Dear Doctor,
I have been diagnosed with genital warts and I am very worried. Should I be concerned about my long term health?
EM
Dear EM,
Genital warts are common, and usually cause no symptoms. They are usually flat and raised growths on the external genital region, or inside the vagina and on the penis in men. They are disfiguring and annoying. They may sometimes be painful or itchy, and can rarely interfere with childbirth.
Ninety per cent of genital warts are caused by certain strains of the Human Papilloma Virus (HPV). It is worth noting that the HPV types that cause genital warts are not associated with cancer of the cervix, which is a common worry in people with genital warts.
Other HPV types may be found occasionally in visible genital warts as co-infections. These other types of HPV are associated with changes that may be associated with cancer of the cervix. In addition to warts on genital areas, HPV has been associated with warts on the nose, eyes, mouth and the wind-pipe.
Diagnosis of genital warts is usually made by visual inspection. A biopsy may be done if the diagnosis is uncertain or if there is no response to treatment. The main reason for treating genital warts is to relieve symptoms, including relieving cosmetic concerns. If left untreated, genital warts can resolve spontaneously, remain unchanged, or increase in size or number.
Treatment modalities include applications of solutions, gels, creams or ointments on the warts. Some of these may damage adjacent normal skin and must be applied by a trained health worker. Other modalities are use of cold energy (called cryotherapy), heat energy or even surgical removal of the warts. Most warts will respond within three months of treatment, but recurrence is also common.
In pregnancy, the warts may be left alone until after delivery, or surgically removed if necessary. Majority of women will have a normal delivery, but any concerns must be discussed with their Obstetrician.
HPV vaccines are now available, offering protection against genital warts and cervical cancer. These vaccines are most effective when administered before sexual contact, and are applicable for both girls and boys. Women with genital warts do not need to get Pap smears more often than recommended.
It’s good to be aware that genital HPV infection is very common, and many types of HPV are passed through sexual contact. Most sexually active adults will get HPV at some point, though most will never know it because HPV infection usually has no symptoms. A diagnosis of HPV in one sex partner is not indicative of sexual infidelity in the other partner. But if one partner develops genital warts, both partners may benefit from screening for other sexually transmitted infections.
— Dr Alfred Murage is a consultant obstetrician and gynaecologist