Genital Warts

Genital warts are inextricably linked to the human papillomavirus or HPV. HPV is a common virus that infects skin and mucous membranes, which can cause genital warts. People with genital warts often feel ashamed, uncomfortable and embarrassed, which sometimes leads to depression. For HPV there is no treatment, genital warts are easy to treat, but they can come back and can then be treated again. 

What are genital warts? 

Genital warts are warts around or on the genitals. They are caused by the human papillomavirus (HPV). This is an STI (sexually transmitted infection). You can contract and pass on this virus without noticing it, through contact of the genitals, but also through fingers that have been in contact with a genital wart or a used towel or washcloth. The warts can form after you have come into contact with the HPV. Even if you have no symptoms, you can still infect your sexual partner(s). In rare cases, a mother can infect her child at birth. The time between infection and development of the genital warts is between 3 weeks and 8 months. 

What forms of HPV and genital warts are there? 

The highly contagious HPV (human papillomavirus) has 150 types of which 30 types focus on the genitals. These 30 types are divided into low-risk and high-risk types. High-risk types are those that can cause cervical cancer. Almost all cervical cancer is caused by HPV. The types are classified by numbers. Types 16 and 18 are the most risky. The most common low-risk HPV types are 6 and 11, they are not carcinogenic, but are the cause of genital warts in 90% of cases. Some genital warts are barely visible. There is no connection between warts elsewhere on the body and genital warts. Warts on the hands cannot cause genital warts.  

How can you recognise an HPV infection and genital warts? 

Many people have been infected by HPV (80% of women and men), but did not realise it. Most infections are automatically about whether the immune system suppresses the virus, how this works exactly is not yet fully known. Usually the virus does not cause any symptoms. Possible complaints include: 

  • Bleeding during and after sexual contact
  • Pain and/or a burning sensation in the vagina
  • Difficulty with bowel movements

In addition, a low-risk type of HPV infection can be recognised when it results in genital warts. The genital warts look like fleshy, soft skin-coloured, pink-red or grey-white warts. For women, genital warts may appear on: 

  • Labia  
  • The cervix and/or  
  • Anus

For men, genital warts may appear on: 

  • The penis  
  • And/or anus 
  • The urethra 

The presence of genital warts around the anus does not necessarily mean that there has been sexual anal contact.  Genital warts are first small and then usually grow in groups. Sometimes there is only one wart. Sometimes the warts can bleed or itch, they can cause some hindrance during sexual contact or during bowel movements. 

Is there anything I can do about HPV infection and genital warts? 

You can reduce the risk of HPV infection by using condoms during sexual contact. Although condoms are not 100% safe (because if the warts are higher on the penis than the condom reaches, there may still be contamination) it appears that using a condom reduces the risk of contamination. Immunity plays a major role in the virus. When your immunity is up to date, the infection will be less likely to strike and if the virus is dormant it can always remain dormant due to a good immunity. A healthy lifestyle is important for good immunity. A healthy lifestyle also means good hygiene. Always wash your hands after going to the toilet. Use washcloths and towels only for yourself. A healthy lifestyle means living as healthily and regularly as possible with a varied diet. Get enough sleep, avoid stress and exercise regularly. Moderate your alcohol consumption or do not consume any alcohol at all, and most importantly, do not smoke. When you smoke, your immune system does not work as well because it damages the cells. Cervical cancer is more common in women who smoke.  

What are the treatments for HPV and genital warts? 

Choice of the doctor  

Genital warts usually disappear by themselves after a long time. However, they can be removed if they cause discomfort and inconvenience. Removing the warts does not mean that the HPV is no longer present. The warts can also come back and can be treated again. 

Medication 

There are no medicines against HPV.  However, there is the aforementioned prevention against certain types. In the case of genital warts, the following cream or ointment can be chosen from, to be applied by yourself: 

  • Podophyllotoxin cream 
  • Imiquimod cream 5% 
  • Fluorouracil cream  
  • Cidofovir cream 1%  
  • Sinecatechins ointment 

Some substances should not be used during pregnancy. Before treatment, read the package leaflet on how to apply the product. Wash your hands well after applying the cream or ointment. The products often have to be used for a longer period of time, but are more likely to be stopped when the warts are gone. 

Alternative treatments 

Other treatments of genital warts include:  

  • Cryotherapy, the warts are frozen by a doctor using liquid nitrogen. It is possible that more than one treatment is required. 
  • Chemical cauterisation with trichloroacetic or bichloroacetic acid. The doctor applies this medicine, it breaks the cells.  
  • Electrocauterisation, in which the warts are burned away with a special device. 
  • Surgical removal or removal. This usually happens under anaesthesia. 
  • Laser treatment, in which the wart is evaporated.  

 

Lifestyle changes 

If you have genital warts, it is advisable to have safe sex with a new partner or changing partners. This also applies if your sexual partner(s) has genital warts. Be aware that condoms do not provide 100% coverage. If you have a regular partner, the use of a condom is in fact unnecessary because the virus is exchanged between partners and when HPV is detected (as there are genital warts), the transfer has probably already taken place. The fact that you, your partner or both have an HPV infection with or without genital warts does not necessarily mean that there is an issue of infidelity. The virus may have been dormant and present for a long time. Good immunity by living hygienically and healthily (see "Can I do something myself about HPV infection and genital warts") can keep the infection at bay. If having an HPV infection and/or genital warts affect the quality of your life, such as feelings of anxiety and shame, or feelings of depression, then talk about it with a confidant or consult a doctor.  

Additional risks and side effects of HPV infection and genital warts 

HPV is contagious and can result in genital warts. Some warts can get very big and start to inflame. This can occur in healthy people, although it is rare. We see it more often in people who have a weakened immune system due to, for example, HIV (the AIDS virus) or a treatment that suppresses the immune system (for example after a transplant). The tumours are not malignant, but they do penetrate the tissues. They have to be surgically removed. Genital warts at the outlet of the urethra can cause trouble urinating. They have to be removed. 

High-risk HPV types can develop into cancer after years. The most common cancer is cervical cancer. We also see cancer of the labia, anus, penis, oral cavity, throat and oesophagus.  

How can you prevent HPV infection and genital warts? 

An HPV infection and therefore genital warts cannot be completely prevented, but you can reduce the risk by having safe sex when you have multiple partners or when you have a new partner. Limit your partners. It is almost impossible to know when you have contracted the virus, therefore it makes little sense to warn former partners. However, you can alert your new partner(s). Women can be tested for HPV (smear), men are not (yet) tested. There are vaccines for both groups. See: "Prevention by the government" about vaccinations and smears. In addition, good immunity can prevent HPV infection and genital warts (read more: "Can I do something myself about HPV infection and genital warts"). 

 

 

References

Thuisarts.nl. (z.d.). What is HPV? Available at: https://www.thuisarts.nl/hpv-vaccinatie/wat-is-hpv-0 (Viewed on 1 May 2019).  

RIVM.nl. (z.d.). Symptoms of illness. Available at: https://www.rivm.nl/hpv-humaan-papillomavirus (Viewed on 1 May 2019).  

Rijksvaccinatieprogramma.nl (z.d.). HPV vaccination National Vocational programme. Available at: https://rijksvaccinatieprogramma.nl/vaccinaties/hpv (Viewed on 1 May 2019).  

Rijksvaccinatieprogramma.nl (z.d.). HPV vaccination Outside the National Vocational Programme. Available at: https://lci.rivm.nl/richtlijnen/hpv-vaccinatie-buiten-het-rijksvaccinatieprogramma (Viewed on 1 May 2019).  

Personal health record. (z.d.). Treatment of genital warts. Available at: https://www.patient1.nl/encyclopedie/anogenitale-wratten-behandeling-en-medicatie (Viewed on 1 May 2019).  

Thuisarts.nl. (z.d.). Treatment of genital warts. Available at: https://www.thuisarts.nl/genitale-wratten/ik-heb-genitale-wratten (Viewed on 1 May 2019).  

Huidartst.com. (z.d.). Genital warts. Available at: https://www.huidarts.com/huidaandoeningen/genitale-wratten/ (Viewed on 1 May 2019).  

RIVM. (z.d.). HPV type 6 and 11. Available at: https://lci.rivm.nl/richtlijnen/humaanpapillomavirusinfectie-anogenitale-wratten#preventie (Viewed on 1 May 2019).  

ISALA. (15 January 2019) 5378 The smear. Consulted on 1 May 2019 at https://www.isala.nl/patientenfolders/5378-uitstrijkje/ (Viewed on 1 May 2019).  

Marra. E., Berkhof.j. de Vries. J.C. , Schim van der Loeff. M.F. (22-01-2018). Is vaccination of boys/men against HPV useful? Available at: https://www.ntvg.nl/artikelen/vaccinatie-van-jongens-mannen-tegen-hpv-zinvol (Viewed on 1 May 2019).  

The digene. (z.d.). Find out who is infected. Available at: http://www.hpvtest.nl/getting-the-test/talking-to-your-partner/ (Viewed on 1 May 2019).  

UMC-Utrecht. (z.d.). Risk/phenomena. Available at: https://www.umcutrecht.nl/nl/Ziekenhuis/Ziekte/Genitale-wratten (Viewed on 1 May 2019).  

Soaaids.nl. (z.d.). Symptoms of genital warts. Available at: https://www.soaaids.nl/nl/soas/veel-voorkomende-soas/genitale-wratten (Viewed on 1 May 2019).  

Mantotman.nl. (z.d.). Testing for men on HPV. Available at: https://mantotman.nl/nl/alles-over-mannenseks/hiv-en-soas/soas-abc/genitale-wratten-en-hpv (Viewed on 1 May 2019).  

Mekkes. J.R., (09-03-2013).  Tumour by enlarged wart. Available at: https://www.huidziekten.nl/zakboek/dermatosen/btxt/BuschkeLowenstein.htm (Viewed on 1 May 2019).  

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