Genital Warts in Women
Genital warts are a sexually transmitted infection that causes small, flesh-colored or pink growths on the labia, inside the vagina, and on the cervix, as well as around the anus.
They are the most easily recognized sign of infection by the human papilloma virus (HPV). Although genital warts affect both woman and men, the infection is more common in women than men.
Genital warts are caused by the human papillomavirus (HPV). There are more than 100 types of HPV. Some HPV viruses cause common warts (verruca vulgaris) that appear on the fingers or hands. Other HPV viruses cause genital warts. HPV viruses are also the cause most cases of cervical cancer, but the HPV viruses that cause genital warts are not the same as those that can cause cancer.
Does it hurt to have genital warts?
Some warts are so small and painless they are unnoticeable. Others are three or more inches around and make it painful for a woman with genital warts to sit or walk. Sometimes the warts itch or burn, and scratching them can cause irritation.
How do women become infected with genital warts?
Genital warts are very contagious and are spread by direct skin-to-skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (for example, hand-to-genital contact).
Most people with the virus do not have visible warts but can still transmit the virus. Treating the warts may not decrease the chance of spreading the virus. Therefore, all people who are sexually active should be regarded as potential sources of HPV, not just those with visible warts.
A woman infected with HPV may not see warts appear for weeks to a year or more after being exposed; it is not usually possible to know when or how you became infected.
How are genital warts diagnosed in women?
To diagnose genital warts, a doctor will usually conduct a physical exam and biopsy any suspicious-looking growths.
How is HPV diagnosed in women?
The most common way of diagnosing HPV is with a Pap test. While a Pap test by itself doesn’t usually definitely diagnose an HPV infection, it can identify infected abnormal cells and precancerous changes in the cervix that may be precursors to cancer.
If there is an abnormal pap smear, the doctor often will do advanced testing on the material to determine if, and which kind, of HPV may be present.
In some cases, during a physical examination, the appearance of genital warts in any sexually exposed area will prompt some doctors to diagnose HPV without futher testing. Some physicians may confirm the diagnosis by doing a biopsy (collecting a tissue sample from the wart) and sending it to a to a lab for analysis.
How are genital warts treated?
Genital warts often recur and are easily spread, so getting rid of them can be a challenge. Part of the treatment involves evaluating the woman’s sexual partner(s) as well as discussing techniques to prevent the spread of the warts. Obviously, the woman must avoid sexual contact with any partner(s) who infected with HPV.
There are several topical treatment options for genital warts:
- For small warts, self-treatment with the prescription cream imiquimod (Aldara) is sometimes successful, although it can irritate surrounding skin. The cream is applied three times a week until the warts dissolve.
- Larger or persistent warts can be dissolved with a topical agent such as podophyllin or trichloracetic acid (TCA) applied directly. Because these medicines (especially podophyllin) can cause chemical burns if used incorrectly, women should not try to apply them at home. Podophyllin must be removed several hours after it is applied and usually needs to be reapplied several times at weekly intervals. Pregnant women should not use podophyllin, because it can cause birth defects.
- A prescription topical cream, podofilox, which a woman can apply herself for three times per week for up to three weeks, may also be effective.
If warts persist or return after treatment, the doctor will make sure they are not cancerous by doing a biopsy, using a topical or local anesthetic. Once cancer has been ruled out, the doctor may try these treatments:
- The doctor can burn or freeze off the warts using electrocautery or liquid nitrogen (cryosurgery). These techniques are sometimes used instead of topical agents when warts are extensive or occur in particularly sensitive locations.
- The doctor may inject the warts with alpha interferon several times a week for about three weeks. Though less likely to cause pain and scarring than other treatments, alpha interferon makes some women feel as though they have the flu and is not safe for use during pregnancy.
- For persistent warts, laser surgery may be used. This option usually requires local or general anesthesia.
Because it is hard to tell if all warts have been removed, a woman should be rechecked by her doctor after six months. Additional treatment may be necessary. The doctor will probably want to do a Pap test every six months thereafter for at least a few years to make sure no cancerous changes have occurred.
Are there health complications for women from genital warts?
Pregnancy and childbirth
Genital warts may cause a number of problems during pregnancy. Because genital warts can multiply and become brittle, your doctor will discuss options for their removal, if necessary.
Genital warts also may be removed to ensure a safe and healthy delivery of the newborn. Sometimes the warts become larger during pregnancy, which may make it difficult to urinate if the warts are in the urinary tract. If the warts are in the vagina, they can make the vagina less elastic and cause obstruction during delivery. If the warts block the birth canal, a woman may need to have a cesarean section (C-section) delivery.
Infants born to women with genital warts can develop warts in their throats. Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent blocking of the breathing passages.
HPV, genital warts, and cervical cancer
There are about 100 known strains of HPV. Of the thirty strains that occur in genital areas, ten are considered high-risk and most likely to cause cervical cancer. They usually do not produce visible genital warts, although they could.
Cervical cancer usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.
How can women avoid getting HPV?
Preventing the spread of genital warts involves the same safe-sex practices required to prevent the spread of any sexually transmitted disease. Because abstinence from sexual activity while the warts are contagious can be impractical, condom use is important until all warts have been successfully treated. Male condoms, however, do not provide total protection, since a mans scrotum can harbor the wart virus.
There are several ways for both women and men to lower their chance of getting HPV:
- HPV Vaccines can protect males and females against some of the most common types of HPV. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given before a person's first sexual contact, when he or she could be exposed to HPV.
- For girls and women, two vaccines (Cervarix and Gardasil) are available to protect against the types of HPV that cause most cervical cancers. Gardasil also protects against most HPV strains that cause genital warts. Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls as young as 9 years of age. It is recommended that females get the same vaccine brand for all three doses, whenever possible.
- For boys and men, Gardasil protects against most genital warts. This vaccine is available for boys and men aged 9 through 26.
- For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV.
People can also lower their chances of getting HPV by being in a faithful relationship with one partner, limiting their number of sex partners, and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.