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genital-warts-treatment

Genital Warts

Genital warts is a sexually transmitted infection widely spread in England. It is caused by HPV (human papilloma virus). The main attribute is small bumps on the skin around genitals which do not cause any pain. Genital warts is not a threat to health. However, they loook extremely unpleasant and can create great enconveniences.

Medication

What are genital warts?

Genital warts are also referred to as condyloma acuminata or venereal warts. Genital warts are one of the most common sexually transmitted dermatological lesions that appear in the genital area due to the human papillomavirus (HPV). They may appear as small, flesh-colored bumps, small and flat lesions or a cluster of several warts that makes a cauliflower like form in both women and men.

In women they will grow on the vulva, in cervix, vaginal walls and anal area. In men, lesions may appear in the gland or tip of penis, the shaft, scrotum or the anus. They may also be found in new born babies in their larynx and throat and mouth in men and women who practiced oral sex with an infected person.

Genital warts have no cure and some strands have a high association with cervical and penile cancers, therefore treating this disease is very important. 

What causes genital warts?

Genital warts are caused by a type of virus called HPV: Human papillomavirus. There are over 100 types of HPV and of these, 35 types are associated with genital warts. HPV types are divided into two categories.  Low risk benign HPV lesions and high risk neoplastic HPV lesions.

Low risk benign HPV lesions: The most common types are HPV 6 and 11. They make up approximately 90% of genital warts and recurrent respiratory papillomatosis (RRP) cases.

RRP is an uncommon disease in which warts will appear throughout the respiratory tract.

High risk neoplastic HPV lesions: HPV 16 and 18 are the most common types that lead to cancer lesions. Recent studies have shown that 70% of vaginal, cervical and penile cancers are caused by these 2 types of HPV. 

How common is it?

According to the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC), 2/3 of sexually active people will get infected. Being a very contagious disease it is mostly found in people in reproductive ages mostly around 17 and 33 years of age. 

How is it transmitted and what are the risk factors?

Being a sexually transmitted disease, it is transmitted through vaginal, anal and oral intercourse. Because it affects different parts of the genital area, condoms do not protect entirely against this disease. Both male and women are equally affected, and it is most common in people in reproductive ages between 17 and 33 years of age. Having unprotected sex with multiple partners or partners whose sexual history is unknown to you are risk factors for becoming infected with this disease. Other risk factors are initiating sexual intercourse at an early age, multiple partners, smoking, use of oral contraceptives, weakened immune system, and children from infected mothers who were infected during childbirth. 

What are the signs and symptoms of genital warts?

Genital warts are usually painless, but they are uncomfortable because of the itching sensation they produce, the size or the location they are in. Some of the symptoms you might feel are:

  • Painless bumps or lesions in vagina, vulva, anus, penis, scrotum, larynx
  • itching
  • vaginal, anal or discharge in penis
  • urinary tract infections
  • bleeding during intercourse
  • vaginal or penile discharge
  • irregular intermenstrual cycles
  • fatigue
  • weight loss
  • loss of appetite
  • Other sexually transmitted diseases

How long does it take for genital warts to appear?

Genital warts may appear days after sexual contact, in other cases it can take some months for them to be present. Other people may get infected with the virus but never get genital warts.

What are the complications?

The most important complication is the association of genital warts with cancer. It is known to cause cervical, vaginal and penile cancer. Cervical cancer is the second most common cancer in women making u over 445,000 cases in the world. Recent studies have shown that up to 270,000 deaths in 2012 can be accounted to cervical cancer. Other complications are:

  • Neoplastic lesions
  • Recurrent genital warts: After being treated, there is a risk of 19% recurrence rate after 3 months and up to 23% after 6 months. There are lesions that hare hidden in genital area that makes the virus reproduce itself again infecting other parts of the body and partners through contact.
  • Aesthetic problems such as disfiguration of the area where the warts are located.
  • Transmission to newborn babies through childbirth

How can genital warts be prevented?

There are over 100 types of this virus, but there are currently 2 vaccines in the market that protect you against the most common types of HPV virus up to more than 50%.

Gardasil 9: protects you against 9 HPV strains. It is recommended n women from 9 to 26 years of age for the prevention of genital warts, precancerous lesions and cervical cancer. In males from 9 to 26 years is used for the prevention of genital warts, precancerous lesions and anal cancer.

Cervarix: Is used to protect you against the high risk neoplastic strains 16 and 18 that are associated with cervical cancer. It is recommended in people from 9 to 26 years of age as prevention for this lesions.

Are there side effects by using the vaccine?

There are mild side effects after using the vaccine such as mild pain in the location of the injection, redness and allergic reaction to the injection, myalgia, fatigue and headaches have been reported. 

Other ways to protect yourself from being infected are:

  • Using barrier preservatives such as condoms when having sexual intercourse. Even though it doesn’t protect you 100% from acquiring the disease, it will protect the parts that cover the condom. The other types of birth control methods such as pills, diaphragms and others will not protect you against genital warts.
  • Know the history of your sexual partners.
  • Be in monogamous relationships
  • Limit the number of your sex partners
  • Do not smoke, abuse alcohol or use drugs
  • Avoid the use of douches: Douches are known to eliminate the normal bacteria in your vagina which protects you against sexually transmitted diseases, therefore douching is not recommended.

It is important to know that following all of these steps will help you be protected against HPV and its complications. All of these tips work together in conjunction to protect you better than just following one. 

How are genital warts diagnosed?

Diagnosis of genital warts are mostly made through physical examination. Your GP through regular checkups will identify the lesions. In other cases, when the warts are inside the vaginal walls or cervix, other types of exams should be made to identify the lesions.

Pap tests: It is important for women in reproductive age to have regular pelvic exams and pap tests. These exams help in the detection of other sexually transmitted diseases and HPV. In this exam a sample of cells from your cervix is taken to later be tested through a microscope to check for abnormalities.

Acetowhitening: There are times the lesions are not able to be seen with the naked eye, therefore if your doctor suspects you may have genital warts, 5% of acetic acid solution will be applied in the area where the lesion is suspected for a few minutes. If the area is infected, it will turn white.

Colposcopy: With this test, your doctor will enhance and magnify the view of your cervix. Warts and precancerous lesions will be able to be observed.

Biopsy: If the lesions have been treated and recurrent genital warts are observed, it is possible to have a biopsy of the tissue to check for abnormalities. 

How are genital warts treated?

If genital warts are left untreated, there is a chance that they will grow in size, increase in number and spread to other locations. Other cases have been seen where the genital warts have spontaneous resolution without any treatment. Genital warts may reappear through time, so medical treatment is always recommended to avoid transmission of the disease to other body parts and to other people.

There are different options for treatment depending on the location and severity of the warts. Here are some of the topic treatments that can be applied directly to your skin. 

Imiquimod: Pododpyhyllin and podofilox Trichloroacetic acid TCA Sinecatechins
Dosage: Imiquimod 3.75%: Topical cream applied in area. Imiquimod 5%: Applied topically 3 times a week no more than 16 weeks until warts disappear. Podophyyllin 25%: applied on skin prior an allergic test for 1-4 hours. Subsequent applications may be necessary TCA 80%: topical liquid applied in area of lesion to treat warts Topical ointment 15%: Apply topically every 8 hours for no more than 16 weeks or until warts are no longr visible.
Side effects: Allergic reaction in site of application, erythema, headache, burning sensation, bleeding, stinging, pain, eczema, edema, flaking, erosion, vomiting, dizziness, fever, alopecia Severe scarring, Paraphimosis in men. Urticaria, paresthesia, fever, thrombocytopenia, polyneuritis, coma, paralytic ileus. Severe burning, erythema, irritation, inflammation, tenderness of skin. Erythema, edema, pain, discharge, bleeding, scarring, vsicular rash, ulceration, burning sensation, discomfort, desquamation, decoloration, hyperesthesia, eczema.
Cautions: Avoid exposure to area with sunlight. IT is unknown if pregnant women can use it, therefore not recommended. Only to be applied by a doctor. It is not recommended during pregnancy. Only to be applied by a physician. Caution is advised during pregnancy and lactation. Not to be used for urethral, intravaginal, cervical, intra-anal or rectal warts. Sexual contact should be avoided while ointment is on skin. Caution is adviced during pregnancy.

What happens if genital warts treatment fails?

There are other options that can be considered if the treatment failed or there is a recurrence of the disease. Visible warts can be also removed through other techniques that dermatologist can do.

Ablative therapy:

Cryotherapy: Nitrogen liquid is used to freeze the warts on your skin. It is highly effective and has few adverse reactions such as swelling, erosion and ulceration. It is safe to use during pregnancy.

Electrodesiccation and curettage: A sharp curettage is used to remove the warts and then an electric current is used to eliminate and dissect the lesion.

Surgical excision: Depending on the size of the lesion anesthesia is used to eliminate and remove the warts from your skin. This is one of the most effective techniques and has very little wart recurrence.

Carbon dioxide laser treatment: It is used by physicians and requires anesthesia depending on the size of the lesion. It uses a laser to remove the warts. It is highly effective but recurrence has been observed.

Infrared coagulation: a beam of light is used to treat the warts on your skin. It is highly effective but can leave some scarring. 

What should you do if you are pregnant and have genital warts?

If you’re pregnant and suffer from genital warts, it is important for you to visit a GP or a OB/GYN to treat your disease. There are many treatments that can’t be used because there aren’t enough tests available to see if they can or will affect you or your baby. Over the counter medicines should be taken with precaution and a doctor will give you the best treatment for you.

If you leave your genital warts untreated, it can bring serious complications to your child. It may get infected through childbirth and acquire recurrent respiratory papillomatosis. Warts will appear in its air way and can grow to sizes that will block the airway and not allow it to breath correctly that can lead to death. 

What is the long term outcome of genital warts?

Genital warts that are visible may be removed and never reappear. There are chances that if your immune system is not strong enough to fight the virus it may stay dormant and you will suffer genital warts in many occasions throughout your life time. If you still have the virus in your body you may still infect yourself in other parts of your body and others. Therefore, it is advised to take the medication as prescribed and visit a doctor to give you the best medicine that will suit you.

Sources:

  • https://emedicine.medscape.com/article/763014-medication
  • https://www.healthline.com/health/std/genital-warts#outlook
  • https://www.nhs.uk/conditions/genital-warts/#genital-warts-and-cancer
  • https://www.emedicinehealth.com/genital_warts/article_em.htm#what_is_the_outlook_for_a_person_with_genital_warts_hpv
  • https://www.medicalnewstoday.com/articles/155236.php
  • https://www.aad.org/public/diseases/contagious-skin-diseases/genital-warts#treatment
  • https://www.womenshealth.gov/a-z-topics/genital-warts
  • https://www.cdc.gov/std/treatment/2010/genital-warts.htm
  • http://www.who.int/immunization/topics/hpv/en/
  • http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/000721/human_med_000694.jsp&mid=WC0b01ac058001d124