Genital Warts

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It is a superficial mucocutaneous infection that affects the penis, vulva, vagina, cervix, perineum, and perianal area.

Causes

  • Human papilloma virus (HPV): causes viral warts (condylomata acuminata)
  • Treponema pallidum: causes syphilitic warts (condylomata)
  • Molluscum contagionsum virus
  • Painless bumps (single or multiple eruptions which can be pearly, filiform, fungating, cauliflower or plaque-like
  • Discharge, vaginal bleeding, urethral bleeding or obstruction

Differential diagnosis

  • Herpes simplex
  • Syphilis

Investigations

  • Pap smear
  • Colposcopy
  • Biopsy if cancer is suspected

Treatment objectives

  • Alleviate symptoms
  • Stop bleeding if there is any
  • Relieve urethral obstruction if there is any
  • Search for co-existence of other STIs

Non-pharmacological treatment

  • Cryotherapy (recommended to treat external genital/perianal warts, vaginal warts, and urethral meatal warts)
  • Surgical excision has the highest success rates

Pharmacological treatment

Keratolytic

Adult:

Podophyllum resin 25% topical solution

Apply solution to lesion

OR

Adult:

Imiquimod 5% topical cream

Apply every 4 hours, 3 times a week for a maximum of 16 weeks

Prevention

  • Vaccination with 2 or 4-valent HPV vaccine. The 9-valent HPV vaccine is preferable (if available) as it covers 9 subtypes of the HPV strains 6, 11, 16, 18, 31, 33, 45, 52 and 58.
  • Encourage partners to correctly and consistently use condom during sex.

Referral

  • Refer for specialist care treatment is ineffective, to prevent complications
  • Refer to an oncologist if precancerous cells are detected