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General Questions and Answers
What are anogenital warts and what causes them?
Anogenital warts (sometimes just called genital warts) are small
lumps that develop on the genitals and/or around the anus (back
passage). They are caused by a virus called the human papillomavirus
(HPV). There are over 100 types of this virus. Most anogenital
warts are caused by types 6 or 11. ('Common' warts that many people
have on their hands and feet are caused by a different type of
HPV.)
How do you get anogenital warts?
The virus is passed on by sexual contact. You need close 'skin
to skin' contact to pass on the virus. This means that you do not
necessarily need to have penetrative sex to pass on infection.
Sharing sex toys may also pass on infection. Very rarely, anogenital
warts may be passed on from hand warts. They may also rarely be
passed on to a baby when a woman gives birth.
It can take weeks or months to develop warts after being infected
with HPV. Also, most people infected with HPV do not develop warts.
You can be a 'carrier' of the virus without realising it, and you
may pass on the virus to others who then develop warts. It is also
possible to pass on the virus after warts have been treated or
gone.
Because it can take some time to develop warts after being infected
with HPV, if you have just developed noticeable anogenital warts,
it does not necessarily mean that either partner has been recently
unfaithful. You may have had HPV for a long time without developing
warts.
Also note that you may get anal warts even if you have not had
anal sex.
How common are anogenital warts?
They are common and are one of the most commonly diagnosed sexually
transmitted infections in the US. Many more people are infected
with the virus, but do not develop visible warts (they are 'carriers').
An individual has over a 5 in 10 chance of having HPV infection
in their lifetime. However, most people do not know that they have
been infected because they have no symptoms. Only about 1-2 in
100 people with HPV infection develop anogenital warts.
Where do anogenital warts develop?
In men the warts usually develop on the outer skin of the penis.
In women the warts usually develop on the vulva, just outside the
vagina. Warts may also develop on the skin around the anus in both
men and women.
Sometimes warts develop inside the vagina, on the cervix, on the
scrotum, inside the urethra (the tube that drains urine from the
bladder to the outside) or inside the anus. Rarely, they occur
in the mouth or nose.
What do anogenital warts look like?
They look like small, skin-coloured lumps on the skin (similar
to the common warts that many people have on their hands). Warts
that develop on skin that is warm, moist, and non-hairy (such as
the vulva) tend to be soft. Warts that develop on skin that is
dry and hairy (such as the shaft of the penis) tend to be firm.
The number of warts that develop varies from person to person.
Some people have just a few that are barely noticeable. Some people
have many around their genitals and anus.
What are the symptoms of anogenital warts?
In most cases, the warts cause no physical discomfort. They sometimes
cause irritation and soreness, especially if they occur around
the anus. Sometimes anogenital warts can bleed or cause pain on
intercourse. If you have warts inside your urethra or anus, this
can sometimes cause bleeding when you pass urine or bleeding from
the anus.
They are benign; that is, they cause no serious physical illness.
However, the warts look unsightly and some people become distressed
by this.
Do I need any tests?
Anogenital warts can usually be diagnosed by their typical appearance
when you are examined by a doctor or nurse. Your doctor or nurse
will examine your external genitalia to look for warts. They may
also suggest that they do an internal examination of your vagina
or back passage to look for warts here.
So, tests are not usually needed to confirm the diagnosis of anogenital
warts. However, up to 1 in 4 people with anogenital warts also
have another sexually transmitted infection. Tests such as 'swabs'
are commonly advised to check for other infections - even if you
do not have any symptoms.
If you have anogenital warts, your doctor or nurse may refer you
to a sexual health specialist in a genito-urinary medicine or to
a sexual health clinic for treatment. If you are worried that you
may have anogenital warts or another sexually transmitted infection,
you may choose to visit a sexual health clinic from the outset.
What are the treatment options for anogenital warts?
There are a number of different treatments that can be used to
treat anogenital warts and they are described below. Whatever the
treatment, it usually takes several weeks of treatment to clear
the warts. Sometimes it can take up to six months of treatment.
Treatment may be a little uncomfortable and cause some irritation
of the skin around the area that is being treated. Also, smokers
tend to respond less well to treatment, so stopping smoking may
be beneficial to your treatment.
Sometimes one treatment may not be successful. If this is the
case, another treatment may be advised. There is also a chance
that anogenital warts can return after treatment. This is because
the treatments do not clear the human papillomavirus itself but
just tend to treat the warty lesions.
No treatment
One option is not to have any treatment. Anogenital warts are
not serious, but can be unsightly. Some people prefer to just leave
them alone. There is a good chance that they will go without any
treatment. In fact, about one third of visible warts disappear
by themselves over 6 months.
Chemical treatments
A number of chemicals, when put on to warts, will 'burn' or destroy
the wart tissue.
Podofilox
(Condylox Gel or Solution) is a chemical that comes as a
cream or lotion. This may be prescribed for you to put on the
warts at home. You should apply it twice daily for three days,
followed by four days' rest. This is repeated four to five times
depending on the type of Podofilox (Condylox Gel or Solution)
you are given (so the whole treatment lasts about four to five
weeks). There are some points to note about Podofilox (Condylox
Gel or Solution):
You must not use it if you are pregnant.
You should not put Podofilox
(Condylox Gel or Solution) on broken skin or open wounds and
you should be careful to avoid getting it on normal skin around
the warts.
Sexual contact is not recommended soon after the cream/lotion is
applied to your skin as it may cause irritation for your partner.
You should be careful to follow the instructions carefully when
you are applying the cream/lotion and you should not apply too
much. If you apply too much, the cream/lotion may start to have
unwanted effects inside your body.
Imiquimod cream is another alternative. You apply the cream to
your warts at bedtime and wash it off 6-10 hours later. This is
repeated three times per week for up to 16 weeks. It may take some
weeks before the treatment works. There are some points to note
about imiquimod cream:
Imiquimod may weaken condoms and diaphragms so you should not rely
on these as contraception whilst you are undergoing treatment.
You must not use it if you are pregnant.
Sexual contact is not recommended soon after the cream is applied
to your skin as it may cause irritation for your partner.
You should not put imiquimod cream on broken skin or open wounds
and you should be careful to avoid getting it on normal skin around
the warts.
In some people, imiquimod cream can cause either permanent loss
of pigmentation (light areas) of the skin or it may cause permanent
excess pigmentation (dark areas) of the skin where it is applied.
Trichloroacetic acid is an alternative that is sometimes used.
It is applied by a doctor or nurse once a week for several weeks.
Other chemicals may be advised by a specialist if there is little
success with the above.
Physical treatments
Various techniques can destroy the wart tissue. They include:
Freezing warts with liquid nitrogen is a common treatment. This
is called cryotherapy. Liquid nitrogen is sprayed on or applied
to the wart. Liquid nitrogen is very cold. The freezing and thawing
destroys the wart tissue. To clear the warts fully you may need
several treatments, a week or so apart. This treatment may be used
if you have a small number of warts.
Surgical removal of warts under local anaesthetic may be an option
if you have just a few warts that can be easily removed in this
way.
Electrocautery is other techniques that destroy the warts by 'burning'.
A laser is sometimes used to destroy the warts by 'burning'
Which is the best treatment?
Each treatment has pros and cons. The treatment decided upon depends
on factors such as how many warts are present, where they are,
whether a home or clinic based treatment is preferred, etc. For
example, some chemical treatments should not be used internally
(on the cervix, vagina or inside the anus); some chemical treatments
should not be used if you are pregnant; cryotherapy is usually
only used for small to moderate numbers of warts, etc.
What about my sexual partner?
Current sexual partner(s) may wish to be checked to see if they
have warts or other sexually transmitted diseases.
Is there a link between anogenital warts and cervical cancer?
The types of HPV that most commonly cause anogenital warts (types
6 and 11) do not increase your risk of cervical cancer. HPV types
6 and 11 cause over 9 out of 10 cases of anogenital warts. However,
some other types of HPV do increase your risk of developing cervical
cancer. You may have more than one type of HPV infection at the
same time (one type that causes anogenital warts and one type that
may increase your risk of cervical cancer).
So, it is important that women with anogenital warts (the same
as every woman) have cervical screening tests at the usual recommended
times and do not 'put it off'. You do not need to have cervical
screening tests more regularly if you have anogenital warts. See
separate leaflet called 'Cervical Screening Test' for further details.
Prevention of anogenital warts
Condoms
Condoms (male or female) may prevent HPV from being passed on
to new sexual partners who are not infected. However, they do not
completely protect you from getting anogenital warts as the skin
that is not covered by a condom can become infected. But condoms
do help to protect against other sexually transmitted infections
such as chlamydia and HIV. You should also use condoms whilst having
oral sex and you should not share sex toys.
It is commonly advised that you should use condoms when you have
sex whilst you are being treated for warts, and for at least a
further three months after they have gone.
HPV vaccine
The type of HPV vaccine that the Department of Health has chosen
for the national immunisation campaign (Cervarix® vaccine)
does not protect against the common types of HPV that cause anogenital
warts (types 6 and 11). However, it does protect against HPV types
16 and 18 which are are involved in the development of most cases
of cancer of the cervix. A leaflet called 'HPV Immunisation' gives
further details.
What is the outlook?
Anogenital warts can usually be cleared with treatment. However,
in about 1 in 4 cases, new warts develop at some time after successful
treatment. This is usually because the same infection has 're-activated',
not because you have a newly-acquired infection. If warts do recur,
they can be treated in the same way.
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