HIV 101: Treatment of Genital Warts

The continuum of HPV infection ranges from clinical, to subclinical, to latent disease. One percent of sexually active adults have clinically active disease. Five percent have subclinical lesions detected only by enhancing techniques such as acetowhitening. Twenty-five percent of sexually active adults have HPV DNA detected in areas without clinical lesions or in areas that are acetowhite negative -- this is latent disease. While the risk of transmission among persons with clinical active disease is not known, the majority of couples with visible genital warts have partners that are concordantly infected. The risk of transmitting the infection from persons with subclinical or latent infection is also unknown. Latent disease may be responsible for the persistence of infection despite therapy.

Etiology

Numerous HPV types can cause genital warts. In general, HPV types 6 and 11 are low-risk types and produce benign lesions. High-risk HPV types or those associated with anogenital cancer, most commonly in the transition zone of the cervix and anus, are usually caused by HPV types 16 and 18. In a small group, HPV infection persists and may progress to cancer. The exact mechanism for this is unknown.

Clinically, condyloma appear as soft sessile masses, that average 2 to 5 mm in size but may reach several centimeters in diameter and height. Lesions are frequently multifocal and in general, their color is gray, pale yellow or pink. In women, lesions appear on the vulva, cervix, and perineum or about the anus. In men, they can occur on the penis or perianal area, and less frequently on the scrotum. Patients are usually asymptomatic. However, trauma to lesions can cause bleeding, itching, or irritation. In addition, women may experience vaginal discharge.

Treatment of Genital Warts

Treatment is not shown to reduce the transmission to sexual partners nor to prevent the progression to dysplasia or cancer. Because genital warts are sexually transmitted, investigation for other sexually transmitted diseases is warranted. Women with genital warts or those whose partners have genital warts should have a routine cervical cytological screening (Papanicolaou smear) to detect cervical dysplasia. See table above for specific information on treatment.

References

1. Baker G.E., Tyring S. Therapeutic approaches to papillomavirus infections. Inf Dis Dermatol. 1997, 15: 331-340.

2. Odom R.B., James W.D., Berger T.G. Andrew's Disease of the Skin. 9th edition. Philadelphia, (PA); W.B. Saunders Co; 2000. pp 514-51.

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