Genital Warts in Women

What are Genital Warts?
Genital warts are a highly contagious type of sexually transmitted disease (STD) caused by human papillomavirus (HPV). In women, HPV most dominantly affects those between the ages of 16 and 25. Genital warts are fleshy bumps that can be found in the vulvar region, the inside of the vagina, on the cervix, or on and around the anus. Women most commonly first get them on the tissue at the opening of the vagina that is closest to the anus and on the labia surrounding this tissue. Sometimes these bumps can even arise in the mouth or throat after having oral sex with someone who has the disease. Genital warts can either aggregate in groups or they can be spread out over the genital area.

If genital warts are not treated, they can either go away on their own or they may grow into a bump that looks like cauliflower. Since there is no way to know which will happen, those who think they may have this disease should go to their doctor for an exam and treatment. Treatment for external genital warts usually includes a variety of medications that can be rubbed on the warts to make them go away, such as:
- Podophyllin solution 10-25%: rubbed on the warts weekly (no more than 6 weeks) by the doctor. Wash the medication off 1-4 hours later.
- Podofilox solution 0.5%: rub on warts twice a day for 3 days, then take 4 days off. Repeat this cycle until the warts go away (but no more than 4 cycles).
- Trichloroacetic acid (TCA) 80-90%: the patients doctor should rub on warts weekly, but no longer than 6 weeks.

Another route for treating external genital warts is cryosurgery. This process involves freezing the warts in order to kill the infected tissue. A probe containing liquid nitrogen is usually used to produce temperatures below -20 degrees Celsius. Cryosurgery produces better results than podophyllin or trichloroacetic acid.

Internal warts (and those external ones that will not respond to the previously mentioned means) can be treated through various surgeries such as electrocautery or laser therapy. Electrocautery involves killing the warts through the use of an electrical current, while laser therapy involves removing them through the use of a carbon dioxide laser. Alpha interferon (an antiviral drug) may also be used to remove any warts that may have developed inside the vagina. This gel is injected (through the use of an applicator) into the vagina twice a day each week for 5 days in a row until the warts go away.

Transmission and Recurrences
It is important that the patient understands that genital warts can be removed through various treatments, but these treatments will not provide a permanent cure for the human papillomavirus. Therefore, once infected by this virus, it will stay in the bodys system for a lifetime, often in a dormant state. As a result, recurrences of genital warts are usually the result of the dormant virus becoming active again, as opposed to reinfection by a sexual partner. The virus will only be transmitted to another person if that person comes in contact with viral shedding from the warts themselves. If the person in question is not experiencing an outbreak at the time of contact, it is unlikely that the virus will be transmitted. Remember that the virus is always present, but the chance of infection during an outbreak is much greater than at any other time.

HPV spreads through skin-skin contact, and condoms establish a barrier to prevent that sort of contact. However, genital warts may be spread via contact throughout the perineum, the entire region between the legs, so while condoms help, they're not going to provide absolute protection. Really, if there are warts present in the genital region, all sexual contact should be avoided until after successful treatment has been completed. If the patient does engage in intercourse, latex condoms should be used. Oral-genital contact, as well as genital-genital contact, can transmit the virus, so condoms are just as important in oral sex as they are in intercourse. It is important to use latex condoms and not natural skin ones, since the pores in natural skin condoms are large enough to allow virus particles to escape through the barrier.

Pregnancy and HPV
At some point in her life, a woman infected with HPV may decide that she wants to have children. At this point she will be faced with the decision of either risking unprotected sex or becoming pregnant through artificial insemination. Unprotected sex is safer when warts are not openly visible, although HPV lesions may be microscopic. Unfortunately, the stress associated with pregnancy and childbirth has been known to cause the warts to reappear. This is dangerous because sometimes the infected mother can pass the virus to her child either during gestation or during the delivery process. If this occurs, there is a chance that the child will subsequently develop laryngeal papillomatosis (throat warts). This disease can be fatal, as the warts can cause blockage of the airways.

A New Vaccine in the Future
While all of this may sound discouraging, many researchers are optimistic about soon releasing a vaccine against HPV. As a virus, HPV has a coat of proteins around its genetic material, and the human immune system may be able to generate a defense against the virus through exposure to some of those viral proteins before it actually encounters the real thing. Currently, clinical testing is underway using some viral proteins to see if they actually work in vaccinating people against HPV.

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