thinly into the lesions and leaving the cream on for at least 6–10 hours.
Afterwards, wash off the cream with mild soap and water. It is also important to have medical supervision before you start, as this cream is not for internal use.
It would be best to continue using the cream until all visible warts around the genitals have cleared, or for a maximum of four months.
Common side effects include redness and pain around the warts because imiquimod quickly stimulates the immune system after a few applications.
If this happens, stop using the cream until the redness settles, then restart gradually, once or twice a week. Other side effects are joint and muscle aches and headaches.
Less commonly, it may cause tissue irritation, diarrhoea and mood changes. It may also permanently cause skin darkening or lightening.
Please read the accompanying medication leaflet to learn how to use it and its potential side effects. When you have warts, you should abstain from sex until completely clear or use condoms.
However, be careful, as imiquimod cream can damage or weaken latex condoms or diaphragms. You should also avoid having sex with the cream applied as it may irritate your partner’s skin.
Sinecatechin
Another wart cream that can be self-applied for external genital warts contains the green tea extract (epigallocatechin gallate) known as sinecatechin. It is applied by hand thinly over the warts and there is no need to wash it off following application.
Again, treatment should continue until the warts have cleared but for no longer than four months. If the warts haven’t cleared in four months, go back to your doctor. Sinecatechin can also cause some skin irritation and be careful not to use it on normal skin or have sex while you have the cream applied, as it can irritate your partner’s skin. The cream may also weaken latex condoms and vaginal diaphragms, so wash it off before using these before sex.
Treatment considerations
When using any of these active skin treatments for genital warts, please keep the following in mind:
- They may take 1-6 months to work, so be patient. You may see some improvement after 4-5 weeks on podophyllotoxin and sinecatecins, but it may be 2-3 months before you start to see any benefits with imiquimod. If there is no response at all in that time, you should change treatment.
- They may not be very effective, especially the first time around, and you may need more than one treatment course to eliminate an outbreak of the warts.
- After completing these treatments, warts can come back, eg a relapse, because they do not eliminate the human papillomavirus.
- The treatments often involve discomfort and skin reactions.
- Using condoms to prevent the spread is important, and stopping smoking can improve your response to treatment.
Specialist genital wart treatments
Beyond topical treatments, there are other treatments that require a specialist.
These may be options if you’ve had no response to the other treatments for months, you’ve had side effects, or the warts are extensive.
The first is a liquid solution known as TCA or Trichloroacetic acid, which requires a specialist’s application as it can affect healthy skin around the warts.
Next, cryotherapy/freezing which involves applying liquid nitrogen directly to the warts to freeze the tissues and kill them off. This treatment may need to be repeated several times and can be painful.
Next, the warts can be removed by cutting them off after using local anaesthetic to numb the skin area.
Alternatively, electric current, laser or heat treatments can achieve the same results: removal of warts. These are quicker but can also have side effects, including bleeding, scarring, pain, soreness and irritation in the area.
Pregnancy with genital warts
If you are pregnant and have genital warts it’s important to be informed. Genital warts are not harmful while you are pregnant – but they can get bigger, become more easily irritated or inflamed, or be passed to your baby during birth, although this is rare.
Most treatments for warts are not recommended during pregnancy, so unless they are very big, we usually do nothing about them until the baby is born. They typically disappear on their own within six weeks after the baby is born, so treatment is often delayed until after the birth.
You may be able to clear the warts with a healthy immune system after 18-24 months, but sometimes they can come back.
Final thoughts
Don’t use salicylic or glycolic acid for genital warts treatment; they do not work and neither do standard verruca or plantar wart treatments for hand/foot warts. They also do not respond to antibiotics; and you should not try scraping or scratching them off at home.
Also, remember genital warts have an incubation period after the initial infection when the virus grows in the body before it shows on the skin.
Many people may suspect their partners of cheating from the time they see the warts, but in fact, they may have been infected months previously and the warts are only just showing now.
This incubation period between when you are infected with HPV and when you develop warts varies from person to person but is typically shorter in women than in men.
This article was originally published on AskAwayHealth.
