Genital warts

Genital warts are a sexually transmitted infection caused by certain types of human papillomavirus (HPV). They are generally pink in color and project out from the surface of the skin. Usually they cause few symptoms, but can occasionally be painful. Typically they appear one to eight months following exposure. Warts are the most easily recognized symptom of genital HPV infection. HPV types 6 and 11 are the typical cause of genital warts. It is spread through direct skin-to-skin contact, usually during oral, genital, or anal sex with an infected partner. Diagnosis is generally based on symptoms and can be confirmed by biopsy. The types of HPV that cause cancer are not the same as those that cause warts. Some HPV vaccines can prevent genital warts as may condoms. Treatment options include creams such as podophyllin, imiquimod, and trichloroacetic acid. Cryotherapy or surgery may also be an option. After treatment warts often resolve within 6 months. Without treatment, in up to a third of cases they resolve on their own. About 1% of people in the United States have genital warts. Many people, however, are infected and do not have symptoms. Without vaccination nearly all sexually active people will get some type of HPV at one point in their lives. The disease has been known at least since the time of Hippocrates in 300 BC. Genital warts may occur singly but are more often found in clusters. They may be found anywhere in the anal or genital area, and are frequently found on external surfaces of the body, including the penile shaft, scrotum, or labia majora of the vagina. They can also occur on internal surfaces like the opening to the urethra, inside the vagina, on the cervix, or in the anus. They can be as small as 1-5mm in diameter, but can also grow or spread into large masses in the genital or anal area. In some cases they look like small stalks. They may be hard ('keratinized') or soft. Their color can be variable, and sometimes they may bleed. In most cases, there are no symptoms of HPV infection other than the warts themselves. Sometimes warts may cause itching, redness, or discomfort, especially when they occur around the anus. Although they are usually without other physical symptoms, an outbreak of genital warts may cause psychological distress, such as anxiety, in some people. HPV is most commonly transmitted through penetrative sex. While HPV can also be transmitted via non-penetrative sexual activity, it is less transmissible than via penetrative sex. There is conflicting evidence about the effect of condoms on transmission of low-risk HPV. Some studies have suggested that they are effective at reducing transmission. Other studies suggest that condoms are not effective at preventing transmission of the low-risk HPV variants that cause genital warts. The effect of condoms on HPV transmission may also be gender-dependent; there is some evidence that condoms are more effective at preventing infection of males than of females.