Genital Warts: Causes, Symptoms, Types

Genital warts are also called condylomata acuminata, venereal warts, anal warts or anogenital warts.

They are caused by the human papillomavirus or HPV. 

There are more than 100 genotypes of HPV and about 40 of them cause infection in the anal-genital region. 

HPV causes various skin and mucosal disorders in the form of skin warts, papillomas, condylomas on the whole body and in the genital area. 

90% of genital warts are caused by HPV types 6 and 11. 

In most cases, HPV infection is only transient and resolves within about 2 years. 

Anogenital HPV infection occurs as one or more lesions at a single site (in the pelvic area, around the anus, between the vagina and anus in women, on the cervix, between the testicles and anus in men). 

They can also appear in the throat in both men and women as a consequence of oral sex. 

Genital warts have a low potential for cancer. 

Most infections occur in sexually active individuals between the ages of 18 and 28. 

Risk factors

• being under 30 years of age 
• smoking 
• eeakened immunity 
• transmission to the child during delivery by an infected mother 

Genital warts in children 

In children, genital warts occur are less common than in adults.   

However, they more often affect girls than boys. 

Genital warts are mostly caused by the HPV virus, which is highly transmissible through contact. 

The most common route of transmission is sexual intercourse, but it can be transmitted through the fingers, the mouth, intimate touching, or even by transmitting the infection in one's own body. 

The risk rises with each new sexual partner. 

HPV types 6 and 11 are the most common forms in children. 

In young people who have not yet had sexual intercourse, warts arise from HPV skin types that have been transmitted to the area, by scratching the wart and then transferring it to the genital area with the fingers. The incidence is more common in children over 4 years of age. 

The condition can be transmitted among adolescents by unprotected sexual contact, or due to close contact transmitted in a non-sexual way, for example by infected laundry, a towel, or an infected object. 

A person infected with the HPV virus may not have any symptoms and the first growths on the skin or mucous membranes appear several weeks or even months after infection. 

A typical manifestation is the appearance of skin warts, growths, condylomas. 

A person may have one small skin bump, a cluster of multiple bumps, or multiple jumpy protuberances. 

Warts can vary in size and appearance. 

They may be:

• large or small  
• flat or cauliflower-shaped 
• colour can be white, pink, red, purple-brown or skin colour 
• swollen, brown-coloured skin lesions may form in the folds, around the vagina and anus, which may smell 

In women, warts appear in the area of the womb, vagina, cervix, around the anus and around the urethra. In women, symptoms may appear even when the warts are not yet visible in the form of vaginal discharge, itching, bleeding and burning. 

In men, warts occur in the penile area, on the foreskin, the area between the testicles and the anus, on the testicle, on the outside and inside of the anus, around the urethra and in the groin. 

Genital warts can also appear on the lips, mouth, tongue and throat after oral sex with an infected person. 

They may not be visible to the naked eye at first. Later on, their growth rises to the surface of the skin, when they become visible to the touch, with the sensation of bumps. Their size may be minute, small to large deposits. 

Common symptoms of genital warts include discomfort in the genital area when underwear is against them and discomfort or pain during intercourse. They may start to bleed when injured. 

The spread of genital warts can be rapid, or they can also have slow growth. 

They are mainly transmitted through sexual activity, including anal, vaginal and oral sex. 

Condylomas (condylomata acuminata) 

Condylomas are skin growths, warts caused most commonly by HPV types 6 and 11. This type of HPV is not high risk for cancer. 

They are usually asymptomatic, but can cause an itching and burning sensation. 

The growths may be pinkish, yellowish-whitish, or even slightly darker than the colour of the skin. 

They may be small in shape, forming separately or in clusters; sometimes these growths may unite to form flat deposits or arise as cauliflower-shaped deposits. They often have a stalk with an off-white coating on the surface and may be odorous.  

Whitish, flat wart-like lesion are called condyloma planum. 

Large condyloma (Buschke-Lowenstein tumor) 

Large to giant condylomas are termed as Buschke-Lowenstein tumor (GCA or Giant Condyloma Acuminata).   

It is a slow-growing large cauliflower-shaped tumor. 

It shares many features with condylomas. 

This type more commonly affects men than women. 

In men, it occurs in the area between the testicles and the anus. In women, in the area between the vagina and the anus. 

This is a rather aggressive type that can grow into the surroundings. Most often they are caused by HPV types 6,11 and 16. 

The appearance of such a huge condyloma is due to insufficient immunity, chronic diseases and poor hygiene. 

In children 

In girls, the appearance of warts appears in the vaginal area, on the vulva, in the area of the urethra and around the anus. 

In boys, the occurrence is more frequent around the anus, on the penis in sexually inactive individuals, warts occur less often. In sexually active adolescents, warts are more common on the penis and on the anus. 

Learn more: What are Warts and How to Get Rid fo them

Information regarding health and sexual activity is needed for diagnosis. 

For genital warts, other diseases such as benign polyps, broad condylomas in syphilis, seborrhoeic keratosis must be differentiated in the diagnosis and other possible causes must be ruled out. 

The doctor will thoroughly examine the areas with warts and, if there is any doubt, take a sample for analysis of the type of HPV virus. 

In women, a pelvic examination is also performed because warts can also occur deep inside the vagina. A vaginal swab is taken to get cells from the cervix and sent for HPV testing. 

The incubation period from infection, to the first symptoms, can last from 3 weeks, to several months before warts appear. 

When new warts appear, the risk of viral transmission is greatest. During this period, extra care should be taken and sexual intercourse should be avoided due to the high infectiousness.  

When infected with HPV, the infection invades healthy cells, which are implanted with viral DNA and produce proteins encoded with viral DNA that produce changes in the tissues, causing them to swell and form skin growths. 

A healthy body can eliminate HPV infection in time and produce antibodies. 

The growth of the HPV virus depends on: 

• the immune system 
• diet
• hormones 
• smoking
• possible infection taking place in the body 

The warts are initially pinkish in colour and may change to soft cauliflower or scallop-shaped formations. 

Genital warts sometimes have a tendency to recur, especially in immunocompromised persons. 

Benign condylomas are often multiple and their course can be prolonged. 

Prevention

• Vaccination against HPV virus - What is HPV and HPV vaccination?
• Protected intercourse using a condom, which reduces the risk of HPV infection. 

HPV vaccines include:    

• Cervarix, protects against 2 types of HPV (types 16 and 18). 
• Gardasil, cprotection against 4 types of HPV (types 6, 11, 16, 18). 
• Gardasil9, protects against 9 types of HPV (types 6, 11, 16, 18, 31, 33, 45, 52 and 58.) 

HPV vaccines are for children and adolescents from the age of 9 years. Both women and men can be vaccinated. 

Learn more:

• Vaccination: Optional, Recommended, or Booster
• Cervical cancer: Causes, Symptoms, Vaccination
• Multiple sexual partners and STDs

Genital warts in pregnancy 

In the case of genital warts, the pregnant woman was probably infected with HPV before pregnancy. 

Before pregnancy, the woman's organism was able to deal with the infection, and no seeding of warts was provoked. 

The reason for the appearance of genital warts in pregnancy is most often a weakening of the immune system, and the passage of various changes of a woman during pregnancy. 

Increased blood supply to the tissues in the pubic area during pregnancy can cause accelerated growth of condylomas in the genital area as the skin and mucous membranes become more engorged. 

Genital warts do not interfere in any way with the course of pregnancy and do not pose any threat to the developing fetus. 

Treatment is applied after delivery to avoid the risk of negatively impacting the pregnancy and endangering the fetus. 

Delivery for genital warts is recommended by C-section (Caesarean) to avoid the risk of transmission of HPV infection from the mother to the fetus.