Genital Warts and HPV

Whenever I diagnose genital warts in a teenager it's always a huge deal. Tears, sometimes devastation, and about a million questions usually follow.

Girls and guys want to know:

"Exactly what are genital warts?" "How did I get them? We always use a condom!" "But my partner didn't have any warts -- so where did they come from?"

"Can you get them any other way besides from sex"

"How well does treatment work?"

"Will the warts ever go away for good?"

"Isn't this going to totally screw up my sex life?"

"What about oral sex? Can we still do it?"

"Am I going to infect someone else?"

"Will I ever be normal again?"

And girls want to know:

"Does this mean I can't have children?"

"Am I going to get cancer?"

These are real questions from real patients. As you learn the answers, remember one fact and some good news:

· Fact -- Genital warts (known as condyloma acuminata) are the most common viral sexually transmitted disease in this country.

· Good news about genital warts -- You can lower your chances of getting them, having them doesn't mean your sex life or reproductive life is over, and good treatments are available.

What Exactly Are Genital Warts? Genital warts are just that -- warts that you get in the genital area. They are caused by human papilloma virus, or HPV for short.

An easy way to think about genital warts is to compare them to common warts (hand warts) or plantar warts (foot warts). You first get those kind of warts by contact with HPV on someone else's skin or on an inanimate (non-living) object. The virus then infects your skin and causes the bumps you see as warts.

Genital warts come about the same way but are spread mainly through sexual contact. If you have genital skin-to-skin contact with an infected partner, then the virus can work its way into your genital skin and presto, you are now infected and may develop genital warts.

HPV loves areas of skin trauma and friction. Since there's lots of friction going on during sexual contact, it's easy to see why HPV readily spreads down there.

Can you get genital warts from non-sexual contact? It's possible but probably not common. For example, you could spread hand warts to your genital area by touch. And since HPV can be recovered from inanimate objects like tanning couches, underwear and sauna benches, it's possible to pick up the virus from these types of sources.

Genital warts show up as one or more painless fleshy growths.

· In girls -- Warts can pop up on the vulva, vaginal introitus (entrance), labia majora and minora, perineum (the skin between the vagina and anus), and anal area. They can also hide inside the vagina and on the cervix.

· In guys -- Warts can appear on the head and shaft of the penis, the scrotum, the pubic area, and the anal area.

Girls may be amazed to find out they have warts around their anus. "But I've never had anal sex!" they say. This happens because vaginal warts can easily spread to the anal area by normal genital touching. And, of course, having anal sex puts the receptive partner at risk for getting anal warts and the insertive partner at risk for getting penile warts.

A doctor can almost always diagnose genital warts by a simple examination. Sometimes a biopsy is done to make a diagnosis. In a biopsy, the entire bump, or a part of it, is removed under local anesthesia and sent to a lab for analysis.

The tricky thing about genital warts is that even if you don't have any bumps you may still be infected. That's not fair, but it's true. Those infections are silent, meaning your genital skin is infected but you don't know it.

Silent infections are all too common with STDs like genital warts, chlamydia, gonorrhea, and even herpes. That's why STDs are spread so easily -- you can give or get them and be none the wiser.

Am I at Risk for Getting Genital Warts? You are if you have any sort of genital-to-genital contact with another person (guy-girl, girl-girl, guy-guy).

Life would be so simple if you could do just two things and eliminate your risk of getting genital warts or any STD:

· Ask your partner if he or she ever had genital warts or an STD.

· Look at your partner's genitals to see if he or she has any bumps.

But life is not so simple:

· Some people lie about their past sex life or history of STDs.

· Some people cheat on their partner.

· A girl can have tiny warts at the entrance to her vagina, inside her vagina, or on her cervix that she doesn't know about.

· Guys and girls can have silent HPV infection.

· People may be too embarrassed or afraid to mention their HPV secret.

· Someone thinks the warts he or she got treated years ago don't matter anymore -- but that person could still be contagious.

Here's how you can cut down on your risks of getting HPV and genital warts:

· Don't start having sex too young. An earlier age of first sex increases your risk of getting HPV.

· Don't have multiple sex partners. The risk of genital HPV infection increase with the number of sex partners.

· Use condoms. Condoms help prevent HPV from getting onto you.

Reality Check: Even if you always use condoms during sex, you could still pick up HPV from an infected partner. That's because a condom only covers the head and shaft of the penis. The base of the penis, the scrotum and the rest of the genital skin are still exposed. STDs like genital warts, herpes, molluscum, crabs and syphilis can spread to and from that unprotected skin.

You should also:

· Know your partner well.

· Talk with your partner about sexual health issues.

· Know that it's possible to get mouth warts from performing oral sex on someone with genital warts. Using a dental dam (a latex barrier placed over the vagina) or a wearing a non-lubricated condom during oral sex can cut down on that risk.

· Schedule regular check-ups and STD tests for you and your partner.

· Know that a vaccine is being tested to help prevent HPV infection.

What If I Already Have Genital Warts? Then know that:

You can pass HPV to a partner even if your warts are treated, since HPV can stay in your skin after the bumps are gone. However, it's not the end of your sex life or reproductive life.

You can still have a satisfying sex life, but you will need to be open and honest with your partner. Get the warts treated by a doctor and use condoms to help cut down the chance of spreading it to your partner. Don't forget -- you may have gotten the warts from your current partner who may have a silent infection.

HPV infection itself does not mess up your ability to have babies.

In young women, HPV infection may actually go away for good. How long that takes and in which women that will happen is not known.

Effective treatments for genital warts are definitely available. These include:

Home treatments:

· Condylox -- a liquid medicine

· Aldara -- a cream medicine

Office treatments:

· cryotherapy (freezing)

· acid treatment

· electrodessication (burning off the warts with an electric current)

· surgical removal

· laser treatment

Discuss with your doctor which treatment is right for you, since each has its own side effects and risks.

What's All the Worry About HPV? The big deal about HPV is not that it causes wart bumps, since those are usually easy to detect and treat.

The big deal is that there is a strong association between HPV infection and pre-cancerous and cancerous changes of the cervix, vulva and penis. In women, these cervical changes can be found on a PAP test. Also, gay men with anal warts have an increased risk of getting anal cancer.

Certain types of HPV (there are more than 70 of them) are more strongly associated with these pre-cancerous and cancerous changes. For example, HPV types 6 and 11 usually cause external genital warts and are considered low risk for cancer. HPV types 16 and 18 often infect the cervix and are considered high risk for cancer.

There are tests to detect these different HPV types but they are not routinely done since they don t really change how the problem is managed. You still need regular check-ups with your doctor.

Reality Check: Just because you have genital warts does NOT necessarily mean you are going to get pre-cancerous or cancerous changes. It does mean that you need to be followed closely by your doctor because these changes could occur. In fact, experts believe HPV is only one factor in causing these changes. Other factors -- especially cigarette smoking -- are thought to contribute.

So... Girls, you need to have regular PAP tests if you are sexually active (or once you turn 18) to make sure your cervix is healthy. If any abnormal or pre-cancerous cells are found on your PAP test, your doctor will discuss what that means and what treatment is needed.

This is so important, because in teenage girls the cervix is at a great risk for HPV infection and is susceptible to the changes HPV can cause. That s because a teenage girl s cervix is still maturing.

Guys, you should have regular check-ups with your doctor who should do a careful genital examination.

Now take a minute and go back to the questions you first read. They are real questions and tough answers for sure, but there are answers, and there is help. Don't be afraid to talk with your doctor about HPV and genital warts because it s a hard issue to deal with alone.