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Genital warts (condylomata acuminata) are caused by the human papillomavirus (HPV). Over 200 different types of papillomaviruses have been discovered. Approximately 40 of these viruses are capable of causing an infection in the genital area, whereas the rest cause skin infections such as warts on the hands and soles of the foot, and molluscum. Viral, cauliflower-like lesions in the genital area are called genital warts. 

As the infection can spread via oral sex and skin contact, condom use does not provide complete protection. Over 80% of all people are infected by HPV at some point in their lives, but frequently the infection does not cause any symptoms. Around 90% of these infections heal spontaneously within a couple of years, thanks to the body’s immune system. The infection is most common in young adults aged 20 to 25 years. Genital warts are usually caused by papilloma virus types 6 and 11. Only about 1% of those infected develop visible warts, and the time from infection to the appearance of the warts varies from months to several years. 

Human papillomaviruses are classified into low-risk and high-risk types based on how strongly they are linked to squamous cell carcinoma or dysplasias. The viruses causing genital warts belong to the low-risk group. 

The high-risk HPV infections that may cause cancer can be prevented by vaccination. Those who have been vaccinated should still attend for Pap tests. 

When should I seek treatment?

Genital warts are usually diagnosed based on their typical appearance at an appointment with a healthcare professional, but sometimes a biopsy may be needed to confirm the diagnosis.

Genital warts in males

In males, genital warts occur as small growths in the glans penis, penile shaft, scrotum, or around the anus or between the buttocks. In many cases, there are warts in several places at the same time. Genital warts are usually asymptomatic, but when they occur in the urethra, they may cause symptoms such as stinging. 

Genital warts in females

In females, genital warts occur as protruding, cauliflower-like warts in the external genitalia. In the vagina and the cervix, the warts can appear in a flat shape. If genital warts are observed in the external genitals, a Pap smear or cervical smear should be considered, in order to discover possible abnormal cells in the cervix. 

Treatment of genital warts

Genital warts are treated with topical products such as podophyllotoxin and imiquimod, and also by freezing (cryotherapy), electrocauterization, laser ablation and surgical removal. A doctor’s prescription is needed for the topical products. 

Genital warts often reappear after treatment. If a female patient is diagnosed with abnormal cells in the Pap smear, depending on the situation, monitoring in primary care or further examinations at a gynaecology outpatient clinic may be needed. 

Information sources: The Finnish Medical Society Duodecim, Terveysportti, Lääkärin tietokanta database

FSHS General Practitioner 28.6.2022

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