Vulvar and vaginal warts are one of the clinical manifestations of human papillomavirus (HPV) infection (picture 1A-C). Approximately 90 percent of anogenital warts are associated with HPV types 6 and/or 11, which are of low oncogenic potential [1-3]. Additional HPV types (including high oncogenic risk types) may be identified, but usually as co-infections with HPV 6 or 11.
For most patients, the presence of genital warts is concerning because of their cosmetic appearance, association with a sexually transmitted disease, bothersome symptoms, absence of a cure, and social stigma . Although treatment can eradicate the warts, disease recurrence is common and occurs in 20 to 30 percent of patients overall.
This topic will discuss treatment of vulvar and vaginal warts in women. The epidemiology, pathophysiology, clinical manifestations, and diagnosis of anogenital warts, and issues related to men with anogenital infection, are reviewed separately. (See "Condylomata acuminata (anogenital warts) in adults".)
Patients should be given an explanation of their disease and information about the indications for treatment, treatment options, and prognosis. Written material is available from several sources (see 'Information for patients' below).
Information about human papillomavirus infection — Most women want to know how and when they acquired the disease. We tell them that genital human papillomavirus (HPV) is spread by direct physical contact during sex. They may have acquired the infection years prior to diagnosis since the incubation period can last for months and their first recognition of a lesion may represent a relapse rather than a first episode. Therefore, a new diagnosis of genital warts does not mean that the patient or her partner is having sex outside the relationship. We also inform them that condoms provide some protection against HPV transmission, but contact with genital lesions not covered by the condom can result in infection .