Early Signs & Symptoms of Genital Warts

You may be familiar with warts and know that they are growths in the skin and mucous membranes caused by a virus known as Human Papillomavirus (HPV, for short). What you might not know, however, is that several subtypes of HPV exist, and they may cause warts in different regions of the body. [1]

The two main types of warts that have been identified are cutaneous warts and genital warts. Cutaneous warts can be found anywhere in the body and have different shapes and presentations. Genital warts (or ano-genital warts) are generally found in the skin and mucous membranes of the genitals and anus. [2]

We will be taking a closer look at genital warts, focusing more on their early symptoms, in order to become more familiar with what HPV looks like when it first starts.

Causes of Genital Warts

The cause of genital warts has been identified as mainly HPV subtypes 6 and 11. HPV-6 is responsible for 45-90% of all reported cases. [3] Other subtypes of HPV, such as HPV-1 and HPV-2 (which usually cause cutaneous warts), may cause genital warts, but that is quite rare.

Genital warts are considered a sexually-transmitted disease (STD). They are transmitted from person to person through sexual contact and may spread to the anus through sexual contact with an infected person as well, or from the person’s genitals to their own anus (a process known as autoinoculation). [4]

Transmission may not always be sexual, though. Analyses of patients’ fingers and underwear have demonstrated the presence of DNA of HPV, which gives support to this theory. [5]

What does HPV look like when it first starts?

We must first understand the timeline under which HPV has been known to progress. An infection may occur (during a sexual encounter, for example) but the symptoms may not appear until weeks later. [6] This period has been reported to extend to up to 2 years! [7]

[content_container max_width=’500′ align=’center’]Check Out: How long genital wart last if untreated?[/content_container]

Usually, the only symptom that appears as a result of HPV infection is the wart itself. Genital warts usually have a specific form known as condylomata acuminatum. This wart is a soft, pink swelling, that may have a stalk, and maybe a bit elongated and have a texture resembling a cauliflower. [8]

Several warts may appear in the same patient, and if they are close together, they may fuse and form a large mass. Other forms of genital warts may take the shape of small, flat, solitary warts.

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Aside from the wart itself, there may be some physical discomfort caused by the swelling, and it may become itchy or inflamed, have a bad odor, or discharge fluid. The wart may bleed if it becomes inflamed or gets scratched. [9], [10]

Warts that appear around the opening of the urethra may interfere with the normal flow of urine, causing a disrupted stream or other abnormalities. [11]

There are sites other than the genitals in which genital warts can appear. They can be transmitted to the mouth as a result of oral sex, and the risk of transmission is much higher in persons with compromised immunity, especially due to HIV. [12]

Genital warts can also be transmitted during birth from an infected mother to her baby. These warts can be found in the larynx and may not appear until years later. [13]

Genital warts can also be found in the nose, sinuses, and eyes. [14]

What do genital warts look like in men & women?

Genital Warts on Penis and Vagina

Genital warts usually do not differ in appearance between men and women.[15]

The most common areas of affliction are the frenulum, corona, and glans (tip) of the penis in males, and the posterior fourchette of the vulva in women. These regions correspond to the most likely sites of friction during sexual intercourse.

Genital warts may be aggravated in females during pregnancy.

Sometimes, common warts may be seen on the shaft of the penis in males due to contact with a common wart elsewhere on the body or on a sexual partner.

Is any genital bump or swelling a wart?

Not all swellings or abnormal growths on the genitals are genital warts. Below are some of the most common conditions that affect the genitals and might be confused for genital warts.[16]

Genital Herpes:

Herpes is another viral infection caused by the herpes simplex virus (HSV). It is sexually transmitted, just like HPV.

The typical lesion in herpes is a red, painful, blister or sore, which can sometimes become itchy.

Ingrown Hairs:

Pubic hair can sometimes become ingrown, usually as a result of shaving. This causes a red, tender swelling around the hair follicle.

Pimples:

Just like the pimples, you may get anywhere else, sometimes they can affect the genitals and may be related to menstrual cycles in females.

Skin Tags:

Skin tags are extra pieces of skin that grow on a stalk. They are harmless and usually caused by friction.

Moles:

Moles are symmetrical, well-defined growths that have a consistent coloration. They may give rise to cancer, especially if they start to change in color.

Skin cancers:

A type of cancer called Intraepithelial Neoplasia that occurs in the epithelium (a layer of the skin) can cause swellings that look like warts. The lesion is usually pigmented. Another type of cancer known as Verrucous Carcinoma may be confused for a genital wart.

Lymphogranuloma venereum

A sexually transmitted disease caused by the bacteria Chlamydia trachomatis. The lesion may take the form of a small pustule (a fluid-filled swelling) or papule (a solid swelling), and can be found in the coronal sulcus (the groove under the head) of the penis in males, and the posterior vaginal wall, vulva (external genitals), or fourchette (the back part of the inner lips of the vulva) in females.

Syphilis

The rash caused by syphilis can afflict the genitals and result in papules (solid swellings). These may also become fused like genital warts and form swellings called Condylomata lata.

Cutaneous Crohn’s Disease

Crohn’s disease is an inflammatory bowel disease that can sometimes have symptoms outside of the gastrointestinal tract.

The lesions afflicting the genitals may appear as skin tags or painful red papules on the genitals. [17]

Pearly Penile Papules

Small, dome-shaped, skin-colored swellings (papules) typically found on the coronal sulcus (groove at the base of the head) of the penis. They are wrongly assumed to be sexually transmitted, but are actually considered a normal variant, not a disease, and they are unrelated to sexual activity. [18]

Vestibular Papillomatosis of the Vulva

Small, shiny, skin-colored growths on female genitals, most doctors consider them a normal variation and not a disease. [19]

How can I prevent genital warts from occurring?

The best bet is not engaging in an unprotected sexual activity. If unprotected sex does occur, then checking the genitals regularly afterwards will help identify warts as soon as they appear. [20]

Some countries have adopted the use of a vaccine against HPV, which can prevent or reduce wart infections. These countries (such as Australia) have reported a reduction in the rates of infection by HPV-6, HPV-11, HPV-16, and HPV-18, resulting in a decrease in the rate of affliction with genital warts. [21]

References:
[i] Badaracco G, Venuti A, Di Lonardo A, Scambia G, Mozzetti S, Benedetti Panici P, et al. Concurrent HPV infection in oral and genital mucosa. J Oral Pathol Med 1998;27 (3):130-134.
https://www.ncbi.nlm.nih.gov/pubmed/9563805/
[ii] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.
[iii] Aubin F, Pretet JL, Jacquard AC, et al. Human papillomavirus genotype distribution in external condylomata: a large French national study (EDiTH IV). Clin Infect Dis 2008;47:610–15. 229
Arima Y, Winer RL, Feng Q, et al. Development of genital warts after incident detection of human papillomavirus infection in young men. J Infect Dis 2010;202:1181–4. 230
Krzyzek RA, Watts SL, Anderson DL, et al. Anogenital warts contain several distinct species of human papillomavirus. J Virol 1980;36:236–44.
[iv] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.55.
[v] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.55.
[vi] https://www.healthline.com/health/healthy-sex/how-long-do-genital-warts-last#istreatment-necessary
[vii] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.55.
[viii] https://www.zavamed.com/uk/early-signs-of-genital-warts.html
[ix] https://www.zavamed.com/uk/early-signs-of-genital-warts.html
[x] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.56, 25.57.
[xi] https://www.zavamed.com/uk/early-signs-of-genital-warts.html
[xii] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.56, 25.57.
[xiii] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.56, 25.57.
[xiv] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.56, 25.57.
[xv] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.56, 25.56.
[xvi] https://www.zavamed.com/uk/early-signs-of-genital-warts.html
[xvii] https://www.dermnetnz.org/topics/genital-crohn-disease/
[xviii] https://emedicine.medscape.com/article/1058826-overview
[xix] https://www.healthline.com/health/vestibular-papillomatosis
[xx] https://www.zavamed.com/uk/early-signs-of-genital-warts.html
[xxi] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.58.

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