Genital or venereal warts can occur singly or in clusters of rough, bumpy growths. In women they typically develop around the anus, vagina and vulva, and sometimes on the cervix. The warts are less common in men, but when they occur, they develop in and around the anus, penis, groin or scrotal areas, and can grow inside the urethra. The warts are caused by infection with human papillomavirus (HPV), of which there are more than 100 types, 30 of which can be transmitted via sexual contact (during oral, vaginal, or anal sex with an infected partner and via skin-to-skin contact during any type of sex with someone who is infected). About two-thirds of people who have sexual contact with a partner who has genital warts will develop the warts, usually within three months.
In women, some strains of HPV present an increased risk of both bladder and cervical cancer. (There’s now a vaccine against the types of HPV that can lead to cervical cancer.) In men, HPV can increase the risks of penile and rectal cancer. To detect any precancerous changes, women with genital warts should have vaginal and uterine pap smears every six months. There are no equivalent tests for men, but those who are exposed to HPV or develop genital warts should see their physicians for prompt treatment. Approximately 14 million people in the United States are infected with HPV and each year an estimated one million more cases are diagnosed. In Europe, approximately 15 million people are infected.
In November of 2006, the FDA approved an ointment for treatment of genital warts that contains an extract of green tea (Camellia sinensis) as its active ingredient. The product, Polyphenon E® ointment, will be available by prescription. In studies prior to FDA approval, nearly 400 men and women with external genital and anal warts applied the ointment three times a day until their warts were gone. (However, new ones can develop as long as you’re infected with HPV.) If you want to try the new green tree extract ointment, ask your physician about a prescription. Side effects seen during the studies included redness, itching, burning, pain/discomfort, ulceration, swelling and local hardening of the skin.
Other methods of removing genital warts include cryotherapy (freezing them), laser therapy, and the loop electrosurgical excision procedure (LEEP), in which a loop-shaped instrument is passed underneath the wart to cut it out. There are also chemicals to dissolve warts over a period of weeks. None of these treatments completely eliminates an HPV infection, so the warts can always come back. Condoms may offer some protection against HPV, but don’t cover all areas of the skin where the virus may lurk. Mind/body methods, such as hypnosis and guided imagery can be very effective in treating cutaneous warts and are worth trying for the genital variety as well.
Andrew Weil, M.D.