Salicylic acid genital wart

Contents

Creams, Gels, and Ointments

Options for gels, creams, and ointments are imiquimod cream, podofilox gel, and sinecatechins ointment.

Imiquimod is a cream you apply yourself to external warts to boost your immune system. You apply imiquimod 5% cream at bedtime, 3 times a week for 16 weeks. You apply imiquimod 3.75% cream every night. With either strength, you should wash the treated area with soap and water 6 to 10 hours after you put it on. You should also avoid sex while imiquimod is on your skin because it can weaken condoms and diaphragms.

Podofilox and podophyllin resin are gels designed to kill the warts. After they are applied to the external wart, the area needs to air dry before coming in contact with clothing. Podofilox isn’t recommended for warts on the cervix, vagina, or anal canal. It’s also not meant for larger areas. If you use too much or don’t let it air dry, you could spread the gel to other areas and cause irritation to skin areas.

Sinecatechins ointment is made from green tea extract. Sinecatechins 15% ointment is applied to warts 3 times a day for up to 16 weeks. You should avoid all sexual contact while the ointment is on your skin.

If the warts are in a moist area, or in a spot where skin rubs together, talk to your doctor before using a topical medicine.

If you’re pregnant, you should avoid these medications.

HPV Treatment: Warts, Genital Warts, Cervical Dysplasia

There is no cure for HPV, but treatments are available for the symptoms caused by the virus.

Cryotherapy can be used in a medical office to remove skin and genital warts. Evgeniy Kalinovskiy/Alamy

Of the more than 150 types of HPV (human papillomavirus), at least 40 can infect the anal or genital area, according to the Centers for Disease Control and Prevention (CDC).

Most of these infections never cause any symptoms and go away on their own, with no treatment, the CDC notes. (1)

But if an infection persists, some types of HPV can cause genital warts, and others can cause a variety of types of cancer, including cervical cancer and oropharyngeal cancer — cancer on the back and sides of the throat, tonsils, and base of the tongue.

Other types of HPV can cause common, nongenital skin warts on other areas of the body.

Treatment for HPV depends on the specific issue or symptoms caused by the virus. There is currently no medical way to rid your body of HPV once you have it.

How Genital Warts Are Treated

Genital warts — which are usually caused by HPV types 6 and 11 — can appear throughout the genital area, as well as inside the anus, vagina, or urethral opening, and on the cervix.

There are a few patient-applied and doctor-applied medicines for external genital warts. At home, you can apply:

  • Imiquimod cream, an immune enhancer that stimulates the production of interferons and other immune system substances
  • Podofilox solution or gel, which stops cell division and causes wart tissue to die
  • Sinecatechins, a type of green-tea extract

To treat your external genital warts, your doctor may administer:

  • Podophyllin resin (similar to podofilox), which stops cell growth
  • Trichloroacetic acid, which chemically burns off warts
  • Bichloroacetic acid, which does the same

Aside from these, your doctor may try cryotherapy (freezing the wart) or various surgical treatments (excision, electrosurgery, laser therapy) to treat your external warts.

For internal genital warts, treatment may involve cryotherapy with liquid nitrogen, surgical removal, trichloroacetic acid, or bichloroacetic acid.

Treatment for Precancerous Cervical Changes

In women, some types of HPV can cause the growth of precancerous cells on the surface of the cervix — known as cervical dysplasia — which can lead to cervical cancer.

Nearly all cases of cervical cancer are caused by HPV, with 70 percent of cervical cancer cases resulting from HPV types 16 and 18, according to the CDC.

Getting regular Pap or HPV tests raises the likelihood of catching cervical dysplasia early, and removing precancerous growths can help prevent cervical cancer from developing.

Severe cervical dysplasia is treated with one of several types of surgical procedures, including:

  • Cryosurgery
  • Laser therapy
  • Cold knife conization (or cold knife cone biopsy), in which a cone-shaped piece of abnormal cervical tissue is removed with a scalpel or laser knife
  • Electrosurgery

If cervical dysplasia has progressed to cervical cancer, a woman may be advised to have a hysterectomy (removal of the uterus), or to undergo radiation therapy, chemotherapy, or both.

RELATED: Cervical Cancer Treatment

Treating HPV-Related Cancers in Other Parts of the Body

In addition to causing cervical cancer, HPV can cause several other types of cancer:

  • Anal cancer
  • Oropharyngeal cancer
  • Penile cancer
  • Vaginal cancer
  • Vulvar cancer

At present, there are no established screening guidelines for HPV-related cancers other than cervical cancer, so typically these cancers are found only when they cause symptoms, and treatment is based on the stage of the cancer when it is detected.

Home Remedies for Common Skin Warts

Common skin warts frequently go away on their own without any treatment, especially in children. But it can take two to three years for a wart to go away, so many people opt to treat them.

Home remedies and over-the-counter products for warts are generally safe for people in good health, but if you have diabetes, loss of sensation in your feet, or poor circulation to your feet, do not attempt to treat foot warts on your own. See a doctor for treatment.

One way to treat warts at home is with a topical, over-the-counter product that contains salicylic acid. For best results, soak the wart area in warm water for 10 to 20 minutes, then use a disposable emery board to remove the layers of dead skin before applying the salicylic acid. Repeat the soaking and skin removal steps between each treatment. (2)

A similar approach is to do the soaking and sanding steps, then cover the wart with a small piece of duct tape. Remove and replace the duct tape every five or six days, repeating the soaking and sanding step each time you replace the tape.

Over-the-counter cryotherapy products, which freeze the warts to break down the abnormal tissue, are also available but can be painful to use. They are also not as effective as the cryotherapy treatment a doctor can deliver.

RELATED: 11 Tips to Protect Your Feet and Legs if You Have Diabetes

Medical Treatment for Skin Warts

If you choose to see a physician for treatment of warts, you may receive one of the following:

  • Cryotherapy
  • Cantharidin, a chemical that causes a blister to form under the wart
  • Electrosurgery or LEEP (loop electrosurgical excision procedure) — which burns warts off with an electric current — combined with curettage, a technique that involves scraping off the wart with a sharp knife or spoon-shaped tool
  • Excision (cutting out the wart)

If these treatments are ineffective, your doctor may opt for more potent treatments, such as laser treatment, chemical peels, or injections of bleomycin, an anti-cancer medication. (3)

Immunotherapy may be an option for warts that are resistant to all other forms of treatment.

This type of treatment may involve shots of a natural virus-fighting protein called interferon, which can help give your immune system a boost.

How to Prevent Common Skin Warts

HPV is ubiquitous, meaning it’s found everywhere, so it may be impossible to prevent all warts. (4) But you can lower your risk by following these common-sense suggestions:

  • Don’t bite your nails or pick at hangnails.
  • Don’t scratch or pick at existing warts.
  • Don’t touch other people’s warts.
  • Don’t share razors, towels, socks, or shoes with other people.
  • Wear flip-flops or shower sandals in public showers, locker rooms, and around swimming pools to avoid getting plantar warts.
  • If you have a plantar wart, wear slippers or shoes around the house to avoid spreading them to others.
  • Keep any warts on your feet dry, as moisture encourages them to spread. (5)

Additional reporting by Ingrid Strauch.

Warts

Wart treatment

Often warts disappear on their own, although it may take many months or even years for the warts to go away. But some warts won’t go away on their own. Doctors are not sure why some warts disappear and others do not.

Do warts on the skin need to be treated?

Generally, yes. Common warts are often bothersome. They can bleed and cause pain when they’re bumped. They can also be embarrassing, for example, if they grow on your face. Treatment may decrease the chance that the warts will be spread to other areas of your body or to other people.

How are warts on the skin removed?

First of all, it’s important to know that warts on the skin (such as on the fingers, feet, and knees) and warts on the genitals are removed in different ways. Don’t try any home remedies or over-the-counter drugs to remove warts on the genital area. You could hurt your genital area by putting certain chemicals on it. You also shouldn’t treat warts on your face without talking to your doctor first. The following are some ways to remove common warts from the skin. Talk to your doctor about which treatment is right for you.

  • Applying salicylic acid. You can treat warts on places such as the hands, feet, or knees by putting salicylic acid (one brand name: Compound W) on the warts. To get good results, you must apply the acid every day for many weeks. After you take a bath or shower, pat your skin dry lightly with a towel. Then put salicylic acid on your warts. The acid sinks in deeper and works better when it is applied to damp skin. Before you take a shower or a bath the next day, use an emery board or pumice stone to file away the dead surface of the warts.
  • Applying cantharidin. Your doctor may use cantharidin on your warts. With this treatment, the doctor “paints” the chemical onto the wart. Most people don’t feel any pain when the chemical is applied to the wart. You’ll experience some pain and blistering of the wart in about 3 to 8 hours. After treatment with cantharidin, your doctor will place a bandage over the wart. You can remove the bandage after 24 hours. With mixtures of cantharidin and other chemicals, you can remove the bandage after only 2 hours. When you see your doctor again, he or she will remove the dead skin of the wart. If the wart isn’t gone after one treatment, your doctor may suggest another treatment.
  • Applying liquid nitrogen. Your doctor may use liquid nitrogen to freeze the wart. This treatment is called cryotherapy or cryosurgery. Applying liquid nitrogen to the wart causes a little discomfort. To completely remove a wart, liquid nitrogen treatments may be needed every 1 to 3 weeks for a total of 2 to 4 times. If no improvement is noted, your doctor may recommend another type of treatment.
  • Other treatments for warts on the skin.Your doctor can also remove warts on the skin by burning the wart, cutting out the wart, or removing the wart with a laser. These treatments are effective, but they may leave a scar. They are normally reserved for warts that have not cleared up with other treatments.

How does cryosurgery work?

Cryosurgery is a 2-step process that removes the wart without hurting the skin around it. The first step is getting your wart ready to be removed. You can help with this step. The second step is freezing the wart, which will be done by your doctor in his or her office. You may need to have several freezing treatments before the wart is completely removed.

What do I need to do to prepare the wart for cryosurgery?

You must do some things on your own at home to get the wart ready for removal. Doing these things before you come to your doctor’s office can reduce the number of freezing treatments you need. You should do the following:

  1. Every night for 2 weeks, clean the wart with soap and water and put 17% salicylic acid gel on it.
  2. After putting on the gel, cover the wart with a piece of 40% salicylic acid pad (one brand name: Mediplast). Cut the pad so that it is a little bit bigger than the wart. The pad has a sticky backing that will help it stay on the wart.
  3. Leave the pad on the wart for 24 hours. If the area becomes very sore or red, stop using the gel and pad and call your doctor’s office.
  4. After you take the pad off, clean the area with soap and water, put more gel on the wart and put on another pad. If you are very active during the day and the pad moves off the wart, you can leave the area uncovered during the day and only wear the pad at night.

What happens next?

After 2 weeks of this treatment, your wart will have turned white and will look fluffy. Your doctor will then be able to remove the white skin layer covering the wart and use cryosurgery to freeze the base (root) of the wart. If your skin reacts strongly to cold, tell your doctor before cryosurgery.

Cryosurgery can be uncomfortable, but it usually isn’t too painful. The freezing is somewhat numbing. When your doctor places the instrument on your skin to freeze the wart, it will feel like an ice cube is stuck to your skin. Afterward, you may feel a burning sensation as your skin thaws out.

Healing after cryosurgery usually doesn’t take long. You will probably be able to enjoy all your usual activities while you heal, including bathing or showering. Cryosurgery leaves little or no scar. After the area has healed, the treated skin may be a bit lighter in color than the skin around it.

How are warts in the genital area treated?

Genital warts must be treated by your doctor. Warts in the genital area can be removed, but there’s no cure for the viral infection that causes the warts. This means that the warts may come back even after they have been removed.

Can Duct Tape Get Rid of Warts?

Warts, also known as common warts, are small bumps on your skin that are caused by a virus. They’re most common in children and young adults. Warts usually go away without treatment, but they can take several years to fully go away. However, some people might want to get rid of their warts faster.

Duct tape is a popular home remedy for warts, but it isn’t a good idea for everyone. Keep reading to find out if you should use duct tape to get rid of a wart.

How to use duct tape to get rid of warts

To use this remedy:

  1. Apply a small piece of duct tape directly to the area of your wart and go about your day.
  2. Once every three to six days, remove the duct tape and rub the wart with an emery board or pumice stone. You may also consider soaking the wart in warm water while it’s exposed.
  3. Replace the duct tape with a new piece after 10 to 12 hours of air exposure.

This process is called “duct tape occlusion,” and it should remove the wart, layer by layer. It may take several weeks for this method to fully get rid of a wart.

Some doctors recommend using salicylic acid as an over-the-counter topical treatment for warts. You can find a wart removal treatment that contains salicylic acid at nearly any drugstore. Using a treatment like this in addition to duct tape could help your wart go away faster.

Why does duct tape get rid of warts?

Warts are a virus within the body. They can reoccur. Unlike other treatments, duct tape doesn’t seek to treat the underlying virus that causes the wart or to identify the “root” of the wart. Instead, covering a wart with duct tape prevents the virus from spreading further by stopping the wart from contacting other parts of your skin.

Duct tape is made of three layers: a strong, stretchy layer that resembles a fabric; a mesh layer; and an adhesive chemical layer. The combination of strength in the upper layers and chemical adhesion in the bottom layer might be a clue to what makes duct tape work to treat warts.

The duct tape adheres to the top layer of the wart. When you tear the tape off, a layer of the wart will often come off with it. This may be less painful than remedies like freezing. Additionally, it uses fewer chemicals than over-the-counter oral treatments and is more cost-effective than laser treatment.

There is research that seems to demonstrate that duct tape works better for wart treatment than other methods, such as freezing. But there’s also conflicting research that concludes treating a wart with duct tape is no better than a placebo treatment. One study claims that duct tape is 80 percent effective for speeding up the rate at which warts go away. But almost every study that looked into the science of this treatment has had a relatively small sample size.

More clinical research is needed to discover if, and why, duct tape works to get rid of warts.

What to know before you use this method

Avoid using duct tape on a wart that is:

  • near your genitals
  • under your armpits
  • close to one of your mucous membranes (inside your nose or mouth)

Plantar warts, which occur on your heels or other parts of your feet, may be more resistant to these treatments because the layers of skin on your feet tend to be more difficult to remove.

If you have genital warts, you should be examined by a doctor. Human papilloma virus (HPV), which causes topical and genital warts, can be transmitted sexually. Women with certain strains of HPV may be more at risk for cervical cancer. Since men and women can spread genital warts sexually, you should be tested to see what strain of HPV you have before you try any home treatments for your warts.

Duct tape can cause redness, bleeding, rashes, and pain upon removal. If you have sensitive skin, this method is not a good choice.

Talk to your doctor before trying home remedies if your warts:

  • are painful
  • interfere with your daily activities
  • crack and bleed

These are symptoms of other types of skin growths.

The bottom line

Using duct tape to treat warts won’t work for everyone. And the data that we have about treating warts with duct tape is still inconclusive, but it’s probably a low-risk approach. Other approaches such as topical salicylic acid and freezing (cryotherapy) might be a better choice. If you try this remedy without success, remember that most warts will eventually go away without treatment. See a dermatologist if you’re concerned about a wart’s appearance or if you have warts that keep coming back.

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What Are Warts?

Warts are tiny skin infections caused by viruses of the human papillomavirus (HPV) family. Although kids get warts most often, teens and adults can get them too. Sometimes warts are sexually transmitted and appear in the genital area. But most warts affect the fingers, hands, and feet.

What Are the Kinds of Warts?

Types of warts include:

Common warts. Usually found on fingers, hands, knees, and elbows, a common wart is a small, hard bump that’s dome-shaped and usually grayish-brown. It has a rough surface that may look like the head of a cauliflower, with black dots inside.

Flat warts. These are about the size of a pinhead, are smoother than other kinds of warts, and have flat tops. Flat warts may be pink, light brown, or yellow. Most flat warts are on the face, but they can grow anywhere and can appear in clusters.

Plantar warts. Found on the bottom of the foot, plantar warts can be very uncomfortable. You might feel like you’re walking on a small stone.

Filiform warts. These have a finger-like shape, are usually flesh-colored, and often grow on or around the mouth, eyes, or nose.

What Causes Warts?

HPV viruses that cause warts can be passed from person to person by close physical contact or from touching something that a person with a wart touches, like a towel, bathmat, or a shower floor.

How Long Before Symptoms Appear?

The length of time between when someone is exposed to an HPV

and a wart appears varies. But warts can grow very slowly and may take many months to develop.

How Long Do Warts Last?

Warts are different in different people. In time, many warts disappear on their own.

With treatment, warts can usually be removed within a few weeks, but they may come back if the virus causing them stays in the skin.

How Are Warts Treated?

Warts can be treated in various ways:

  • Over-the-counter medicines contain acids that are applied to the wart. The acids are peeling agents that remove the dead skin cells of the wart and cause the wart to eventually fall off. OTC treatments shouldn’t be used on the face or genitals without consulting a doctor first as some of them may damage the skin.
  • Cryosurgery (pronounced: kry-o-SUR-juh-ree) is where a doctor freezes the wart with liquid nitrogen. This treatment is usually done in the doctor’s office.
  • Laser surgery may be used for warts that are hard to remove.

Within a few days after treatment by a doctor, a small wart will usually fall off, although you may need more than one treatment. Treatment may take longer for larger warts.

Over-the-counter treatments may take longer than the doctor’s office treatments, but can be used as initial treatment on the hands or feet. Your doctor may also tell you to use OTC treatments after you’ve had an in-office procedure.

You might also have heard that you can use duct tape to remove a wart. Talk to your doctor about whether this type of home treatment is OK for you.

What Can I Do to Feel Better?

Most warts can handled at home:

  • Soak the wart in warm water, and then remove dead skin on the surface of the wart with an emery board (that’s never going to be used for nails) before applying the medicine. Be careful not to file into the normal skin around the wart.
  • Keep the area of the wart covered while the medicine works.
  • Don’t rub, scratch, or pick at the wart. Doing so could spread the virus to another part of your body or cause the wart to become infected.
  • Don’t share towels or other personal items with others.

Can I Prevent Warts?

Not all warts can be prevented. But it’s always a good idea to wash your skin regularly and well. If you cut or scratch your skin, be sure to use soap and water because open wounds are more at risk for warts and other infections.

It’s also a good idea to wear waterproof sandals or flip-flops in public showers, locker rooms, and around public pools (this also can help protect against other infections, like athlete’s foot).

If you do have a wart, don’t rub, scratch, or pick at it or you may spread the virus to another part of your body or cause the wart to become infected.

When Should I Call a Doctor?

Although many warts disappear on their own with time, it’s a good idea to show your wart to a doctor, who can recommend a treatment method if you need one.

If you discover a wart on your face or on your genital area, call your doctor. He or she can determine the best treatment for those areas, which are very sensitive.

Also call the doctor if a wart or the skin around it is:

  • painful
  • red
  • bleeding
  • swollen
  • oozing pus

Reviewed by: Larissa Hirsch, MD Date reviewed: February 2019

On this page:

  • What are warts?
  • Transmission
  • Types of warts:
    • Common warts
    • Plantar warts
    • Flat warts
    • Genital warts
  • Self-care
  • Medical treatment
  • Prevention
  • For more information

What are warts? Warts are benign skin growths caused by the human papilloma virus (HPV). The virus, which is acquired through cracks in the skin, causes a thickening of the outer layer of skin. Warts affect 7-10% of the population, and young people are more commonly affected. Most warts are not worrisome, medically speaking, and are primarily of cosmetic concern except when causing discomfort, particularly on the bottom of the feet.

Transmission: Warts are transmitted by direct contact or indirect contact (e.g., public showers or swimming pool areas). They can be transmitted to one’s self or others. Picking or scratching at warts can increase the risk of transmission. Trauma may play a role in the development of warts as they often occur at pressure points, for example, on the bottom of the foot.

Types of warts: Each type of wart is caused by a slightly different virus and treatment may vary. The common forms include the following:

Common warts (verruca vulgaris) are flesh-colored, small raised spots on the skin with a rough surface. The size of the wart varies and may appear anywhere on the skin, particularly on the elbows, knees, hands, fingers and around the nails. The black dots found in these warts, often called seeds, are superficial blood vessels and not actual seeds.

Plantar warts (verruca plataris) are no different than common warts except that their location on the bottom of the foot may result in a flat appearance from being pressed into the foot by the weight of the person. Plantar warts may occur singly or in a pattern, grouped closely together. They may cause pain, redness and swelling. See Images on Wikipedia.

Flat warts(verruca plana) have a smaller, smoother surface than common warts. They may appear in great numbers on the face and may also occur elsewhere, particularly on the arms and legs.

Genital warts (condylomata accuminata) may be small or large. When large, they may have a cauliflower-like appearance. They grow on warm, moist surfaces such as the genital and rectal areas. They are usually, but not always, sexually transmitted. Do not treat genital warts yourself; medical treatment is necessary. These warts are commonly treated with weekly applications of podophyllin, liquid nitrogen or other agents, which may be irritating to the skin. Genital warts are common, contagious and may be difficult to eradicate. See also:

  • Images on Wikipedia
  • Pap Tests and HPV
  • HPV and Vaccination

Self-care: You can treat warts, except genital warts, without visiting a doctor. Apply salicylic acid liquid or plasters (available without prescription) according to package directions. If using liquid, cover the wart with a waterproof adhesive tape like duct tape or white athletic tape. After 2-3 days, soak the area in warm water, then scrape away the dead gray/white skin with a pumice stone or metal nail file. Repeat until the wart has disappeared.

Duct tape alone as an occlusive dressing has been effective at resolving warts. See article on “Duct Tape More Effective than Cryotherapy for Warts” in the American Family Physician Journal.

If the wart does not completely disappear, see a clinician for medical treatment.

Medical treatment: Warts often disappear spontaneously over several years. If warts are painful, subject to infection or cosmetically objectionable, they should be treated. Treatment depends on the size, location and number of warts as well as the activities of the infected person. Warts may be very difficult to cure; often multiple treatments are needed, and even then treatment success cannot be guaranteed. Types of treatment include the following:

Cryotherapy (liquid nitrogen) is used on many warts at UHS. First, any dead skin surrounding the wart may be scraped off. Next, liquid nitrogen is applied, producing an uncomfortable blister within two days of treatment. Many warts require more than one treatment with the second treatment being performed 2-4 weeks after the first.

Electrodessication (electrocautery) is usually used only after warts have not responded to other procedures. It consists of burning the wart with a high frequency current, followed by scraping the surface. It should be used cautiously as it may occasionally cause scarring. This process is rarely used at UHS.

Salicylic acid is often used for plantar warts. A 40% salicylic acid plaster is cut to the size and shape of the wart and covered with an occlusive tape (e.g., duct tape). Alternatively, a 17-20% liquid may be applied. After 24 hours, the wart is pared down. This is repeated every day if the area is not too irritated. This method may be used at UHS. Salicylic acid is also available without prescription; follow package directions and do not use on genital areas.

Prevention:

Remove warts that are present.

Do not pick at warts to avoid spreading them.

Wear footwear in public showers and other public areas to avoid plantar warts.

Use condoms for intercourse. Condoms reduce but do not eliminate the risk of HPV transmission.

For more information:

At UHS:

  • Schedule an Appointment: Appointments are required for most medical services, however options are available for urgent concerns.

  • Nurse Advice by Phone is available day and night, which may save a trip to UHS, the ER or an urgent care facility.

Molluscum Contagiosum and Warts

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Like MC, warts result from infection with a double-stranded DNA virus trophic to human skin. In the case of warts, the agent responsible is human papillomavirus (HPV), of which there are more than 150 serotypes.11 Some are known to cause cervical cancer, but common warts that affect nongenital skin are not thought to have malignant potential. With the exception of cervical lesions, determining the serotype of a wart is not clinically useful. Some physicians use the serotype of cervical lesions to determine how aggressively they evaluate and treat the patient.

The most useful information is gleaned from clinical appearance and the area of the body that is affected. Trained clinicians usually can diagnose warts based solely on their typical appearances in different locations.12 Non-genital warts are subcategorized into common, periungual, flat, filiform, and plantar types.

DIAGNOSIS

Common Warts

Common warts (verrucae vulgaris) are irregularly surfaced, domed lesions that can occur almost anywhere on the body (Figure 3). Multiple warts are common and are spread by skin-to-skin contact or contact with a contaminated surface. After initial infection, warts frequently are spread by autoinoculation from scratching, shaving, or other skin trauma.

FIGURE 3.

Common wart.

FIGURE 3.

Common wart.

On exposed skin, these warts tend to be hard and, if not affected by mechanical forces, develop the typical carpet-like (verrucous) surface (Figure 4). On areas that receive frequent friction, such as the hands, the firm, nodular aspect predominates (Figure 5). On areas that are moist or occluded, warts tend to be softer and more polypoid.

FIGURE 4.

Verrucous wart.

FIGURE 4.

Verrucous wart.

FIGURE 5.

Small nodular wart on the hand.

FIGURE 5.

Small nodular wart on the hand.

Periungual Warts

Periungual warts occur at the nail margins (Figure 6). As with other warts on the hands and feet, they often show peeling and roughening of the surface and tend to be somewhat abraded although not as much as palmar warts. They can affect the shape of the nail by undermining its side and pushing the nail up or causing partial detachment, sometimes mimicking the changes that occur with onychomycosis (Figure 7). Occasionally, when the wart affects the nail matrix or when destruction of the wart injures the nail matrix, permanent nail deformity can result.

FIGURE 6.

Periungual warts.

FIGURE 6.

Periungual warts.

FIGURE 7.

Periungual wart affecting toenail.

FIGURE 7.

Periungual wart affecting toenail.

Flat Warts

Flat warts (verrucae planus) are smooth, flat-topped variants of common warts that are 2 to 4 mm in diameter. They most often occur on the face and extremities of children and on the lower legs of women, where they may be spread by shaving11(Figure 8).

FIGURE 8.

Flat warts on the face of a child.

FIGURE 8.

Flat warts on the face of a child.

Filiform Warts

Filiform warts have frond-like projections that often rapidly grow. They are common on the face (Figure 9).

FIGURE 9.

Filiform wart on the face.

FIGURE 9.

Filiform wart on the face.

Plantar Warts

Plantar warts occur on the plantar surface of the foot (Figure 10). Because of the forces exerted on the foot, plantar warts tend to become callused and grow into the foot instead of rising above the plantar surface. They often occur in multiples, are firm, and can be very painful. Patients may feel as if they are walking with a pebble in their shoe. Plantar warts can be differentiated from a corn or callus by paring down the surface (Figure 11). A wart has the typical punctate pattern of multiple pinpoint blood vessels (Figure 12). Warts also do not retain the normal fingerprint lines of the hands and feet, as calluses and corns do.

FIGURE 10.

Plantar wart on the heel.

FIGURE 10.

Plantar wart on the heel.

FIGURE 11.

Paring of plantar wart.

FIGURE 11.

Paring of plantar wart.

FIGURE 12.

Punctate pattern of plantar wart after paring.

FIGURE 12.

Punctate pattern of plantar wart after paring.

Mosaic plantar warts present with a tile-like pattern (Figure 13) that has been described as a confluence of multiple warts.11 The pattern has been attributed to the natural cylindrical projections (which can be seen in cross section) that wart tissue forms.13

FIGURE 13.

Mosaic plantar wart.

FIGURE 13.

Mosaic plantar wart.

TREATMENT

Treatment options for warts include mechanical destruction and adjustment of the patient’s immune system through medications, and observation. The most commonly employed treatments involve destroying the affected tissue by freezing, burning, curetting (usually with electrodesiccation), or applying topical acids. Chemotherapeutics are sometimes used in refractory or severe cases (Table 1). A review of the placebo arms of 17 treatment trials showed an average spontaneous regression rate of 30 percent at an average of 10 weeks.14 Six trials using salicylic acid averaged a 75 percent cure rate, and two trials comparing cryotherapy and salicylic acid found no difference in success rates.14

TABLE 1

Methods of Destroying Warts

Acids

Over-the-counter salicylic acids (e.g., Compound W, DuoFilm liquid or patches)

Bi- or trichloroacetic acid

Freezing

Liquid nitrogen freeze via spray gun or cotton-tipped applicator at −196 C (−320.8 F)16

Cryogun with nitrous oxide tank freeze at −89 C (−128.2 F)16

Aerosol spray with adapter freeze (e.g., Verruca-Freeze) at −70 C (−94 F)16

Burning

Electrocautery, LEEP, laser

Chemotherapy

Bleomycin (Blenoxane)

LEEP = loop electrosurgical excision procedure Information from reference16.

TABLE 1

Acids

Over-the-counter salicylic acids (e.g., Compound W, DuoFilm liquid or patches)

Bi- or trichloroacetic acid

Freezing

Liquid nitrogen freeze via spray gun or cotton-tipped applicator at −196 C (−320.8 F)16

Cryogun with nitrous oxide tank freeze at −89 C (−128.2 F)16

Aerosol spray with adapter freeze (e.g., Verruca-Freeze) at −70 C (−94 F)16

Burning

Electrocautery, LEEP, laser

Chemotherapy

Bleomycin (Blenoxane)

LEEP = loop electrosurgical excision procedure Information from reference16.

All treatments are hampered by wart persistence and recurrence. Warts are only an outward symptom of an underlying infection; topical treatments do not eradicate HPV but merely hold it at bay.15

Acids

Many patients treat warts themselves with over-the-counter salicylic acid preparations. Advantages of these acids include convenience, reasonable cost, minimal discomfort, and reasonable effectiveness. Disadvantages include the length of time before results are seen (usually weeks to months) and complex instructions. Patients have to soak the wart in water for five to 10 minutes before each application (daily for liquids, every 48 hours for patches), then debride the dead skin after each application.

Bi- and trichloroacetic acids are applied in the physician’s office on a weekly basis, usually after paring down the wart. Although this usually is a painless and effective procedure, these more potent acids have a greater potential to significantly burn surrounding skin.

Acids are well suited for use in children (as long as they don’t put the affected area in their mouths) and are appropriate for plantar warts and warts on sensitive body parts where cryotherapy would be more painful.

Freezing

The different methods of freezing warts are presented in Table 1. One advantage of a nitrous oxide cryogun versus a liquid nitrogen gun is its ability to adhere the probe to the skin and elevate the lesion to avoid damage to underlying structures, such as veins, nerves, or tendons (Figure 14). Liquid nitrogen at −196°C (−320.8°F) and nitrous oxide at −89°C (−128.2°F) exceed the temperature required for complete tissue destruction (−50°C ), but liquid nitrogen produces a faster freeze.16 A reasonable option for the low-volume practitioner is Verruca-Freeze, a liquid applied from a spray can, at −70°C (−94°F).

FIGURE 14.

Freezing a wart with nitrous oxide cryogun.

FIGURE 14.

Freezing a wart with nitrous oxide cryogun.

The wart is frozen until it and 1 to 2 mm of surrounding skin have turned white (Figure 15). A repeat freeze after thawing causes more effective tissue destruction than a single freeze. The affected tissue turns red or blisters over the next one to two days, then gradually sloughs off over the following weeks. The dead tissue also may generate an immune system reaction to help resolve additional warts. Freezing is time-efficient and works well for most warts. In plantar warts, the discomfort and blistering after freezing can temporarily limit mobility.

FIGURE 15.

Liquid nitrogen cryospray with 1 to 2-mm margins of freeze.

FIGURE 15.

Liquid nitrogen cryospray with 1 to 2-mm margins of freeze.

Burning

Burning and surgical removal are usually reserved for resistant warts. Appropriate anesthetic measures are necessary because of the associated pain. Treatment can be accomplished in a single visit and is effective, but as with all destructive methods, not guaranteed. A disadvantage is prolonged recovery time from an often large and deep skin defect. Full-thickness excision and suturing are not warranted and can produce additional scarring and complications. Filiform warts are easily shaved or snipped off with an iris scissors (Figure 16). Light electrocautery of the base provides hemostasis and destruction of the residual wart.

FIGURE 16.

Shaving of filiform wart.

FIGURE 16.

Shaving of filiform wart.

Chemotherapy

Chemotherapy with bleomycin (Blenoxane) injection causes acute tissue necrosis. As with cryotherapy, the tissue left behind may stimulate an immune response. Disadvantages are the pain of injection and the expense of the drug. Bleomycin is a sterile powder that is reconstituted with saline. It is stable for only 24 hours after mixing, so it cannot be saved for dosing multiple patients on different days. Chemotherapy may be useful at a designated wart clinic, where several patients can be treated from the same vial of bleomycin in a single day. It is commonly used for plantar warts.

Immunotherapy

HPV infection does not disappear once the gross lesions are destroyed. Cell-mediated immunity is required to keep the infection in check, as demonstrated by the high prevalence of warts among immunosuppressed organ-transplant recipients and patients with acquired immunodeficiency syndrome.17,18 Several treatment methods for warts are directed toward enhancing the immune response that suppresses HPV infection (Table 2).

TABLE 2

Immune-Modulating Methods of Wart Treatment

Injected agents

Candida antigen

Mumps antigen

Interferon alfa-2b (Intron A) and interferon alfa-N3 (Alferon N)*

Topical agents

Imiquimod (Aldara)

Systemic agents

Cimetidine (Tagamet)

*— Interferon alfa-2b and interferon alfa-N3 are used in the treatment of genital warts.

TABLE 2

Injected agents

Candida antigen

Mumps antigen

Interferon alfa-2b (Intron A) and interferon alfa-N3 (Alferon N)*

Topical agents

Imiquimod (Aldara)

Systemic agents

Cimetidine (Tagamet)

*— Interferon alfa-2b and interferon alfa-N3 are used in the treatment of genital warts.

Most people have been exposed to Candida and will mount an immune response. Candida antigen (0.1 mL of 1:1,000 solution, as is used for dermal testing) is mixed with 0.9 mL of 1-percent lidocaine (Xylocaine) and injected into the base of the wart (Figure 17). The wart is then stabbed repeatedly with the needle. Although uncomfortable, this procedure induces an immune response and brings about resolution of the wart in many cases.

FIGURE 17.

Candida antigen injection of plantar wart.

FIGURE 17.

Candida antigen injection of plantar wart.

In a small study19 using mumps or Candida injection, 74 percent of participants had resolution of the injected wart and, of those with resolution, 78 percent also had resolution of all of their noninjected warts. Candida antigen is available in a multi-dose vial that can be saved with refrigeration, so the cost is not prohibitive. Candida antigen can be used on most verrucae, particularly plantar warts.

Cimetidine (Tagamet) is known to stimulate T-lymphocyte populations, which are important in controlling viral infections. At a dosage of 30 to 40 mg per kg per day, it has been tried with varying success in the treatment of warts. A small trial20 in children found cimetidine to be as effective as the usual topical agents or cryotherapy. Another trial21 combining cimetidine with levamisole (an immunomodulator used in the treatment of colon cancer) reported cure rates of 85.7 percent versus 45.5 percent with cimetidine alone. However, in a more recent double-blind study,22 cimetidine was not found to be significantly more effective than placebo in adults or children, although there was a trend toward efficacy in younger patients. Cimetidine or watchful waiting could be considered for use in children who cannot tolerate destructive treatment methods.

The immunomodulating agents interferon alfa-2b (Intron A), interferon alfa-N3 (Alferon N), and imiquimod are approved for genital HPV. In addition to case reports, one study23 of 50 patients showed a 56 percent clearance rate with imiquimod. Imiquimod is more rapidly being adopted into clinical practice because of its easy application. It may be useful in non-genital HPV, but more study is needed.9

Topical application of sensitizing agents such as diphenylcyclopropenone, dinitrochlorobenzene, and squaric acid causes an allergic contact reaction that has been used for treatment of warts, but these chemicals are not commonly stocked by family physicians.

Top things to know

  • Genital warts can present in many shapes and sizes—from large lumpy plaques, to small singular bumps
  • Even if genital warts are not visible, it does not mean a person doesn’t have them. Some warts may be internal (like within the vagina or anus), while other people may carry the virus without showing symptoms
  • Two strains of the human papillomavirus—HPV 6 and HPV 11—are responsible for most cases of genital warts
  • Treatments include at-home topical medications or removal by a healthcare provider

What are genital warts?

Genital warts are a sexually transmitted infection (STI) caused by certain strains of the human papillomavirus (HPV). HPV is a very common virus with over 100 strains (5). Some strains can cause cancerous changes, while others cause no physical symptoms and resolve themselves (4,19).

Two strains of HPV in particular—HPV 6 and HPV 11—are responsible for about 9 out of 10 cases of genital warts (8,9).

Genital warts may also be known by other names such as genitoanal warts, anogenital warts, or condylomata acuminata.

What are the symptoms of genital warts?

Not everyone who has been infected with these strains of HPV will have genital warts. Often people who carry the strains have no symptoms (5). For those who do have symptoms, genital warts come in many shapes, sizes, and presentations.

Appearance

Genital warts can be small, large, singular, or in clumps.

Warts are usually non-pigmented (meaning that they are the same color as the surrounding skin), but sometimes can present in many different colors, such as pink to red to brown, grey, and white (14).

They often appear in groups of 5–15 warts which are 1–5 mm (0.04–0.2 in) each in diameter (14). They may resemble cauliflower, and are often found on moist areas around the genitals and anus, or inside the vagina and the cervix (14,7). Other types of genital warts look more like regular warts (a bump with thickened skin) and are usually on dry skin. Other genital warts appear smooth and flat, and some are difficult to even see (7).

Sensation

Genital warts do not usually cause pain or discomfort. Sometimes they can be itchy, bleed, or make sex painful (14).

Location

Genital warts can be both external or internal. External genital warts appear on people of all genders, such as on the vulva, labia, pubis, glans clitoris, entrance to the urethra, perineum (the area between the genitals and the anus), penis, scrotum, and around the entrance to the anus (7,8,14). If someone suspects that they have genital warts, using a handheld mirror can be helpful to check difficult to see areas.

Other times genital warts can also be present inside of the body, such as in the vagina, the cervix, the inner side of the labia, and inside of the anal canal (7,8,14).

How are genital warts spread?

If a person develops genital warts, this doesn’t necessarily mean that they got them from their most recent partner. It can take months or even years from contracting HPV until wart symptoms actually present (8).

HPV is spread through contact with infected skin and mucous membranes (the soft moist skin present at the openings of your genitals and mouth). This means that warts are usually spread through sex, including penis-in-vagina sex, anal sex, genital-to-genital contact, and oral sex. Genital warts are highly contagious, so even without penetrative sex, HPV can be spread from one person to another (5).

Even if a person does not have any visible genital warts, this does not necessarily mean that they are wart-free (8). People infected can still spread the virus even without any warts present.

How common are genital warts?

HPV is the most common sexually transmitted infection in the United States (6,2) and the world (5).

HPV is extremely common—in the United States, most sexually active people will get at least one strain of HPV during their lifetime (11).

Since genital warts are not considered a reportable disease to the Centers for Disease Control (CDC) it is difficult to estimate how many people actually have genital warts across the United States.

How can I prevent genital warts?

Using a barrier device (like a condom or a dental dam) can help prevent the spread of genital warts. However, if someone’s warts are outside of where the condom covers (like on the scrotum or base of the penis) and skin contact occurs, genital warts can be spread to the partner. Even when no genital warts are present, HPV can still be present on the skin and spread during sexual contact.

Vaccination

There are currently vaccinations available that protect against certain strains of HPV that cause cervical cancer (like HPV 16 and 18). One type also protects against HPV 6 and 11, which cause most cases of genital warts. These vaccinations are becoming more common and are recommended for adolescents and young adults (5,18). These vaccines do not treat existing HPV infections, and are most protective when administered before becoming sexually active. Speak to your healthcare provider to learn if an HPV vaccination is right for you.

How are genital warts diagnosed?

Genital warts are usually diagnosed by visual inspection during a pelvic exam (8). Sometimes a healthcare provider may take a biopsy (a small sample of the wart) and send it off to the lab for confirmation (8).

If diagnosed, it is important to get current sexual partners also assessed by a healthcare practitioner, as well as to notify previous sexual partners, from at least the last 6 months (14).

Being diagnosed with genital warts, like being diagnosed with any STI, can have negative psychological effects. Having genital warts can lead to feelings of anxiety, depression, and feelings of decreased quality of life, especially around the time of first diagnosis (13).

How are genital warts treated?

The goals of treatment for genital warts are to remove the wart(s) and reduce any symptoms (8). The type of treatment for warts depends on many factors, including size, shape, location, cost, and the preferences of the patient and healthcare provider (8).

Do not use over the counter wart treatment products. These are designed for different types of warts on thicker-skinned areas (like the soles of the feet) and should not be used on the genitals, which are much more sensitive.

Self-applied treatments

Some people are prescribed topical medications that are applied on the warts for a specified period of time (usually weeks or months). This type of treatment comes with instructions and follow-up visits to the healthcare provider (8).

Healthcare provider treatments

In some cases, healthcare providers need to apply treatment themselves in a clinical setting. These treatments can include cryotherapy (freezing warts with liquid nitrogen), electrocautery (heat generated through electricity), laser removal, surgical removal, or application of chemical therapy (8).

Sometimes genital warts may reappear after they have already been treated—this is common within the first 3 months (8). While treatment for warts is not a cure, given enough time, a healthy body will usually resolve the infection on its own.

Sometimes genital warts go away on their own when left untreated, while other times they stay the same, or even increase in number and size. There is no “one size fits all” treatment.

Special cases and additional information

Cancer

When DNA from human papillomavirus is measured from samples of genital warts, sometimes more than one type of HPV shows up. About a third of HPV strains found from genital wart biopsies can also contain high-risk, cancer-causing HPV strains (12).

This is why it is important to always get diagnosis and treatment from a professional, especially if the warts are bleeding, very firm or hard to the touch, or sores (14). If left untreated, these high risk strains can cause cancer of the vulva, anus, or penis (14).

Smoking

People who smoke cigarettes are more likely to have, or acquire, genital warts (16). Smoking cigarettes is also associated with a recurrence of genital warts (16).

Immunosuppression

People who are a lowered immune system (like with HIV, diabetes, or undergoing immunosuppressive therapy) may be more likely to contract and develop genital warts, and additionally may be harder to treat (14,8).

Remember, not all bumps on the genitals are due to genital warts. Some small bumps are normal body variations, while other can be caused by skin infections, or by STIs such as genital herpes. When in doubt, talk to a healthcare provider.

to track protected and unprotected sex.

HPV and Genital Warts

What are genital warts?

Warts are never welcome, but finding them on your genitals is particularly disagreeable. Genital warts (also called venereal warts) are flesh-colored, pink, or grayish-white growths that appear on the genital and anal areas of the body.

Like all warts, they’re caused by a type of human papilloma virus (HPV). Skin-to-skin contact during sexual activity is what allows them to spread, and spread they have. An estimated 20 million Americans have the HPV virus that causes the warts today, with some 6.2 million of us contracting it each year. To put it another way, at least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives, according to the Centers for Disease Control and Prevention.

What is HPV?

Human papilloma virus is a virus with more than 100 different types, which are responsible for conditions that range from the relatively harmless and common plantar warts found on the soles of the feet to the more worrisome genital warts. (One type of HPV causes warts on the hands and feet; another kind produces them in the genital region.) Some types of genital HPV don’t cause warts at all, while others have been linked to cervical cancer.

What are the symptoms of genital warts?

Most people who who are infected with HPV do not know it. Sometimes women will notice painless flesh-colored or grayish growths on the vulva (the outer, visible part of the female genitals), inside the vagina, or around the anus. A man might notice them on the tip or shaft of the penis. These growths, which might be itchy or mildly sore, can increase in size and develop a cauliflower-like appearance.

Other possible symptoms include mild irritation, burning, itching, or pain around the genitals or anus; increased or foul-smelling vaginal discharge or vaginal bleeding; or pain accompanying intercourse.

Often the virus will remain in the skin or mucous membrane and never produce warts. And if it does, there’s a very good chance you won’t notice them, especially if they’re hidden inside the vagina, on the cervix, or inside the urethra (the tube that carries urine from the bladder out of your body). The warts may also be small and flat, so that they’re not easily noticed even if they’re on the outside of the body.

If genital warts are left untreated, they may disappear on their own within six months. The HPV virus will still be in your system, however, so the warts could reappear later.

How is HPV diagnosed?

Most women are diagnosed with HPV after they receive an abnormal Pap test, the cancer-screening test women receive during their annual gynecological exams. Many pre-cancerous changes to the cervix are related to HPV, although it is still very rare that HPV will cause cancer. Another test, called the HPV DNA, is available to test for HPV in women and can help health care providers decide if further tests or treatment is necessary. No HPV tests are currently available for men.

Can genital warts cause cancer?

The warts themselves are benign and don’t cause cancer. But some types of the HPV virus (whether they give rise to warts or not) are major risk factors for cervical cancer. This is one reason it’s so important for women to get Pap tests as part of their regular gynecological exams.

According to the Centers for Disease Control, cancers of the penis, vulva, vagina, and anal area are linked to certain types of the HPV virus as well.

What are my treatment options?

Currently, there is no treatment to cure HPV. There are very good treatments, however, for the problems HPV can cause, like genital warts and cervical cell changes.

Genital warts can be removed, which may help reduce discomfort, although experts disagree about the value of removing warts. In 20 to 30 percent of cases, external genital warts will disappear by themselves if left alone, a fact that leads some doctors to recommend a “wait and see” approach. Other physicians, however, advise that the warts be removed immediately. Although this isn’t certain, some researchers believe that the HPV virus may spread to sexual partners more readily if genital warts are visible. Warts may be removed in a clinic or doctor’s office through cryotherapy (freezing off the warts with liquid nitrogen), electrocautery (burning them off with an electrical current), chemicals, lasers or knives. Some procedures may require a local anesthetic. Patients have reported that the acid is excruciatingly painful when applied to anal warts, so review all the options with your doctor. Most chemical methods of wart removal aren’t approved for pregnant women.

Your doctor might also want to remove the less common internal warts (in the vagina, on the cervix, inside the anus, or in the man’s urethra).

Depending on the size and location of your warts, your doctor may recommend imiquimod, a cream you apply at home. Imiquimod enhances your immune system, helping your body rid itself of the warts and delaying or even preventing their recurrence.

It is very important that you not try to get rid of genital warts by using over-the-counter medicines that are meant to be used on the types of warts found on the hands and feet. They’re too harsh for the genital area.

How effective is the treatment for genital warts?

If the warts are going to reappear, they’ll usually do so within the first three months after treatment. In 70 to 80 percent of cases, there’s no recurrence within the first six months. Remember, though, that the HPV virus will remain in your body. As with other sexually transmitted diseases, your partner must be treated as well, since an infected partner can easily spread genital warts to you.

How can I keep from getting HPV and genital warts?

Getting regular PAP tests will help detect problems if they occur. And in June 2006, the US Food and Drug Administration approved the first vaccine (HPV4) developed to prevent cervical cancer, genital warts, and other diseases related to genital human papillomavirus (HPV). In June, 2009, the FDA licensed a second vaccine, HPV2. The vaccines protect against certain types of HPV that are responsible for 70 percent of cervical cancers. Only HPV4 protects against 90 percent of genital warts. The Advisory Committee on Immunization Practices recommends the vaccine for all girls between the ages of 11 to 12-years-old, and for females between the ages of 13 to 26-years-old who have not been vaccinated. These vaccines are administered in 3 doses with the final dose given a minimum of 24 weeks after the initial dose. The U.S. Centers for Disease Control and Prevention advises using safe sex and PAP tests in addition to the vaccine since it does not work for all HPV types. Some critics of the vaccine, including Norwegian physician Dr. Charlotte Haug, have also noted that cervical cancer is extremely rare in developed countries and that it can almost always be prevented through regular PAP screenings.

If you’re not in a monogamous relationship, be sure you don’t have unprotected sex; condoms can help prevent the spread of genital warts. But since warts can occur on parts of the genital and anal areas that condoms don’t cover, the virus can be still be spread through sexual contact. If you’re considering a new sexual partner, both of you should be tested for sexually transmitted diseases before having sex, according to federal health agencies.

FDA Licensure of Bivalent Human Papillomavirus Caccine (HPV2, Cervarix) for Use in Females and Updated HPV Vaccination Recommendations from the Advisory Committee on Immunizaiton Practices (ACIP). Morbidity and Mortality Weekly Report (MMWR). Centers for Disease Control and Prevention. May 28, 2010

American Social Health Association. HPV: Get the Facts. 2001.

Kwasniewska A, et al. Dietary factors in women with dysplasia colli uteri associated with human papillomavirus infection. Nutr Cancer 1998;30(1):39-45

National Institute of Allergy and Infectious Diseases Fact Sheet. Human Papillomavirus and Genital Warts. March 2001.

Moore RA, et al. Imiquimod for the treatment of genital warts: a quantitative systematic review. BMC Infect Dis 2001;1(1):3.

Centers for Disease Control. HPV and HPV Vaccine Information for Healthcare Providers. August 2006.

Centers for Disease Control. Genital HPV Infection. April 2008.

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