Genital warts usually are painless but may itch. If allowed to grow, they can block the openings of the vagina, urethra, or anus and become very uncomfortable. Depending on their location, genital warts can cause sores and bleeding. Genital warts often grow more rapidly during pregnancy. An increase in the size and number of genital warts is also seen when a person's immune system is weakened by diabetes, an organ transplant, Hodgkin's disease, HIV/AIDS, or other conditions.

There are other genital HPV infections that cannot be seen with the naked eye. Some are more dangerous than genital warts because they are associated with cancers of the cervix, vulva, vagina, or penis.

The majority of those now seeking treatment for genital warts are young women between the ages of 15 and 29.

What can be done?
Diagnosis-Medical examination

Medical examination is the first step in determining if there is a genital HPV infection. Many times a woman does not notice warty lesions, but her physician may see something out of the ordinary while performing a routine gynecologic examination or Pap smear that suggests the need for further scrutiny.

After inquiring about the woman's health history, the physician will examine her genital area.

Lesions may be seen better when the area is first rinsed with a solution of 3 to 5% acetic acid (vinegar), which helps to reveal flat or undistinguished lesions or tissue changes by making them appear whiter.

Pap smear

Pap smear of cells from the cervix and upper vagina may be done even if tissue appears normal. Pap smear results can be used to screen for tissue changes in the cervix and help corroborate findings of other tests like colposcopy or biopsy.

Colposcopy

Colposcopy, viewing the cervix through a special microscope, may be used to identify subtle tissue changes. Colposcopy also allows a sample of any suspicious tissue to be taken by the examiner.

Prior to colposcopy, the perineum, vagina and cervix will be washed with a vinegar solution. With the woman lying in the pelvic examination position, a speculum is used to widen her vagina for better viewing. The colposcope is positioned just outside the vulva, and a light is shined in to illuminate the cervix and highlight any irregular-appearing areas. At this time, small snips of cervical tissue may be removed for laboratory analysis (biopsy) or determination of the specific HPV type.

Colposcopic examination takes about 20 to 30 minutes and is only somewhat more uncomfortable or involved than a standard pelvic examination. As with other minor surgical procedures, though, removing tissue for biopsy can in rare instances lead to bleeding, infection or more serious complications.

Treatment

Infection with HPV has no definitive cure. HPV is a persistent and difficult-to-eradicate organism, so treatment must usually be repeated and an infected woman monitored throughout her life for recurrence or development of precancerous changes whether or not warts are apparent.

Because the 'live' virus resides in the lesions it creates, treatment for HPV consists primarily of controlling infection spread through removal of visible warts or precancerous lesions.

Lesion removal can be accomplished by various forms of surgery, by freezing, or by chemicals or drugs applied locally. The method(s) used will depend upon the extent of infection, location and accessibility of lesions, and potential of the lesions for cancer. To ensure that as many lesions as possible are treated, colposcopy may be used during therapy to better view internal lesions.

Surgery

Surgery is sometimes used to cut away warts located where treatment without anesthesia would cause discomfort, or warts so extensive that simultaneous reconstructive surgery is required. Surgery can take the form of either excisional biopsy done as an outpatient procedure or a more involved procedure performed under anesthesia. Discomfort postoperatively can be relieved by pain medication; bleeding or scarring may sometimes occur.

Cryotherapy

Cryotherapy (freezing) may be done several ways. Superficial cryotherapy involves liquid nitrogen applied by cotton swab to minor external warts.

Extensive lesions can be frozen faster and to a greater depth with a cold cautery device which pinpoints warts on the perineum, the cervix and most areas in the vagina. Cold cautery cryotherapy is usually performed within one week after menstrual flow ceases, though it cannot be used in women who are pregnant.

After cryotherapy women may experience cramping, abdominal pain, infection or (rarer) cervical scarring. Analgesics (usually non-aspirin pain medication) given before cryotherapy will relieve discomfort, and icepacks applied externally after the procedure will reduce any swelling or inflammation. Considerable watery vaginal discharge for 10 to 20 days after cryotherapy is normal. However, a woman experiencing fever, pain unrelieved by analgesics, or unusually prolonged discharge should contact her physician immediately.

Laser therapy

Laser therapy utilizes a high-intensity beam of light to vaporize lesions, particularly those that are external, perianal, or in less accessible locations.

In the hands of a well-trained and experienced physician, laser therapy is highly effective in removing multiple lesions. Laser therapy is generally more expensive than other forms, and risks include removal of too much tissue, delayed healing, scarring or pain, including chronic pain.

Acids

Acids such as trichloroacetic acid (TCA) or bichloroacetic acid (BCA) can be carefully painted on visible warts using a small cotton swab or wooden applicator. To be effective, TCA or BCA must be applied in proper concentrations, but these sometimes cause a burning sensation after treatment. Local and systemic analgesics will help relieve any discomfort. Scarring and chronic pain are potential aftereffects.

Drugs:

5-Fluorouracil (5-FU) cream^tm this medicinal cream applied to the vulva on a regular regimen can be effective in controlling external lesions. However, it should not be used by pregnant women and may cause serious skin irritation. It is also used as a chemotherapy drug.

Interferon^tm a newer drug approved for injection into a muscle or select lesions, interferon is expensive, has significant systemic side effects and cannot be used during pregnancy.

Podophyllin^tm once a popular treatment, painting of visible lesions with Podophyllin is used less often now because it cannot be used during pregnancy or for most internal lesion sites and because of possible carcinogenesis and toxic reactions.

Follow-up

After any HPV treatment, the treated area should be kept clean and dry (cornstarch dusting, cotton underwear and loose clothing are recommended). Sexual intercourse should be avoided until healing has occurred externally and internally (usually 2 to 4 weeks).

Diligence in keeping scheduled follow-up appointments is needed to keep HPV under control.

Follow-up colposcopy and Pap smears are usually scheduled at 3-month intervals after treatment of HPV and yearly thereafter. These tests monitor that the cervix, in particular, remains free of precancerous or cancerous tissue.

A woman with HPV should notify any sexual partner(s) of her infection, use latex condoms with every partner (unless in a mutually monogamous relationship), and urge that her partner be treated for HPV if his physician has identified HPV lesions. Not only do these measures express consideration for her partner, they also diminish her chances of being reinfected with new or different types of human papilloma virus.

What can I do?

Information is your best defense against HPV infection or its potential for vulvar cancer.

Know that you are not alone. Although you may be upset to learn that you have HPV infection, it is increasingly common among sexually active adults. Share your concerns with your health care provider and your partner. There may also be a support group in your area for HPV patients and partners.

If you are infected with HPV, maintain good hygiene including proper rest, stress reduction and diet. Acidy foods will bother it.  Decrease alcohol intake and illicit drug use. Healthy habits will bolster your immune system's ability to minimize the effects of HPV.

Condoms are recommended for all sexual contacts other than a mutually exclusive (monogamous) relationship. Condoms prevent transmission of infection to your partner and lower your risk of becoming infected with a different form of HPV or other sexually transmitted diseases.

Applying spermicides with nonoxynol-9 to affected or treated areas may be helpful in reducing transmission of the virus. Discuss with your physician whether spermicide application is appropriate for you and your HPV treatment regimen.

Everyone with genital lesions, and all partners of persons with genital lesions, should alert new sexual partners about HPV infection risk and take precautions to limit spread of HPV.
In addition, every sexually active person should be aware of the prevalence of HPV and take measures to lower their risk of infection.