Genital Warts Genital warts, also known as condyloma acuminatum, are primarily sexually transmitted lesions caused by infection with the human papillomavirus (HPV). The condition, which is mainly transmitted through sexual activity, manifests as wart-like growths on the skin and mucous membranes, with varying sizes and shapes. These growths commonly occur in the anal and genital areas. While they can be treated using various methods, they often recur, necessitating prolonged and repeated treatment.

Genital warts are primarily wart-like lesions caused by infection with the human papillomavirus (HPV), a sexually transmitted disease. They are also known as anogenital warts, condylomata acuminata, venereal warts, or genital warts, and are mainly transmitted through sexual contact. The skin lesions mainly manifest as growths on the skin or mucous membranes, varying in size and shape, often occurring in the anal and external genital areas. They can be treated through various methods, but tend to recur and require prolonged and repeated treatment.

Genital Warts

They can affect the urethra, genitals, and anus, causing external genital warts, vaginal warts, perianal warts, anal warts, urethral warts, and cervical warts, among others.

Giant Condyloma Acuminatum

This condition is rare and has an invasive nature, often caused by HPV-6. Although histologically benign, it may have deep invasion and in rare cases can spread to regional lymph nodes, often requiring surgical treatment.

Bowenoid Papulosis

Characterized by flat, often pigmented papules, commonly found near the penis, vulva, or around the anus. It is often caused by HPV-16 and may progress to squamous cell carcinoma, showing abnormal epithelial development and cellular atypia.

In addition, genital warts are closely related to subclinical and latent HPV infections. In patients with latent HPV infection, the local skin and mucous membranes appear normal, and acetic acid tests are negative, but HPV can be detected through molecular biology methods. Latent HPV infection is generally considered one of the main reasons for the recurrence of genital warts. Subclinical HPV infection presents as skin lesions not discernible to the naked eye, with positive acetic acid tests, and is also associated with the recurrence of genital warts.

Genital warts are almost always transmitted through sexual contact, primarily through vaginal intercourse to the genital area through contact with HPV-infected skin or mucous membranes. In rare cases, transmission can occur through anal intercourse to the anus, or through oral sex to the mouth and throat. Genital warts that are not visible to the naked eye can also transmit HPV. In very rare cases, pregnant women can transmit HPV to newborns during childbirth. Additionally, children who have experienced sexual abuse may also develop genital warts.

There are over 100 types of HPV, with over 40 capable of infecting the anogenital area. HPV infection is widespread in the population, and different subtypes are associated with different diseases. Most anogenital HPV infections tend to resolve on their own, without causing related diseases. When HPV infection is not cleared, it may develop into diseases such as genital warts.

Some HPV types are associated with an increased risk of cancer (such as cervical cancer), referred to as high-risk HPV, while the rest are not clearly related to cancer, known as low-risk HPV. 90% of genital warts are caused by low-risk HPV types 6 and 11. Sometimes, genital warts also feature mixed infections of low-risk and high-risk HPV.

Data shows that 31% of genital wart lesions contain high-risk HPV, such as types 16, 18, 52, and 56. Furthermore, high-risk types such as HPV 16 and 18 may be associated with cervical intraepithelial neoplasia (CIN) and other premalignant lesions.

Sexual behavior is the main risk factor for genital warts. It is more likely to develop genital warts when:

- Having multiple sexual partners.

- Engaging in high-risk sexual behavior, such as having multiple partners or partners with HPV infection.

- Engaging in unprotected sexual activity, such as not using condoms.

- Immune system issues (e.g., HIV infection, AIDS, or immunosuppressive medication) can lower the body's immunity to diseases and infections, making it more susceptible to larger and more difficult-to-treat genital warts with higher recurrence rates.

- Data confirms a link between smoking and an increased risk of genital warts, with a higher daily number of cigarettes or longer smoking duration correlating with a greater risk of genital warts.

- Male circumcision may reduce the risk of HPV infection.

Genital warts commonly occur in sexually active young and middle-aged individuals, with an average incubation period of around 3 months. Genital warts usually present with no symptoms, but a few patients may experience a sense of foreign body, pain, itching, discomfort during sex, foul odor, bleeding, and emotional distress. Urethral genital warts can manifest as terminal hematuria, abnormal urine flow, or urethral bleeding. Genital warts can vary in location, size, and shape.

Location

Common sites include the moist skin/mucous membrane areas of the external genitalia and around the anus.

In males, they typically occur on the glans, coronal sulcus, frenulum, urethral meatus, penile shaft, and perineum.

In females, they commonly occur on the labia majora, labia minora, vaginal introitus, clitoris, vagina, cervix, perineum, and perianal region.

In homosexual populations, they often occur in the anal and rectal areas.

In rare cases, they can occur in extragenital locations such as the oral cavity, armpits, breasts, and interdigital spaces.

Size and Morphology

In the initial stages, the lesions appear as small, soft, reddish papules, sometimes too small to be discernible to the naked eye. As the lesions progress, they increase in number and size, taking on forms such as papillary, cauliflower-like, cockscomb-like, or mushroom-like, and can be white, pink, or grayish, with possible ulceration, exudation, rupture, bleeding, or infection.

Giant Genital Warts

This rare condition presents with larger, cauliflower-like growths, often pink in appearance, resembling benign lesions, but with an invasive nature that often requires surgical treatment.

Bowenoid Papulosis

This condition presents with flat, often pigmented papules, often occurring near the penis, vulva, or around the anus. It is often caused by HPV-16 and may progress to squamous cell carcinoma, showing abnormal epithelial development and cellular atypia.

Most patients do not have noticeable symptoms, so males may not easily detect genital warts (even when visible to the naked eye), and females are even less likely to notice genital warts inside the vagina or on the cervix.

Current treatments include outpatient and inpatient treatments, often requiring multiple sessions. There is currently no universally recognized optimal treatment regimen for all patients.

Outpatient treatment refers to self-treatment at home, mainly involving topical medications such as imiquimod cream. Inpatient treatment refers to treatments conducted by healthcare professionals at medical institutions, mainly involving physical and surgical treatments.

Physicians will develop individualized treatment plans based on factors such as the size, number, location, treatment costs, treatment side effects, and patient treatment experience, adopting a comprehensive prevention and control strategy to achieve the most satisfactory therapeutic effect. Additionally, patient treatment preferences, compliance, and the professional level of the physician can also influence treatment selection.

In some cases, clinical physicians may opt for combination therapy, such as simultaneously selecting outpatient and inpatient treatments.

Patients with compromised immune function are treated similarly to those with normal immune function. However, in patients with compromised immune function, the success rate of genital warts treatment is lower and may require longer treatment and more frequent follow-up assessments.

1. Surgical excision: This involves physically removing the warts by cutting them out. This is typically recommended when the warts are extensive and other treatments such as medications or cryotherapy have not been effective in removing them. However, it's important to note that surgical removal may not guarantee complete eradication of the virus, so additional medical treatment may still be necessary.

2. Procedures for cervical cell abnormalities: In cases where high-risk HPV strains have caused abnormal cervical cell changes, certain types of surgical procedures may be recommended. These procedures often require anesthesia and are usually more costly than other treatment methods.

It's important for patients to discuss the potential benefits and risks of surgery with their healthcare provider before making a decision. Surgical intervention may carry the risk of spreading the warts, so careful consideration is essential.

1. Adherence to treatment: Patients undergoing external treatments such as topical medications should follow the prescribed treatment regimen consistently.

2. Maintaining dryness and cleanliness: Keeping the affected areas dry and clean can aid in the natural drying of the warts.

3. Psychological support: While genital warts are a common and benign condition, they can impact an individual's psychological and social well-being. Therefore, attention to the patient's mental health is important.

4. Sexual contact precautions: Patients should avoid sexual contact in the affected areas until they are completely healed.

1. Disclosure to sexual partners: It's important for individuals with genital warts to inform their sexual partners about their condition.

2. Sexual activity avoidance: Patients should refrain from engaging in sexual activity until the warts have completely resolved. Even after the warts have disappeared, the HPV virus may still be present and transmissible to sexual partners.

3. Proper condom use: Consistent and correct use of condoms may reduce the likelihood of transmitting genital warts. However, it's important to note that condoms may not provide complete protection against HPV transmission.

1. Evaluation for children: Children with genital warts should be evaluated by a healthcare professional to understand the underlying causes and assess the possibility of sexual abuse.

2. Pregnancy: During pregnancy, rapid wart growth may occur. Treatment options such as cryotherapy or surgery can be considered, but the risks should be thoroughly explained to the pregnant woman.

3. Immunocompromised individuals: Individuals with HIV or compromised immune function are more susceptible to genital warts and may experience poor treatment response and frequent recurrence. These patients should actively manage their underlying health conditions in addition to treating the warts.

4. Partner screening: As a precaution, it's advisable for the sexual partners of individuals with genital warts to undergo screening for sexually transmitted diseases and receive specialized medical examination within the past 6 months.

5. Persistent or recurrent warts: Genital warts that do not resolve or recur after treatment may require a biopsy to rule out other issues.

1. Responsible behavior: Enhancing personal responsibility and avoiding non-marital sexual activity can help reduce the risk of genital warts.

2. Condom use: While condoms can provide some level of protection against HPV transmission, they may not offer complete prevention.

3. Male circumcision: Male circumcision may reduce the risk of HPV infection.

4. Immune system health: Maintaining a healthy immune system and avoiding immune-related conditions such as HIV can help reduce the likelihood of developing genital warts.

5. HPV vaccination: Both males and females can receive HPV vaccines to prevent genital warts. It's generally recommended for individuals under 26 years of age. The available HPV vaccines are the 2-valent, 4-valent, and 9-valent vaccines, all of which have been approved for the prevention of cervical cancer and, in the case of the 4-valent and 9-valent vaccines, for the prevention of genital warts as well.