Genital warts are pretty unexciting, unappealing and have a pretty ugly name, but the human papilloma virus (HPV) is the leading cause of cervical cancer in women, and is also suspected in anal cancers. It also causes actual warts, but only in certain strains. The infection is cleared by your immune system in one or two years usually.

Over 80 per cent of women will have been infected with at least one strain of HPV before they turn 50 – no symptoms doesn’t mean not infected, and infected doesn’t mean certain death or cancer.

Genital warts and HPV are caused by strains of the same virus, and that is something that nobody likes to talk about – women are reluctant to say they have HPV because it means they have the wart virus, but it doesn’t actually mean they have warts. That is why you often hear the distinction between “HPV” and “genital warts”. They are the same thing, more or less, but have different manifestations.

A vaccine is available, but only if you have never been sexually active (and therefore possibly been in contact with the virus). Once you’ve been in contact with it, your immune system has already started to process it and create antibodies, so the vaccine is useless.

Warts (and skin changes) can occur on the genitals, but also on the cervix, vagina, anus, rectum and throat. These changes increase the risk of certain types of cancers. Some types of HPV can cause genital warts and cancer.

    HPV – non-physical-warts variety
HPV of the no-physical-warts varieties (generally types 16 and 18) cause cancer, and it doesn’t matter how old you are. Early 20’s are not a fine time to die of cervical cancer, so the minute you are sexually active (even just touching genitals – it’s passed by skin-to-skin contact, not body fluids), you need to be getting regular (1-2 yearly) pap smears. No exceptions.

Eight out of ten people have HPV and it can be spread with a dirty finger, the brush of a thigh or other barely-there touching. Use condoms. There are over 100 strains of wart virus, with only some affecting the genitals and fewer again causing actual warts to appear.

     HPV – physical warts variety
These warts are most often caused by HPV 6 and 11. You might see warts around your anus, vagina, inside the vagina, urethra or in your anal canal, or even in your throat. A doctor will find the hard-to-reach places.

     Symptoms of physical genital warts

  • When they pop up, they start as very small, soft, moist pink or grey growths
  • Once further developed, they may be flat, raised, single or a floret, or look like cauliflower
  • Grow in clusters of irregular bumps
  • May have stalks
  • May cause burning pain
  • They grow fast
  • May itch or cause discomfort

     Fast facts of physical genital warts

  • They often don’t hurt
  • You can carry HPV in your system but not have any warts
  • HPV can be passed on via oral sex (less common), but is spread by direct skin-to-skin contact during vaginal or anal sex
  • Transmission is by physical contact
  • Warts might pop up weeks or months (or never) after contact with an infected person
  • Infection may occur after direct contact with a visible wart or contact with genital skin where the virus is present.

     Treating physical warts
Treatment for physical genital warts doesn’t rid you of the virus, just of the visible warts, though your immune system will usually get rid of the virus  by itself over time unless you are immune compromised (such as in HIV or chronic illness).

Wart treatments from the pharmacy are not suitable for genital warts, so forget it. They will probably need to be frozen off using cryotherapy (liquid nitrogen/dry ice). You will likely need more than one treatment. Other treatments include podophyllotoxin, a lotion you use at home (not for pregnant women), or other creams or laser treatment.

     Treating abnormal cells of the cervix
Treating the HPV that affects your cervix may need more invasive work if the cell changes are advanced and do not resolve by itself. The strain that causes physical warts does not cause cervical changes.

     Preventing HPV spread
Gardasil is the vaccine against certain strains of HPV, particularly a couple that cause cancer. Both boys and girls can get the vaccine. The vaccine is quite controversial, since it has one of the highest adverse event rates of any vaccine ever.

Condoms are not that effective against the spread of HPV because they do not cover all the skin, but they definitely help.

     Pap tests help prevent cervical cancer
Getting regular pap smears means you can catch any cell changes early, and take action before you get cancer. There are certain changes that occur leading up to actual cancer, and these can be treated usually using surgical techniques to actually remove the cells. This leaves the cervix intact, and all reproductive facilities available.

Pregnant women and those with HIV may see rapid growth of warts.

Your doctor will examine you, and if the warts are internal, a colposcopy may be recommended. Genital warts are pretty classic in their appearance and are easy to diagnose.

Any wart that bleeds, looks unusual, develops into a sore or ulcer, or remains after treatment will need to be removed surgically and checked for cancer. Syphilis can also cause genital warts, so a blood test will often be taken for syphilis.

A pap smear will be done if the warts on on the cervix to check for cervical cell abnormalities. If anything is found, checks should be performed every six months to catch any changes early.


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