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Genital warts
Genital warts are a sexually transmitted infection caused by a virus called the human papilloma virus (HPV). Genital warts are the most common complaint diagnosed at sexually transmitted diseases clinics in the UK, accounting for around a fifth of all diagnoses in 1999. During the late 1990s, there was a rising incidence of genital warts in the UK, affecting both men and women, and in 1999 there were 70,000 cases. Though younger people tend to be more frequently affected, anyone who is sexually active may be exposed to the genital wart virus.
Some forms of the genital wart virus can lead to cervical or anal cancer. This risk is higher in people with HIV because there is more chance that the wart virus will become re-activated due to loss of immunity.
Transmission
The genital wart virus can be contracted during unprotected anal, vaginal or oral sex. It can also be transmitted by close physical contact with the genital warts themselves, as these may shed the wart virus.
Prevention
Using a condom for anal, vaginal, or oral sex offers a degree of protection from infection with genital warts, or from passing on the virus to somebody else. People who are sexually active are advised to have regular sexual health check-ups, where genital warts can be diagnosed if present, and tests for other sexually transmitted infections performed. Most HIV treatment centres have an associated sexual health clinic where free and confidential treatment can be obtained without referral from your GP or HIV doctor.
Symptoms
Genital warts look just like warts which may appear on other parts of the body – usually small nodules with a slightly rough texture. Some people who contract the wart virus do not have symptoms, however, or else do not notice the presence of warts. In women, warts may appear on the inside or outside of the vagina, or on the neck of the cervix, or around the anus. In men, warts may appear on the tip or shaft of the penis, or around the anus.
Some forms of the genital warts virus are associated with an increased risk of cervical or anal cancer. However, these are not the commonest form of the virus. Strains 16, 18, 31, 33 and 35 are more strongly associated with the development of genital cancers.
Diagnosis
Genital warts are diagnosed by visual and manual exam-ination of the genital and anal area.
A Pap smear is a procedure designed to detect pre-cancerous cellular changes called dysplasia early, before cancer develops. Most women know the Pap smear as a ‘cervical smear’. Pap smears involve taking a small scraping of cells from the cervix. When these cells are examined under a microscope, it is possible to see if there are any changes in the cells which suggest there is a risk that cancer could develop in the future.
HIV-positive women are recommended to have Pap smears when they are first diagnosed with HIV, six months later, and then at least once a year. Screening of the anal canal for pre-cancerous cells is under investigation, and some people recommend that gay men with anal warts should receive regular assessment.
Treatment
Infection with the genital wart virus cannot be cured. Treatment involves either the warts being painted with a chemical which burns them, freezing, laser surgery or a new immune stimulating cream. These procedures may feel a little uncomfortable.
When genital warts are diagnosed you may be given the chance to see a Health Adviser. Health Advisers can give you information about safer sex and how to protect your own and other people’s sexual health. They may also be able to help you, where possible or practicable, to contact your sexual partners so they can be tested or treated if necessary. In turn this is intended to prevent you from becoming infected with a sexually transmitted infection through continuing to have sex with someone who is themselves infected.