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| {{DiseaseDisorder infobox |
| | '''Windows Home Server''' is a "server for the home" solution by Microsoft Inc. The core operating system is [[Windows Server 2003]] SBS, and the Dashboard and an embedded website has been added to it. |
| Name = Genital wart|
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| Image = SOA-Condylomata-acuminata-around-anus.jpg|
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| Caption = Severe case of genital warts around the anus|
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| ICD10 = {{ICD10|A|63|0|a|50}} |
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| ICD9 = {{ICD9|078.11}} |
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| ICDO = |
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| OMIM = |
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| DiseasesDB = 29120 |
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| MedlinePlus = |
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| eMedicineSubj = derm |
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| eMedicineTopic = 454 |
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| eMedicine_mult = {{eMedicine2|med|1037}} |
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| MeshName = Genital+Warts |
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| MeshNumber = C02.256.650.810.217 |
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| }}
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| '''Genital warts''' (or '''[[Condyloma]] acuminata''', '''venereal warts''', '''anal warts''' and '''anogenital warts''') is a highly contagious [[sexually transmitted disease]] caused by some sub-types of [[human papillomavirus]] (HPV). It is spread through direct skin-to-skin contact during [[oral sex|oral]], [[genital]], or [[anal sex]] with an infected partner. [[Warts]] are the most easily recognized symptom of genital HPV infection. They can be caused by strains 6, 11, 30, 42, 43, 44, 45, 51, 52 and 54 of HPV; types 6 and 11 are responsible for 90% of genital warts cases.<ref name=eMed_1037>{{eMedicine|med|1037}}</ref> Less than 1% of those infected develop clinically obvious warts, but those infected can still transmit the virus,<ref name=CurrentManagement>{{cite journal |author=O'Mahony C |title=Genital warts: current and future management options |journal=Am J Clin Dermatol |volume=6 |issue=4 |pages=239–43 |year=2005 |pmid=16060711 |doi= |url=}}</ref> although another source states that 70% of those who have sexual contact with an infected partner develop genital warts.<ref name=OpenAccess2006/>{{Dubious|date=September 2009|probability of warts from infected partner}} Other types of HPV also cause [[cervical cancer]] and probably most [[anal cancer]]s.
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| ==Signs and symptoms==
| | Users can log on remotely, can have personal file shares on the server, and can post images to the web using the embedded web site function (Remote Access) |
| Genital warts often occur in clusters and can be very tiny or can spread into large masses in the genital or penis area. In other cases they look like small stalks. In women they occur on the outside and inside of the [[vagina]], on the opening ([[cervix]]) to the womb ([[uterus]]), or around (or inside) the [[anus]]. They are approximately as prevalent in men but the symptoms may be less obvious. When present, they usually are seen on the tip of the [[penis]]. They also may be found on the shaft of the penis, on the [[scrotum]], or around (or inside) the [[anus]]. Rarely, genital warts also can develop in the mouth or throat of a person who has had oral sex with an infected person.
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| The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years (decades) may occur. HPV can last for several years without a symptom.<ref>{{cite web |url=http://www.cancer.org/docroot/CRI/content/CRI_2_2_2x_Can_Anal_Cancer_Be_Prevented.asp?sitearea=|title=American Cancer Society: "Can Anal Cancer Be Prevented?"|accessdate=2008-09-10}}</ref> Having sex with a partner whose HPV infection is latent and demonstrates no outward symptoms still leaves one vulnerable to becoming infected. If an individual has unprotected sex with an infected partner, there is a 70% chance that he or she will also become infected. The [[immune system]] eventually clears the virus through [[interleukin]]s, which recruit [[interferon]]s, which slow viral replication.<ref name=ModernManagement/>
| | Along with the launch of Windows Home Server, a book was released for publicity, "Mommy, Why is There a Server in the House?" |
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| <gallery>
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| Image:SOA-Condylomata-acuminata-female.jpg|Severe case of genital warts on a female
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| Image:SOA-Condylomata-acuminata-man.jpg|Severe case of genital warts on a male
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| </gallery>
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| ==Vaccines==
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| {{Seealso | HPV vaccine}}
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| [[Gardasil]] (sold by [[Merck & Co.]]) is a [[vaccine]] that protects against [[human papillomavirus]] types 16, 18, 6, and 11. Types 6 and 11 cause genital warts, while 16 and 18 cause [[cervical cancer]]. The vaccine is preventive, not therapeutic, and must be given before exposure to the virus type to be effective, ideally before the beginning of sexual activity. The vaccine is widely approved for use by young women, it is being tested for young men,<ref name="Bloomberg">[http://www.bloomberg.com/apps/news?pid=20601202&sid=aajzweDaXZh0&refer=healthcare Cortez, Michelle Fay and Pettypiece, Shannon. "Merck Cancer Shot Cuts Genital Warts, Lesions in Men". ''Bloomberg News''. (Bloomberg.com) 13 Nov 2008.]</ref><ref> [http://www.webmd.com/sexual-conditions/hpv-genital-warts/news/20081113/hpv-vaccine-gardasil-may-help-boys-men HPV Vaccine Gardasil May Help Boys, Men] by WebMD Health News, Nov 13, 2008</ref> and has been approved for males in some areas, such as the UK.
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| ==Management==
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| There is no cure for HPV, but there are methods to treat visible warts, which could reduce infectivity, although there are no trials studying the effectiveness of removing visible warts in reducing transmission.<ref name=FamilyManagement/> Genital warts may disappear without treatment, but sometimes eventually develop a fleshy, small raised growth. There is no way to predict whether they will grow or disappear. Warts can sometimes be identified because they show up as white when [[acetic acid]] is applied, but this method is not recommended on the vulva because microtrauma and inflammation can also show up as acetowhite.<ref name=ModernManagement/> Magnifying glasses or colposcope may also be used to aid in identifying small warts.<ref name=ModernManagement/>
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| Depending on the sizes and locations of warts (as well as other factors), a doctor will offer one of several ways to treat them. Podofilox is the first-line treatment due to its low cost.<ref>{{cite journal |author=Fox PA, Tung MY |title=Human papillomavirus: burden of illness and treatment cost considerations |journal=Am J Clin Dermatol |volume=6 |issue=6 |pages=365–81 |year=2005 |pmid=16343025 |doi= |url=}}</ref> Almost all treatments can potentially cause depigmentation or scarring.<ref name=FamilyManagement>{{cite journal |author=Kodner CM, Nasraty S |title=Management of genital warts |journal=Am Fam Physician |volume=70 |issue=12 |pages=2335–42 |year=2004 |month=December |pmid=15617297 |doi= |url=http://www.aafp.org/afp/20041215/2335.html}}</ref>
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| * A 0.15% – 0.5% [[podophyllotoxin]] (also called podofilox) solution in a gel or cream. Marketed as Condylox (0.5%), Wartec (0.15%) and Warticon (0.15%),<ref name=AbandonPodophyllin/> it can be applied by the patient to the affected area and is not washed off. It is the purified and standardized active ingredient of the podophyllin (see below). Podofilox is safer and more effective than podophyllin.<ref name=AbandonPodophyllin/> Skin erosion and pain are more commonly reported than with imiquimod and sinecatechins.<ref name=GreenTea/> Its use is cycled (2 times per day for 3 days then 4–7 days off); one review states that it should only be used for four cycles.<ref name=OpenAccess2006/>
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| * [[Imiquimod]] (Aldara) is a topical immune response cream, applied to the affected area. It causes less local irritation than podofilox but may cause fungal infections (11% in package insert) and flu-like symptoms (less than 5% disclosed in package insert).<ref name=GreenTea/>
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| *Sinecatechins (marked as Veregen and Polyphenon E) is an ointment of catechins (55% [[epigallocatechin gallate]]<ref name=ModernManagement/>) extracted from [[green tea]] and other components. Mode of action is undetermined.<ref>{{cite web | url=http://www.veregenrx.com/IL331%20Veregen%20PI%20170mm_x_420mm.pdf|format=PDF|title=Veragen package insert|accessdate=2008-08-18}}</ref> It appears to have higher clearance rates than podofilox and imiquimod and causes less local irritation, but clearance takes around longer than imiquimod and sinecatechins.<ref name=GreenTea>{{cite journal |author=Meltzer SM, Monk BJ, Tewari KS |title=Green tea catechins for treatment of external genital warts |journal=Am. J. Obstet. Gynecol. |volume=200 |issue=3 |pages=233.e1–7 |year=2009 |month=March |pmid=19019336 |doi=10.1016/j.ajog.2008.07.064 |url=}}</ref>
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| * [[Liquid nitrogen]] [[cryosurgery]] is safe for pregnancy. It kills warts 71–79% of the time, but recurrence is 38% to 73% 6 months after treatment.<ref name=ModernManagement/> Local infections have been reported.<ref name=ModernManagement/>
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| * [[Trichloroacetic acid]] (TCA) is less effective than [[cryosurgery]],<ref name=OpenAccess2006/> and is not recommended for use in the vagina, cervix, or urinary meatus.<ref name=ModernManagement/>
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| * Surgical excision is best for large warts, and has a greater risk of scarring.<ref name=FamilyManagement/>
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| * Laser [[ablation]] does not seem to be any more effective than other physician-applied methods,<ref name=CurrentManagement/> but is often used as a last resort and is extremely expensive.<ref name=ModernManagement/>
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| * A 20% [[podophyllin]] anti-[[mitosis|mitotic]] solution , applied to the affected area and later washed off. However, this crude herbal extract is not recommended for use on vagina, urethra, perianal area, or cervix,<ref name=ModernManagement/> and must be applied by a physician.<ref name=AbandonPodophyllin>{{cite journal |author=von Krogh G, Longstaff E |title=Podophyllin office therapy against condyloma should be abandoned |journal=Sex Transm Infect |volume=77 |issue=6 |pages=409–12 |year=2001 |month=December |pmid=11714936 |pmc=1744412 |doi=10.1136/sti.77.6.409 |url=http://sti.bmj.com/cgi/content/full/77/6/409}}</ref> Reported reactions include nausea, vomiting, fever, confusion, coma, renal failure, ileus, and leukopenia; death has been reported with extensive topical application, or application on mucous membranes.<ref name=ModernManagement/>
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| * [[Interferon]] can be used; it is effective, but it is also expensive and its effect is inconsistent.<ref name=OpenAccess2006/>
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| * [[Electrocauterization]] can be used; it is an older procedure but recovery time is generally longer. In severe cases of genital warts,treatment may require general or spinal anesthesia. This is a surgical procedure. More effective than [[cryosurgery]] and recurrence is at a much lower rate.
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| ;Discontinued:
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| * A 5% 5-[[fluorouracil]] (5-FU) cream was used, but it is no longer considered an acceptable treatment due to the side-effects.<ref name=ModernManagement>{{cite journal |author=Mayeaux EJ, Dunton C |title=Modern management of external genital warts |journal=J Low Genit Tract Dis |volume=12 |issue=3 |pages=185–92 |year=2008 |month=July |pmid=18596459 |doi=10.1097/LGT.0b013e31815dd4b4 |url=}}</ref>
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| Podophyllin and podofilox should not be used during [[pregnancy]], as they are absorbed by the skin and could cause [[birth defect]]s in the [[fetus]].
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| ==Epidemiology==
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| Genital HPV infections have an estimated prevalence in the US of 10–20% and clinical manifestations in 1% of the sexually active adult population.<ref name=OpenAccess2006/> Incidence of HPV infection has increased between 1975 and 2006.{{where|date=September 2009}}<ref name=OpenAccess2006/> About 80% of those infected are between the ages of 17–33.<ref name=OpenAccess2006/> Although treatments can remove the warts, they do not remove the HPV, so warts can recur after treatment (about 50–73% of the time<ref name=CDC2004>CDC. (2004). [http://www.cdc.gov/std/HPV/2004HPV%20report.pdf REPORT TO CONGRESS: Prevention of Genital Human Papillomavirus Infection].</ref>), and also spontaneously regress.<ref name=OpenAccess2006/> Traditional theories postulated that the virus remained in the body for a lifetime. However, new studies using sensitive DNA techniques have shown that through immunological response the virus can either be cleared or suppressed to levels below what [[polymerase chain reaction]] (PCR) tests can measure. One study testing genital skin for subclinical HPV using PCR found a prevalence of 10%.<ref name=OpenAccess2006>{{cite journal |author=Scheinfeld N, Lehman DS |title=An evidence-based review of medical and surgical treatments of genital warts |journal=Dermatol. Online J. |volume=12 |issue=3 |pages=5 |year=2006 |pmid=16638419 |doi= |url=http://dermatology.cdlib.org/123/reviews/warts/scheinfeld.html}}</ref>
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| == See also ==
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| * [[List of cutaneous conditions]]
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| ==References==
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| {{Reflist}}
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| ==External links==
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| * The ''SexInfo'' website run by students at the [[University of California at Santa Barbara]] has articles on both [http://www.soc.ucsb.edu/sexinfo/article/anal-warts Anal Warts] and [http://www.soc.ucsb.edu/sexinfo/article/genital-warts Genital Warts]
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| * [http://search.dmoz.org/cgi-bin/search?search=Genital+warts Genital warts] at the [[Open Directory Project]]
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| * [http://www.cdc.gov/std/hpv/default.htm HPV information from the US CDC]
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| * [http://www.cdc.gov/std/HPV/2004HPV%20Report.pdf CDC Report to Congress]
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| * [http://dermatology.cdlib.org/123/reviews/warts/scheinfeld.html An evidence-based review of medical and surgical treatments of genital warts.] Noah Scheinfeld and Daniel S Lehman. [[Dermatology Online Journal]] (2006) 12 (3): 5.
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| <!--spacing, please do not remove-->
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| {{STD/STI}}
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| {{Viral diseases}}
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| {{Human papillomavirus}}
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| {{DEFAULTSORT:Genital Wart}}
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| [[Category:Infections with a predominantly sexual mode of transmission]]
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| [[Category:Papillomavirus]]
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| [[Category:Viral diseases]]
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| [[Category:Virus-related cutaneous conditions]]
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