Genital warts are caused by Human Papilloma Virus (HPV). They were long considered inconvenient but benign conditions. Most genital warts are caused by HPV types 6 and 11, which are rarely if ever associated with invasive cancers. However, other strains of HPV (High Risk types) e.g., types 16, 18, 31, 33, 35, 39, 45, 52, 55, 56, and 58 are implicated in the development of moderate to severe squamous dysplasia and of overt cancer of the cervix, anus, vulva, vagina, and penis.
Human papillomaviruses (HPVs) selectively infect the epithelium of the skin and mucous membranes. These infections may be asymptomatic (without any problem), produce warts, or be associated with a variety of benign and malignant diseases.
The incubation period of HPV disease is usually 3 to 4 months, with a range of 1 month to 2 years.
- There are many different types of genital HPV.
- Only certain types of HPV are linked with cervical cancer. These are usually called “high-risk” types.
- The types of HPV that cause raised external genital warts are not linked with cancer. These are called “low-risk” types.
- These wart-types of HPV usually are not usually found on a female’s cervix, and therefore, are not going to carry any risk of cancer.
- It is common for a person to be exposed and have more than one type of HPV, including several “high-risk” types. Yet, most women do not develop cervical cancer.
- Cervical cancer usually takes years to develop.
- Most of the time, men will not have any symptoms or health risks such as cancer with the “high-risk” types of HPV. It is the female’s cervix that needs to be monitored.
Other types of warts
Common warts (verruca vulgaris) most prevalent among young children.
Plantar warts (verruca plantaris) are also widely prevalent; they occur most often among adolescents and young adults.
Condyloma acuminatum (which manifests as anogenital warts) is one of the most common sexually transmitted diseases.
Common warts usually occur on the hands as flesh-colour to brown, hyperkeratotic papules. Plantar warts may be quite painful. Flat warts ( verruca plana) are most common among children and occur on the face, neck, chest, and flexor surfaces of the forearms and legs.
Anogenital warts develop on the skin and mucosal surfaces of the external genitalia and perianal areas. In men, warts are found most frequently at the frenum or coronal sulcus but may affect any part of the penis. They occur commonly at the urethral meatus and may extend proximally. Perianal warts are common among homosexual men but develop in heterosexual men as well. In women, warts appear first at the posterior introitus and adjacent labia. They then spread to other parts of the vulva and commonly involve the vagina and cervix. These lesions may be present without external warts.
The anogenital warts may be confused with many other types of diseases like condylomata lata of secondary syphilis, molluscum contagiosum and a variety of benign and malignant mucocutaneous cancers.
Infections involving the Respiratory system in young children may be life-threatening and presents as hoarseness, stridor, or respiratory distress. The disease in adults is usually mild.
The complications of warts include itching and occasionally bleeding. In rare cases warts become secondarily infected with bacteria or fungi. Large masses of warts may cause mechanical problems, such as obstruction of the birth canal. Dysplasias of the uterine cervix are generally asymptomatic until frank carcinoma develops.
Treatment
Currently available modes of treatment are not completely effective. Many lesions resolve spontaneously. Frequently used therapies include cryosurgery, application of caustic agents, electrodesiccation, surgical excision, and ablation with a laser. Topical antimetabolites such as 5-fluorouracil also have been used. Both failure and recurrence have been well documented with all of these methods of treatment. Cryosurgery is the initial treatment of choice for condyloma acuminatum. Topically applied podophyllum preparations as well as podofilox may also be used. Various interferon preparations have been employed with modest success in the treatment of respiratory papillomatosis and condyloma acuminatum.
Genital Warts
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