Vulvar warts are caused by the human papilloma virus (HPV), which is responsible for highly contagious sexually transmitted infections in the cervix, vagina, and vulva. HPV enters and infects the vulvar skin via microabrasions, and integrates its DNA into the DNA of vulvar skin cells. An estimated 500,000 men and women—the majority in their late teens and twenties—get vulvar warts every year. Vulvar warts are not required for the transmission of HPV to occur, but if present, they are highly infectious because of their high viral load. They are almost always spread through sexual or intimate contact, and they do not have to be visible for the HPV infection for spread to a sex partner.
Genital HPVs are divided into low-risk and high-risk subtypes depending on their associated risk for the development of cancer after causing an infection. The low-risk, non-oncogenic subtypes HPV 6 and/or HPV 11 are detected in about 90% of vulvar and anal warts. Warts themselves do not become cancerous. However, (non-warty) co-infection with high-risk, oncogenic HPV subtypes, such as HPV 16 and HPV 18, in the vulvar skin near a wart is not uncommon. Over time, a persistent high-risk HPV vulvar infection can transform into a pre-cancerous vulvar condition called vulvar dysplasia. If unrecognized and untreated, vulvar dysplasia can, in turn, over several years, become cancer. It is, therefore, important to seek evaluation by a gynecologist if a vulvar wart is suspected or identified in an individual or their sex partner.
Some women develop vulvar warts within a just few weeks after an HPV infection. However, warts can also take months or even years to appear. For this reason, it can be difficult to pinpoint when one became infected. Vulvar warts affect the skin and moist tissues of the genital area. They can look like small, flesh-colored bumps or have a cauliflower-like or skin tag-like appearance. In many cases, vulvar warts are too small to be visible. There may be associated local itching, burning, or discomfort or no symptoms at all.
Vulvar warts may be visualized simply by inspection with the naked eye, but often they are found when looked for under magnification using a colposcope. If a vulvar wart is suspected by either means, a biopsy is done in the office under local anesthesia to confirm the diagnosis. Simultaneous testing for other sexually transmitted infections (gonorrhea, chlamydia, and syphilis) is performed in the same setting using a vaginal swab or a blood test because these other sexually transmitted infections are associated with vulvar warts.
Risk factors for becoming infected with HPV and developing vulvar warts and/or vulvar dysplasia include: having unprotected (i.e., without a condom) sex with multiple partners, having other sexually transmitted infections, having sex with someone whose sexual history is unknown, becoming sexually active at a young age, and having a compromised immune system.
Sometimes vulvar warts go away on their own, or they may enlarge and multiply. When they persist, they can be treated either medically with topicals or surgically. Medical treatments include: podophyllin, podofilox, bichloroacetic acid, trichloroacetic acid, imiquimod, and interferon. Surgical treatments include: cryotherapy, electrocautery, laser treatment, and excision, all of which can be performed under local anesthesia in the office setting. It may take several treatments, both medical and surgical, to remove vulvar warts. During treatment and recovery, sex should be avoided.
- Cryotherapy (freezing): During cryotherapy, liquid nitrogen is applied to freeze and destroy warts.
- Electrocautery: An electric current burns away the warts
- Laser treatment: A laser light destroys tiny blood vessels inside warts, cutting off their blood supply.
- Excision using Loop Electrosurgical Excision Procedure (LEEP): With LEEP, the gynecologist uses an electrically charged wire loop to remove warts.
Vulvar warts can be prevented by having the HPV vaccine and avoiding sexual contact. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching HPV and developing warts. HPV stays in the body even after treatment, so warts can return, so regular follow-up with the gynecologist is important.
We at Adaptive Gynecology are sensitive to the concern women have if they discover vulvar warts. We manage them quickly and reassuringly.
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