Genital Warts In Women (Human Papilloma Virus)

What are the human papilloma viruses?

The human papilloma viruses (HPVs) are a family of over 60 different viruses responsible for causing warts. The majority of the viruses produce warts in areas other than the genitals. They are responsible for the common warts seen on the hands, fingers, and even the face. Most of these viruses are innocuous, causing nothing more than cosmetic concerns. Several virus "types" are confined primarily to the moist skin of the genitals, producing lesions in this area. The lesions produced by these genital viruses are called genital warts. The virus that causes genital warts is not the same as the virus that causes common warts. You cannot develop genital warts from the virus that causes common warts.

Certain types of genital viruses can cause abnormal PAP smears and even cervical cancer. Once contracted, the virus can stay with the infected individual for life. It is estimated that over 50% of sexually active adults are carriers of one of these viruses. Men and women are equally affected. The chance of being a carrier increases with the number of sexual partners. Infection with HPV is now considered to be the most common sexually transmitted disease in the United States. It is also the leading cause of abnormal PAP smears and pre- cancerous changes of the cervix in women. Even though there are reports of pre-cancerous changes occurring on the skin of the male penis, the incidence is insignificant compared to the large number of women who experience pre-cancerous changes of the cervix.

How are genital warts transmitted?

Genital wart viruses are primarily transmitted through sexual contact. Transmission of the virus through soiled clothing or shared sex objects is unusual, but can occur. These viruses require moisture and cannot survive outside the body for any length of time. Therefore, dry objects do not transmit the virus very well. With sexual intercourse, the virus can enter the body through microscopic tears in the superficial layers of the skin, vagina, or cervix. Once the protective outer layer of cells has been penetrated, the virus begins to invade the underlying cells where it multiplies.

After the virus becomes established in the genital skin, the vagina, or the cervix, it can either remain dormant or multiply to cause a genital wart. The wart is the most contagious stage, but a dormant virus can also be infectious. Therefore, preventing the spread of genital warts is extremely difficult. Condoms do not necessarily protect either party against infection. The infection can be located on the testicles of the male partner or the vulva (skin outside the vagina) of the female partner. From these locations, the virus can spread to the partner during sex. Since there are over 12 genital viral types, a woman can become infected by more than one type. Some "types" are more likely than others to cause pre-cancerous changes on the cervix.

What symptoms and problems can genital wart viruses cause?

Most people infected with the HPV viruses have no symptoms and may not know they are infected. Others may develop genital warts of varying sizes. HPV viruses are believed to be responsible for chronic pain and itching around genital openings, even in the absence of warts. For those women infected with certain virus types, pre-cancerous changes or even cancer of the cervix can develop.

The cervix is the end of the uterus that protrudes into the vagina. Cells on the cervix are vulnerable to infection by HPV viruses. If infected by certain types of HPV virus, the cells of the cervix can be transformed by the virus into pre-cancerous cells over time. A PAP smear is an office procedure where tissue scrapings from the cervix are collected to be examined under a microscope for these pre- cancerous changes. Even among women known to be infected, the chance of developing pre-cancerous changes is small. Furthermore, the transformation from pre-cancerous cells to cancer can take several years. In some women, however, this cancerous transformation can occur in less than one year. The HPV virus can also cause pre-cancerous changes in the vaginal and the skin of the vulva (external genital).

The HPV viruses can cause unsightly genital warts that are frequently difficult to eradicate. In a woman under stress or who has a poor immune system, the warts can be very tenacious. Most warts appear on the genitals as fleshy, firm elevations of the skin, similar to warts found on other parts of the body. The warts are usually not accompanied by other symptoms, however, sometimes, they can cause mild itching. Some warts can be so small as to be detectable only with magnification. Others can become so large as to prevent intercourse or childbirth. However, the incidence of large warts obstructing the birth canal, necessitating cesarean sections for the delivery of babies, is rare.