Genital warts

Genital warts: appearance and symptoms

Are genital warts benign growths the skin or mucous membrane. These warts are usually found in the genital area (rarely at other parts of the body). They are therefore also called genital warts. Another term is “pointed condyloma”:

In its formation, the upper (mucus) skin layer (epidermis) grows upwards pointedly, forming warts of pinheads to several centimeters. The soft, warty structures are reddish, gray-brownish or whitish colored. They usually occur in several heaped and can develop into larger papillomatous nodules or plate-like structures (“Hahnenkamm”).

In addition to the classic genital warts, there are also special forms. These include, for example, the Condylomata plana (lat. planus = flat). It is the flat appearance of ordinary genital warts.

In addition, the genital warts develop in rare cases to so-called “Riesenkondylomen(Buschke-Löwenstein tumors or Condylomata gigantea) These large, cauliflower-like tumors destroy tissue and can transform into a cancerous tumor (verrucous squamous cell carcinoma).

Genital warts in the woman

If a woman has genital warts, they often sit on the posterior commissure (posterior junction of the labia majora in front of the perineum) or on the labia. They may also occur in the vagina and cervix, anus and anal canal, as well as in the urethra. Warty warts in the urethra are usually accompanied by warts in the outer genital area (such as the labia).

Genital warts in the man

Most of the warts sit on the penis – preferably on the frontal ligament (frenulum), on the Penisfurche (annular recess behind the glans) and on the inner leaf of the foreskin. Circumcised men no longer have foreskin and are less susceptible to genital warts. If they get any, the genital warts colonize penis root and penis root.

As with women, condylomata acuminata can also form in men in the urethra, anal canal, and anus. Especially male homosexuals are prone to such warts on the anus.

Genital warts on other parts of the body

Genital warts love humid conditions. These are mainly found in the genital and anal areas, which is why they almost always arise here. Only rarely do they grow on other parts of the body. By oral sex, for example, HPV viruses from the genital area can enter the oropharynx and cause warts. This happens very rarely. Also rarely are Condylomata acuminata, for example, in the navel, under the female breasts or in the armpits.

Genital warts in infants and children

If pregnant women have genital warts on their genital warts, they can transmit the triggering viruses to the child at birth. This increases the risk that the newborn will suffer from the so-called Juvenile Laryngeal Papillomatosis. These are warts-like nodules around the larynx and vocal cords. Symptoms include hoarseness, coughing, dysphagia, and audible breath sounds.

General genital warts symptoms

Cause genital warts usually no complaints, so are asymptomatic. For many sufferers, condylomata acuminata are then a purely cosmetic problem that, however, can cause psychological problems (feelings of shame, etc.).

Rarely, genital warts can be uncomfortable Itching, burning or pain, Some women also report increased numbers vaginal discharge, In particular, the surface of larger genital warts may tear and blossoms, for example, during intercourse. If the genital warts grow into the urethra opening, urination can also cause discomfort (bleeding, weak stream of urine).

Sometimes, genital warts prepare Pain during sex (Dyspareunia). That can be very stressful psychologically. Some patients also suffer from the fear that they (or their partner) will become cancerous or become barren through genital warts. Do not be afraid to visit a doctor for genital warts and tell him about your worries and fears!

Genital warts: causes and risk factors

The causes of warts in the genital area and many warts on other parts of the body (extragenital warts) are known as human papillomavirus, also known as human papillomavirus or HPV short. There are over 200 different HPV types, most of which are non-hazardous.

Harmless HP viruses rarely cause malignant diseases, which is why they are also called low-risk types. The best known types are HPV 6 and HPV 11. They are detectable in most cases of genital warts. In some cases, other low-risk HPV symptoms can also trigger warts. Overall, about 40 HPV types can infect the genitoanal area.

High-risk HPV rarely in genital warts

If low-risk types rarely lead to degeneration, high-risk HPV infections (high-risk HPV) are significantly more likely to be associated with private-sector cancers. For example, in almost all cases of cervical cancer (cervical carcinoma) an involvement of high-risk HPV types can be detected. Most of these are HPV 16 or 18. The development of other cancers in the genital area such as penile cancer or vaginal cancers may also be associated with high-risk HPV infection. In the cells of genital warts, however, high-risk HPV types are extremely rare.

How can you get infected with genital warts?

Genital warts are among the most common sexually transmitted diseases. They are mostly over direct skin or mucous membrane contact transmitted, most often over unprotectedintercourse, Especially if you change the sexual partner more often, there is a risk of infection. Although condoms can reduce the risk, but not 100 percent. Because they do not cover all skin areas that may be affected by HP viruses.

A genital warts infection can also over contaminated objects how sex toys happen. Contagion from shared contaminated towels or bath sponges as well as joint bathing can also not be ruled out.

Oral Sex can increase the risk of HPV infection in the mouth and throat area – and thus the risk of developing genital warts similar to thickened skin.

In pregnant women, the triggers of the Transmitted genital warts at birth to the newborn become.

If children with common warts on their fingers scratch their genital or anal areas, it may happen that they develop genital warts. Trigger is then usually the HPV type 2, but sometimes type 27 or 57. In this case, experts of autoinoculation (even contagion).

Attention: If children have warts in the genital or anal area, a clarification is always necessary, because there is a suspicion of sexual abuse!

risk factors

Several factors increase the risk of contracting genital HPV viruses that either cause genital warts or lead to cervical cancer. These include:

• first sexual contacts before the age of 16
• unprotected intercourse (no condoms)
• Smoking (weakens the protective and barrier function of the mucous membrane)
• Birth at a young age and multiple births (pregnancies change the lining of the uterus, making it more susceptible to infection)
• weakened immune system
• other genital infections such as chlamydia or genital herpes

Genital warts: prevention

There is no definite protection against HPV infections and therefore genital warts. However, some measures help reduce the risk of genital warts. The advantage is that these steps can also prevent other, more serious consequences of HPV. These include primarily malignant diseases such as cervix cancer or penile cancer.

Operate Safer Sex!

Unprotected sex is the main risk factor for sexually transmitted diseases such as genital warts. Although a brief skin contact is sufficient for the genital warts transmission, however, studies on other HPV diseases have shown that the success of the treatment with condom protection is greater and lasts longer. Protect yourself with condoms in both vaginal and anal sex.

Even with oral sex you should use condoms or “Leckcktücher” (dental dams). They also reduce the risk of infection.

Go to checkups!

As a result, genital warts and other HPV-related mucosal changes can be detected early and treated. As with almost all diseases, the earlier the diagnosis and treatment, the better the prognosis!

Always remember your sexual partners!

As with all sexually transmitted diseases, the sexual partner should also be examined for genital warts. If you diagnose genital warts inside, be sure to let your / your sexual partner know about it. This will prevent it from spreading and protect your partner from potentially serious illnesses (including cancer)!

Let yourself or your children get vaccinated!

For some years, there is a vaccine against certain types of human papillomavirus (HPV vaccine). It is recommended by the Standing Vaccination Commission of the Robert Koch Institute (STIKO) to all girls aged between nine and fourteen, preferably before their first sexual activity. In June 2018, the STIKO extended the vaccination recommendation to boys between the ages of nine and fourteen. Two different vaccines are available in the German market: One (dual HPV vaccine) protects against the most important causative agents of cervical cancer (HPV 16 and 18). The second vaccine (nine-fold HPV vaccine) is still effective against other types of HPV, including HPV 6 and 11, the two most common genitourinary agents.

Genital warts: diagnosis and examination

Genital warts in many cases do not cause any problems. Nevertheless, you should always have warts in the genital area examined. It may be a malignant disease process. Even harmless genital warts can cause discomfort, especially if they increase in size. In addition, the risk is increased that high-risk HPV infected the skin or mucosa in the genital area elsewhere and there have led to barely visible changes.

Necessary examinations in the investigation of genital warts are carried out by specialists: Potential contact persons are gynecologists (for women), urologists (for men), dermatologists (dermatologists) and venerologists (specialists for venereal diseases).

Medical history (anamnesis)

First, the doctor asks the patient for any symptoms. Do not be afraid to answer questions about your sexual activity as it plays a crucial role in genital warts. In addition, the physician notes general risk factors such as medication, smoking, or other pre-existing conditions that may weaken the immune system. For example, you may be asked the following questions:

• Where exactly do you have complaints?
• Where and which skin changes did you notice? Are these possibly clear warts in the genital area?
• Did you notice genital bleeding outside the menstrual cycle, for example after intercourse?
• Have you frequently changed your sexual partner? Do you use condoms during sex?
• Are you aware of previous illnesses?
• Have you had a sexually transmitted disease in the genital area such as genital warts, chlamydia or syphilis in the past?

Investigations of genital warts

Genital warts in the man The doctor can clarify more thoroughly during a physical examination. Above all, he examines the penile quiche, the exit of the urethra (external urethra meatus) and the enlargement (fossa navicularis) located there. He may spread the urethra opening so he can examine the last few inches of the urethra (Meatoskopie). If there are genital warts at the urethral opening, the doctor performs a urethral reflection (urethroscopy) by. First, however, the genital warts visible from the outside are treated, so that the human papillomaviruses are not dragged into the depths of the urethra during reflection.

Genital warts in women often occur in the labia or the anus and are then usually easily recognizable. In order to discover all warts in the genital area, further investigations are necessary. The gynecologist undergoes a gynecological examination of the vagina scan and then with one speculum (“Mirror”) examine. The blanking is important because sometimes Spekula cover deep-seated genital warts or other growths.

In addition, the doctor takes one smear from the mucosa on the cervix and cervix. Then he stains the smear and examines it under the microscope. This “Pap test” can detect malignant cell changes, as they can be caused by HPV infection, early.

For the clarification of genital warts in the inner genital area of ​​the woman, the doctor can also colposcopy carry out. He examines the vagina and the cervix with the help of a special microscope (colposcope). This makes it possible to detect tiny genital warts and other changes or bleeding in the female genitals.

Further investigations

With warts on the anus, the doctor of the anus and the anal canal will scan with his finger (digital rectal examination). Besides, he can do one anoscopy (Anal canal reflection): He examines the anal canal using a rigid endoscope (anoscope).

Alternatively is also one proctoscopy possible: Again, a rigid endoscope is used, the proctoscope. With his help, the doctor can not only see the inside of the anal canal, but also the lower section of the rectum (rectum). Very rarely, genital warts grow above the dentate line. At this borderline on the inner wall of the intestine changes the structure of the mucous membrane: The covering layer (squamous epithelium) of the anal canal passes here into the mucous membrane of the rectum (high-prismatic epithelium). Genital warts that grow beyond the line indicate defensive weakness. In order not to carry off HPV, externally visible genital warts are usually removed before proctoscopy.

If the other genital warts studies have revealed an unclear finding, the doctor may be able to provide one acetic acid test carry out. He dabbed the suspicious skin / mucous membrane sites with three to five percent acetic acid (in women as part of colposcopy). Barely discernible genital warts turn whitish. The test result is not very reliable, which is why the method is not routinely recommended.

Fine-tissue examination of distant warts

The doctor usually diagnoses genital warts with the naked eye. However, if he has doubts, he removes the wart as a whole and has them examined histologically in the laboratory. Even in the following situations, a genital wart is removed and examined in the laboratory:

• The treatment does not work.
• After successful treatment, new genital warts quickly form.
• The genital warts have a diameter of more than one centimeter.
• There is a suspicion of giant condylomas (Buschke-Löwenstein tumors).
• The lesions are atypical. For example, they are pigmented, multicolored, bleeding or fused with surrounding tissue.
• The patient has an immune deficiency.

HPV detection

Genetics of HPV viruses usually need not be detected in genital warts. Exceptions are giant condylomas: Here, the viruses should be detected by molecular biology and the virus type identified.

HPV detection (including virus typing) may also be indicated in children with genital warts. If HPV 2 is identified as the cause of the warts, this is more likely to suggest the transmission of common skin warts rather than sexual abuse as the cause of genital warts (the latter being mostly caused by HPV 6 or 11).

Exclusion of other venereal diseases

With genital warts, the risk is increased that there are other venereal diseases. Therefore, the doctor will also examine or test patients for syphilis, gonorrhea, HIV, chlamydia and hepatitis B and C.

Differentiation of the genital warts from other skin lesions

There are some diseases that cause similar skin changes as the genital warts (differential diagnosis). For a distinction is therefore sometimes necessary to take a tissue sample, which is examined histologically. Important differential glands in genital warts are:

illness	properties
Condylomata lata	weeping and broad-based papules on the skin Stage II of syphilis
Hair follicle inflammation (folliculitis)	painful, small swelling (pustule) in the area of ​​a (pubic) hair single or multiple occurring may be purulent or non-purulent
Mollusc warts (Mollusca contagiosa)	small, flesh-colored, slightly dented papules, sometimes shiny occur individually or in groups often in children and AIDS patients
Seborrheic warts	sharply set, lens to coin sized warts initially flat and brownish, later hemispherical raised and dark brown to black soft, greasy surface can arise wherever there are sebaceous glands
Soft fibroids	benign tumors of the connective tissue of the skin soft, skin-colored, often petiolate (hence called “stalk warts”) especially in wrinkle regions (on the neck, in the groin etc.)
free sebaceous glands	small skin-colored to yellowish papules
skin tags	flabby skin folds / flaps on the anus harmless, no complaints
Hirsutie’s papillaris vulvae (female) Hirsutie’s papillaris penis (male)	one to several rows of small, whitish-red papillae in the area of ​​the female pubic (vulva) or on the edge of the penile glans no disease value
Lichen nitidus	several pinhead-sized, shiny papules on the penis shaft or on the glans (also on the flexor side of the forearms, etc.) whitish (on darker skin) to reddish-brownish (on lighter skin) no complaints

In addition, the doctor must delineate warts of possible malignant lesions (precursors of cancer or cancer).

Genital warts: treatment

treatment

There are different options of the genital warts treatment. Doctor and patient will decide together on the treatment plan. The following factors should be taken into consideration when choosing therapy measures:

• Size, number and location of the genital warts
• Type and success of previous treatments
• possible basic and concomitant diseases (HIV, chlamydia, etc.)
• Wishes of the patient
• Experience of the attending physician

The sexual partner should also be examined for genital warts and treated if necessary. This prevents partners from infecting each other again and again.

Genital warts treatment with drugs

The genital warts can be treated with externally (topically) applicable medicines. The preparations are available as a cream / ointment or liquid (solution, acid) and are applied directly to the warts. Depending on the active ingredient, the medical genital warts treatment is either carried out by the doctor or by the patient himself. In any case, careful and regular use of the medication is crucial to the success of the therapy.

In the following table you will find a list of the different active ingredients for the genital warts therapy, instructions for use and the most important side effects (NW):

drug	user	Remarks
Podophyllotoxin 0.5% solution 2nd choice: podophyllotoxin 0.15% cream	patient	2x daily for 3 days, then 4 days break; this cycle can be repeated a maximum of four times for a maximum of 10 genital warts with a size of 1 to 10 mm and a maximum total area of ​​1.5 cm2 especially suitable for untreated, individual genital warts in easily accessible and visible places (outer genital area) not use under 18 years, during pregnancy and lactation NW: inflammatory reactions, superficial wounds, redness, burning
Imiquimod 5% cream	patient	3 times a week at night for a maximum of 16 weeks wash off after 6 to 10 hours should strengthen defense system at the affected area especially suitable for untreated genital warts in the outer genital area or around the anus not recommended under 18 years, during pregnancy and lactation NW: inflammatory reactions, superficial wounds, swelling, skin irritation, flu-like symptoms
Sinecatechine-10% ointment	patient	Green tea extract Apply 5 times a day, up to 16 weeks maximum daily dose 250 mg ointment (= maximum 0.5 cm ointment strand) do not use under 18 years and during pregnancy NW: slight local skin reactions (itching, redness, skin irritation, pain)
trichloroacetic	doctor	applied weekly with cotton swabs or wooden sticks leads to cell death as a strong acid especially suitable for small, circumscribed genital warts in several places, especially in the mucous membrane area also applicable during pregnancy NW: immediate burning and pain when applying; Fistulas and skin ulcers

Feigly warts freeze

The technical term for this genital warts treatment is cryotherapy. It is performed by a specialist. In doing so, the physician applies liquid nitrogen to the wart with the aid of a spray or stick (cotton wool, metal), which “freezes” the tissue and causes it to die. The application can be repeated once a week.

This method of genital warts treatment is easy to perform, inexpensive and also applicable during pregnancy. Possible side effects include burning and pain at the treated site. In addition, pigmentation disorders and superficial scars can occur. The HP viruses are not killed by the treatment, so that later in many patients form new genital warts.

Operative genital warts treatment

In surgical genital warts, the tissue growths are removed. The patient receives either a local anesthetic or a general anesthetic. There are several techniques available for the genital warts surgery:

With a electrocautery It is possible to remove genital warts by heating and destroying the tissue by electric current. Doctors use this method especially for large, beet-shaped and recurring genital warts. During the procedure, smoke may develop with potentially contagious virus particles. Therefore, a suction device, face masks and goggles are necessary.

Also by means of a laser therapy can be removed genital warts. The laser works with carbon dioxide or dye (Nd: YAG). Like electrocautery, this method is particularly suitable for large, bed-shaped and recurring genital warts. In addition, there is also a risk of smoke development with the potential spread of infectious HP viruses.

There are also other options for surgical treatment of warts, for example, the curling (curettage) and the removal with the surgical scissors (Scherenschlagexzision). They are particularly suitable for individual genital warts.

Especially when Genital warts around the cervix be removed (such as by laser), the histological examination of a tissue sample is advisable. It may be possible to find malignant cell changes in the tissue (or precursors). Then the surgical procedure is often expanded.

For the treatment of Genital warts in the urethra There are no approved drugs. They are surgically removed as part of a urethral specimen. There is a risk of damage and scarring of the tissue. Possible consequences are sensations of discomfort, pain and narrowing of the urethra.

Genital warts in the anal canal are also usually surgically removed. Again, the procedure can cause scarring and narrowing.

Genital Warts Treatment: Pregnant

During pregnancy, a doctor can treat smaller genital warts with trichloroacetic acid. Other options for treatment of the genital warts in pregnant women are icing, laser therapy and electrocautery. With such invasive methods, however, doctors often wait until the 34th week of pregnancy or later, when there are no major complaints. Because in many cases, genital warts spontaneously improve from the 25th week of pregnancy on their own.

Genital Warts Treatment: Children

In children, genital warts can point to sexual abuse. If the child behaves conspicuously or if traces of violence are visible, this suspicion intensifies. In such cases, a visit to a pediatrician and a child psychologist is advisable in addition to a genital warts treatment at the specialist.

However, genital warts can also be caused by common warts on the hands: for example, if the child is scratching the genital area, it can transmit HPV and cause condyloma.

Genital warts in children can be treated with cryotherapy, laser or electrocautery.

Genital warts: tea tree oil

Some people use tea tree oil to treat genital warts. The essential oil from the leaves of the Australian tea tree (Melaleuca alternifolia) generally has a virustatic effect, that is, it inhibits the proliferation of viruses. However, it is not proven whether tea tree oil can really treat the genital warts.

Genital warts: disease course and prognosis

The disease course of genital warts is different. In some cases, genital warts develop independently even without therapy. Very often, however, they spread out untreated. They can even grow into large growths and cause more and more complaints. Therefore, genital warts should always be treated consistently – also because they are very contagious.

In all treatments, the trigger (HPV) can rarely be completely eliminated. This is why relapses often occur (relapses).

HIV infection or AIDS as well as other genital infections (such as chlamydia, herpes, syphilis) can prevent the success of a genital warts treatment and a positive course of the disease.

HIV patients and organ transplanters must take special care. Their immune system is extremely weakened (organ transplanted by the long use of defense-suppressing drugs, so-called immunosuppressants). With you the risk is clearly increased that Genital warts to cancer (especially: squamous cell carcinoma) degenerate.