Your risk for genital warts

GENITAL warts or condylomata acuminata are caused by the human papilloma virus (HPV), particularly subtypes six and 11. Obstetrician-gynaecologist Dr Michelle Bailey said HPV is a family of sexually transmitted viruses which are very infectious and the incubation period ranges from three weeks to eight months.

The disease in women is primarily caused by vaginal intercourse, but anal condylomata can also occur.

“The risk of getting genital warts increases with the number of sexual partners, and patients with a history of a sexually transmitted disease or oral herpes are also at an increased risk,” the doctor said.

Of note, the ObGyn said most anogenital warts are asymptomatic, meaning they show no symptoms, but for those who have symptoms they are related to the location and number of the warts.

“Patients with a small number of warts are often asymptomatic but some patients may have itching, bleeding, burning, tenderness, vaginal discharge or pain at the site,” she explained.

She said genital warts are skin-coloured or pink, and range from smooth flattened papules to a cauliflower-like appearance. When the warts become very large they form masses that can cause obstruction with defecation, intercourse, or vaginal birth.

HPV, according to Dr Bailey, is much harder to treat when the woman is pregnant.

“The genital warts may become more prolific and more friable, and much harder to treat in pregnancy, as the options are limited. The innate immune defences normally activated in pregnancy can contribute to increased clinical severity of some maternal infections. As a result during pregnancy symptoms may worsen,” she said. “During pregnancy the genital warts get larger and increase in number. The management of these lesions in pregnancy is based on symptomatic treatment and minimising the number of lesions present at birth.”

Unfortunately, Dr Bailey said Caesarean delivery has so far not been shown to reduce the risk of transmission of HPV to the foetus and should only be performed if genital warts are obstructing the birth canal or likely to cause a lot of bleeding.

With regards to the risk to the foetus, Dr Bailey said it is not often that a newborn will acquire HPV during the birthing process, but when it occurs they develop more serious conditions.

“Those newborns who acquire HPV may go on to develop recurrent respiratory papillomatosis (tumours which grow in the respiratory tract) and even when removed they can recur. These tumours can lead to obstruction of the airways and rarely malignancy (cancer),” she said.

Treatments include laser therapy, chemical treatment or surgical removal. Traditional treatment methods are not safe in pregnancy. Treatments to remove warts include cryotherapy: using a chemical to freeze the warts; electrocautery: employing electricity to burn away warts; traditional surgery or laser surgery.

Dr Bailey said condom use helps to reduce the risk of getting HPV, but complete protection is not given as the virus can live on the skin not covered by condoms. There are HPV vaccines which help to prevent most of the strains that cause genital warts, however it is best to get the vaccine before you actually get a wart.