Genital Warts (HPV) in Women

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Quick GuideSTD Diagnosis, Images, Symptoms, Treatment

STD Diagnosis, Images, Symptoms, Treatment

Is there a treatment that will cure genital warts (HPV infection)?

There is no treatment that can eradicate HPV infection, so the only treatment is to remove the lesions caused by the virus. Unfortunately, even removal of the warts does not necessarily prevent the spread of the virus, and genital warts frequently recur. None of the available treatment options is ideal or clearly superior to others.

  • A treatment that can be administered by the patient is a 0.5% solution or gel of podofilox (Condylox). The medication is applied to the warts twice per day for 3 days followed by 4 days without treatment. Treatment should be continued up to 3 to 4 weeks or until the lesions are gone. Podofilox may also be applied every other day for a total of three weeks.
  • Alternatively, a 5% cream of imiquimod (Aldara, a substance that stimulates the body's production of cytokines, chemicals that direct and strengthen the immune response) is likewise applied by the patient three times a week at bedtime, and then washed off with mild soap and water 6 to 10 hours later. The applications are repeated for up to 16 weeks or until the lesions are gone.
  • Only an experienced physician can perform some of the treatments for genital warts. These include, for example, placing a small amount of a 10% to 25% solution of podophyllin resin on the lesions, and then, after a period of hours, washing off the podophyllin. The treatments are repeated weekly until the genital warts are gone.
  • An 80% to 90% solution of trichloroacetic acid (TCA) or bichloracetic acid (BCA) can also be applied weekly by a physician to the lesions. Injection of 5-flurouracil epinephrine gel into the lesions has also been shown to be effective in treating genital warts.
  • Interferon alpha, a substance that stimulates the body's immune response, has also been used in the treatment of genital warts. Treatment regimens involve injections of interferon into the lesion every other day over a period of 8 to 12 weeks.
  • Alternative methods include cryotherapy (freezing the genital warts with liquid nitrogen) every 1 to 2 weeks, surgical removal of the lesions, or laser surgery. Laser surgery and surgical excision both require a local or general anesthetic, depending upon the extent of the lesions.

What if a woman has precancerous changes (dysplasia) of the cervix?

Women who have evidence of moderate or severe precancerous changes in the uterine cervix require treatment to ensure that these cells do not progress to cancer. In this case, treatment usually involves surgical removal or destruction of the involved tissue.

  • Conization is a procedure that removes the precancerous area of the cervix using a knife, a laser, or by a procedure known as LEEP (loop electrosurgical excision procedure, which uses an electric current passing through a thin wire that acts as a knife). LEEP is also referred to as LLETZ (large loop excision of the transformation zone). 
  • Cryotherapy (freezing) or laser therapy may also be used to destroy tissue areas that contain potentially precancerous changes.

What should a person do if exposed to someone with genital warts?

Both people with HPV infection and their partners need to be counseled about the risk of spreading HPV and the appearance of the lesions. They should understand that the absence of lesions does not exclude the possibility of transmission and that condoms are not completely effective in preventing the spread of the infection. It is important to note that it is not known whether treatment decreases infectivity.

Finally, female partners of men with genital warts should be reminded of the importance of regular Pap smears to screen for cervical cancer and precancerous changes in the cervix, as precancerous changes can be treated and reduce a woman's risk of developing cervical cancer. Similarly, men should be informed of the potential risk of anal cancers, although it is not yet been determined how to optimally screen for or manage early anal cancer.

REFERENCES:

Gearhart, P. A., MD. "Human Papillomavirus." Medscape. Updated: Oct 28, 2016.
<http://emedicine.medscape.com/article/219110-overview>

Kasper, D., et al. "Harrison's Principles of Internal Medicine." McGraw-Hill Education/Medical. 19th edition. 201

Medically Reviewed by a Doctor on 11/2/2016

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