Common Warts and Genital Warts

Warts are small benign tumors that appear on the skin caused by infection by the human papillomavirus (HPV), the same virus that usually causes cancer of the cervix, anus or penis. Although they are caused by the same type of virus, warts and cancers in the sex organs usually originate in distinct subtypes of HPV.

Warts
Warts
 

There are more than 150 subtypes of HPV that is a virus that primarily infects the epithelium of the skin and mucous membranes. Each virus subtype has tropism (attraction) over an area of the body. For example, HPV-2 and HPV-4 are associated with common skin warts, HPV-1 to warts that attack the soles of the feet, and HPV-6 and HPV-11 usually infect the region of the anus and genitals.

Warts are most common in children, adolescents and young adults.

It is important to know that a person with common warts does not transmit HPV through sexual intercourse or is at risk of developing cervical cancer. The infection is confined to that area of the skin. A wart in the hand means a hand-restricted HPV infection.

The common skin wart is a benign disease, does not cause cancer and usually goes away spontaneously over time. The occurrence of cancer is usually related to a few HPV subtypes, to genital infections and to the presence of immunosuppression.

Genital warts, also called condylomas, are highly contagious by the sexual route, be it oral, vaginal or anal. Contamination of the mucous membranes of the anus and genitals by HPV leads to a greater risk of cancer of the penis, anus and cervix, especially if they are caused by subtypes 6, 11, 16, 18, 31 or 35.

Not every subtype of HPV causes warts and the onset of cancer is not linked to their presence. The HPV-6 and HPV-11 subtypes, which account for more than 90% of the genital warts, have a low potential for transformation into cancer when compared to the HPV-16 and HPV-18 subtypes, which cause warts less frequently but present a high risk cancer of the cervix. However, it is very common for women who have genital warts to also have pre-malignant lesions in the cervix.

Let's then talk one specifically about common warts and genital warts (condylomas).

Common warts

HPVs that infect the skin are usually contracted when there are lesions such as cuts and scratches that allow the virus to enter the body. The transmission is from skin to skin, but can also occur through objects such as towels and clothing. The virus can also contaminate other areas of the patient's own body. People with skin diseases or injuries are at increased risk of being contaminated.

From HPV contamination until the appearance of the wart there may be an interval of up to 6 months.

Each body reacts to HPV infection differently, which means not everyone who is infected by the virus develops warts. The weaker the immune system, the greater the risk of having them, this includes transplant patients and patients with HIV. In fact it is estimated that as many as 80% of the population will be infected with HPV at some point in life, but only 5% of them will develop warts.

Warts usually appear more often on the hands, feet, knees, elbows and face, but any region of the body can be affected. The wart can be single or multiple, and present various aspects, varying in size, color and shape.

Treatment of common warts

Since HPV is restricted to the wart region, most current treatments are not aimed at attacking the virus itself, but rather destroy the region of the infected skin, trying to preserve the healthy part around.

Before undergoing treatment, it is important to know that 2/3 of the warts heal spontaneously within two years.

There are several options for treating warts, some more effective, some less painful and some slower. The treatment of common warts is different from that of genital warts, although some substances used are the same.

The use of liquid nitrogen is quite effective, but it tends to be somewhat painful and children tend not to tolerate it. The treatment needs to be repeated a few times and lasts an average of 3 months. As it can cause a whitening of the treated skin, it should be well discussed if the patient has dark skin.

Salicylic acid is a less painful option and has a success rate of around 70%. Other options include cytarin-based substance, bichloroacetic acid, tretinoin, 5-fluorouracil, or surgical excision of the lesion.

Imiquimod is a substance that appears to act differently, stimulating the immune system to destroy HPV. It is usually used in combination with one of the treatment options described above.

If you have a wart and want to remove it, seek a dermatologist and discuss the options most appropriate for your case.

Genital wart

The anal and genital warts are called condyloma acuminata. Popularly these genital warts are known as Gallic Crest.

Genital HPV is a highly sexually transmitted disease, and as already explained, the appearance of the wart depends on the infecting HPV subtype.

Genital HPV infection, with or without condyloma, is the most common sexually transmitted disease (STD) in the world, being more common than gonorrhea and chlamydia, syphilis and genital herpes.

Like any STD, its main risk factor is the practice of sex without condoms, especially if it is with several partners. The condom lessens the risk of infection, but in the specific case of HPV, its effectiveness seems to be around 70%, far below those of other STDs. Again, it is important to remember that a person may be infected with HPV even if they do not have visible warts. The contaminated partner may or may not develop condylomata.

Condylomata acuminata can take up to 8 months to develop after sexual intercourse. Anal condyloma usually occurs in people who have anal sex, but mainly in women, does not necessarily indicate that the patient had sexual intercourse through the anal route.

In women, genital HPV lesions usually affect the vulva, cervix, vagina, perineum, and anus. The presence of condyloma in any area of the genital region is a risk factor for the development of cervical cancer.

In men HPV lesions usually appear on the penis, close to the glans. Other possible points are the scrotum and the anus, the latter mainly, but not exclusively, after a homosexual relationship.

The prevalence of condylomata acuminata is higher in patients with immunosuppression, especially in those with HIV (AIDS).

Genital warts are usually asymptomatic, causing only aesthetic discomfort in the case of large, visible condylomas. Sometimes the wart is so small that the patient does not even notice it. In some cases, however, there may be complaints of itching, pain, burning, bleeding and, in women, vaginal discharge.

Genital HPV infections are related to an increased risk of anal, penile, vaginal, and cervical cancers.

Treatment of genital warts

Among the most commonly used substances are liquid nitrogen, podophyllin, Imiquimod, trichloroacetic acid or bichloroacetic acid. In large condylomas, surgical or laser excision is often required.

HPV vaccine



The HPV vaccine is aimed at preventing cervical cancer. There are two vaccines against HPV: one includes subtypes 6, 11, 16 and 18, and another 45 and 31. Therefore, the vaccine includes the main but not all subtypes related to cervical cancer. Therefore, vaccination does not eliminate the need for annual screening because it does not eliminate the risk of cancer by 100%.

Although the primary goal is prevention against cervical cancer, the presence of HSV-6 and HSV-11 subtypes in the vaccine also helps prevent condyloma acuminata.

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