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Female Genital Warts

She looked nervous and anxious when she stepped into my consultation room. “Doc, I have a fleshy lump in my genital area for the past 3 days. It is not painful but itches occasionally. It has been getting bigger and has started to bleed today. Could it be cancer?” she asked worriedly.

E, a 19-year-old student was sexually active since the age of 16. She had 3 previous sexual partners. “I was not using condoms as I was on the pills. I did not worry about sexually transmitted diseases as my current boyfriend is “clean”. He just had his blood tests done few weeks ago,” she said.

Clinical examination revealed that E had a cauliflower-like growth about 1 cm. protruding from the opening of the vagina. She had genital warts.

What are genital warts?

Genital warts are one of the most common sexually transmitted infections. They affect the moist tissues of the genital area like the vulva, the walls of the vagina, the cervix, the area between the external genitals and the anus and the anal canal.

The vast majority of genital warts are the direct result of skin-to-skin contact during vaginal or anal sex, with the rare instance of transmission via oral sex. They can be passed on to others even when there are no visible warts or symptoms.

What are the causes?

Genital warts are caused by the human papilloma virus (HPV) and are almost spread through sexual contact. There are over 100 different strains of HPV. The strains of HPV that cause genital warts are different from those that cause genital cancers such as cervical cancer. However, they can coexist together.

What are the symptoms?

In the females, the symptoms of genital warts include

  • One or more small, flesh-colored, brown, grey or pink swellings in the sites described above

  • A cauliflower-like growth due to several warts growing together

  • Itching or bleeding from the vagina or anus

  • Vaginal discharge

In some cases, genital warts can be so small that they may not be visible. Very rarely, they can multiply and develop into big clusters that may block the vaginal opening.

It is important to note that symptoms of genital warts can appear weeks, months or years after the patient has had contact with HPV virus.

What are the risk factors?

Risk factors include:

  • Having sex with multiple partners

  • Having unprotected sex

  • Having had other sexually transmitted infections

  • Becoming sexually active at a young age

  • Having a weakened immune system, such as from HIV or drugs from an organ transplant

  • Smoking

How are genital warts treated?

Small warts may be removed by applying topical cream or solution.

Larger lesions may need minor surgery. The modalities of surgery include:

  • Electrocautery-- burning the warts with electric currents

  • Cryosurgery-- freezing the warts

  • Laser treatments

  • Excision of the warts

Can genital warts be prevented?

Reducing the number of sexual partners and being vaccinated will help prevent patients from getting genital warts. Using a condom may cut down the risk but not necessarily protect patients from getting genital warts.

After explaining the causation of genital warts to E, I prescribed a topical cream for her. The warts disappeared gradually after a week. I told her that she should reveal her condition to her partner and both of them should be vaccinated. She should also have regular pap smear and HPV testing to prevent the development cervical precancer and cancer.

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