Genital Warts (Condylomata Acuminata): Information, Symptoms, and Treatment of Genital Warts

Genital warts—also known as condylomata acuminata in medical terminology, or condylomas for short—are a viral infection affecting the genital and anal areas. They are benign skin growths that appear as pinhead-sized, reddish or brownish nodules.

They can occur in the genital area in both men and women.

In men, the warts usually develop

• on the shaft of the penis and/or on the foreskin, as well as
• in the anal canal,
• the urethra or urethral opening, or
• in the rectum.

In women, they usually occur

• on the labia,
• at the vaginal opening,
• the anus, in the rectum, or
• on the cervix.

Genital warts are usually caused by human papillomaviruses (HPV). These viruses primarily enter the body through unprotected sexual intercourse.

Pregnant women who are infected with the virus can also transmit the pathogen to their newborn during childbirth.

Causative Agents

There are approximately 90 types of human papillomavirus in total, of which about 50 types can cause genital warts.

However, the most common causative agents for these warts are human papillomaviruses types 6 and 11. In about 90 percent of cases, these can be identified as the cause of genital warts.

In rare cases, human papillomaviruses types 16 and 18 can also be detected. In men, these increase the risk of certain cancers in the genital area (e.g., penile cancer). In women, they are also considered the main risk factor for the development of cervical cancer.

How do the warts develop?

Minor injuries to the skin or mucous membranes occur primarily during sexual intercourse, often without the affected individuals even noticing. These injuries facilitate the penetration of HPV into the skin.

After transmission, human papillomaviruses initially establish themselves in the upper layers of the skin and mucous membranes of the penis, anus, or rectum. They do not necessarily cause genital warts at this stage. Only when certain contributing factors are present does the virus begin to multiply. As a result, genital warts also proliferate.

Factors that promote the development of genital warts include, in particular,

• a weakened immune system and
• existing inflammation.

The first genital warts appear no sooner than two to four weeks after infection. Sometimes it can take several months.

Weakened Immune System

If a person’s immune system is weakened, the risk of developing genital warts after infection is higher. In this case, the HPV viruses can multiply more quickly.

Immunocompromised or chronically ill individuals are therefore particularly susceptible to genital warts. This includes, for example,

• people with AIDS,
• people with diabetes, and
• patients who have received a donor organ and must therefore take medications to suppress the immune system—so-called immunosuppressants.

Other factors that contribute to the development of genital warts

Other risk factors for the development of genital warts include the consumption of

• alcohol,
• cigarettes, and
• drugs.

An unhealthy lifestyle characterized by a lack of exercise, an unhealthy diet, and insufficient sleep also constitutes a risk factor.

In addition, people who have an HPV infection along with other sexually transmitted diseases—such as HIV, genital herpes, or genital yeast infections—are more susceptible to genital warts.

HPV viruses, which cause genital warts, are among the pathogens that cause sexually transmitted diseases © syahrir | AdobeStock

Asymptomatic HPV Infection

Transmission of the genital wart-causing viruses does not necessarily lead to the development of genital warts. As a result, people can carry the HPV viruses without ever noticing it. This is referred to as a silent infection. However, those affected can unknowingly transmit the HPV virus to others.

According to estimates, such a silent infection occurs in about 10 to 15 percent of all people infected with HPV.

Genital warts are extremely contagious, as the HPV viruses that cause them are very easily transmitted. Even a single instance of direct skin-to-skin contact with the affected areas of an infected person is enough to contract an HPV infection.

In particular, unprotected sexual intercourse with frequently changing sexual partners is one of the main risk factors for HPV infection.

Transmission of the Genital Wart Virus During Sexual Intercourse

In most cases, infection occurs through contact or smear transmission during sexual or oral intercourse. This involves direct skin-to-skin contact with the areas of the genital region affected by genital warts.

A condom can effectively prevent viral transmission if the genital warts are located only directly on the penis or vagina. However, if the genital warts also appear in other areas of the genital region, condoms do not provide sufficient protection against HPV infection.

Using a condom may provide effective protection under certain circumstances © Victoria М | AdobeStock

The risk of HPV infection also increases with the number of sexual partners.

• Frequent sexual contact with multiple partners, as well as
• frequent unprotected sexual contact

are therefore also among the risk factors for HPV infection. Furthermore, the risk of HPV infection also increases if a person’s first sexual encounters occur at a young age.

Other ways of contracting the viruses that cause genital warts

HPV can also be transmitted through close physical and skin contact while bathing together or engaging in petting.

In rare cases, transmission is possible via shared items such as bath towels or hand towels.

Genital warts are pinhead-sized nodules that are reddish-brown or whitish in color. They are often overlooked at first.

They usually grow in large numbers and are clustered closely together. If left untreated, they can develop into cauliflower-like skin growths—so-called wart clusters.

Normally, genital warts cause little or no discomfort or pain. In rare cases, they are accompanied by

• small, bleeding cracks (fissures) in the skin around the warts,
• itching, and
• a burning sensation

.

Sharing a towel after bathing can lead to the transmission of HPV © Zoran Zeremski | AdobeStock

Where do genital warts most commonly occur?

In men, genital warts mainly occur

• on the shaft of the penis (51%),
• around the anus (34%),
• on the glans (10%), and
• on the foreskin (8%)

. However, the urethra (10%), scrotum, and rectum can also be affected in men.

In women, genital warts usually grow

• on the labia (66%),
• on the vagina and at the vaginal opening (37%),
• on the anus (23%),
• on the cervix (8%), and
• in the urethra or at the urethral opening (4%).

The process begins with a consultation, during which the doctor asks about the patient’s symptoms. The doctor then examines the external genital area and the anus.

In most cases, genital warts can already be identified by their characteristic appearance. In the early stages, however, genital warts are sometimes barely visible or difficult to see with the naked eye. In this case, the doctor swabs the suspicious skin areas with diluted, 3% acetic acid to make them visible as white patches.

For men, a rectal examination (rectoscopy) or urethral examination (meatoscopy) is now recommended. During this procedure, the doctor can detect genital warts that may have spread unnoticed into the rectum and urethra.

For women, the gynecologist also examines the cervix. This is done using a special microscope called a colposcope. This instrument allows the surface of the cervix to be viewed at 10x to 30x magnification.

For treatment, it is necessary to confirm the diagnosis and clearly identify the causative pathogen. To do this, the doctor takes a small tissue sample under local anesthesia. This sample is then analyzed using molecular biology techniques.

Genital warts can be treated either through self-care under medical supervision or through medical treatment. In the latter case, treatment is performed by a urologist or gynecologist.

The choice of treatment method generally depends on

• the size and location of the genital warts as well as
• the patient’s immune response

.

Causal and Symptomatic Treatment

There are essentially two different treatment options to choose from:

Causal therapy aims to target the virus itself. Symptomatic therapy, on the other hand, focuses on removing the warts. This can be achieved using chemical or surgical methods.

Self-Treatment

As part of self-treatment, the patient must apply special solutions and creams to the genital warts over several weeks. These usually contain the active ingredients

• imiquimod,
• interferon, or
• podophyllotoxin.

Imiquimod and interferon stimulate the immune system so that the body’s own immune cells can more effectively attack and fight the viruses.

Podophyllotoxin, as part of symptomatic therapy, inhibits the growth of virus-infected cells, thereby causing them to die off.

Medical Treatment

If self-treatment is not possible, a doctor will perform the treatment on an outpatient basis. Reasons for this may include genital warts that grow inside the body and therefore cannot be treated with topical cream.

Treatment methods that can only be performed under medical supervision include, among others

• the application of trichloroacetic acid,
• cryotherapy with liquid nitrogen,
• surgical removal, and
• removal via electrotherapy or laser therapy.

To date, it has not been possible to completely eliminate the human papillomaviruses that cause these warts. A complete cure therefore cannot be guaranteed. Even after successful treatment, genital warts can recur. This is particularly true when contributing factors, such as a weakened immune system, are present.

For example, the warts recur within six months in about 20 to 70 percent of patients. The risk of recurrence is particularly high—about 75 percent—for warts that have been surgically removed.

For this reason, it is advisable to undergo regular follow-up examinations after treatment.

Genital warts can only be reliably prevented by avoiding infection with the causative HPV viruses.

Various behaviors and precautions—most importantly, the use of condoms during sexual intercourse—can reduce the risk of infection.

• Use condoms!
• Avoid direct skin contact with affected areas
• Do not share bath towels or hand towels
• Practice good intimate hygiene
• Breathable underwear and clothing (to prevent a warm, moist environment in the genital area)
• Strengthen your immune system through a healthy lifestyle
• Get the HPV vaccine

The HPV vaccine can help prevent infection with certain types of the virus © Sherry Young | AdobeStock

The HPV vaccine is primarily used to prevent cervical cancer. It protects against infection with human papillomavirus types 6, 11, 16, and 18. In Germany, it is recommended for girls aged 12 to 17. It must be administered before the first sexual contact. Typically, three doses are given at intervals of two and four to six months.

However, since other HPV types can also cause genital warts, the HPV vaccine does not provide absolute protection against genital warts.

If infection has already occurred, the partner should also receive treatment. Otherwise, the partner may transmit the virus back to you (“ping-pong effect”).

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How do you recognize genital warts?

Genital warts usually appear as small, skin-colored or reddish bumps in the genital or anal area. They often go unnoticed and cause no symptoms. If you’re unsure, you should always seek a medical diagnosis.

How does HPV infection occur?

Genital warts are primarily transmitted through close skin-to-skin contact, especially during sex. Since the virus can also affect areas not fully covered by a condom, condoms do not provide complete protection.

Can genital warts go away on their own?

In some people, genital warts may resolve on their own, but the HPV infection remains. Targeted treatment is therefore recommended to prevent recurrences and further spread.

How can you protect yourself from genital warts?

The most important protective measures include using condoms, maintaining a strong immune system, and getting vaccinated against HPV, which provides protection especially against HPV types 6 and 11. Nevertheless, no method can offer complete protection.