Veneral Warts

BRIEF OVERVIEW

The human papilloma virus (HPV) is responsible for causing genital warts in the anus and genital area. More than 80 different specific types of HPV DNA have been identified. 45 of these can affect  genital skin. The incidence of HPV infection has risen over the past three decades. An estimated 30 to 50% of sexually active adults in the United States are infected with HPV, making it the most common viral STD. However, only one to two percent of the same population has clinically apparent warts. The treatment for HPV can be difficult. Destructive means such as liquid nitrogen is most popular. Other new therapies, including Aldara™ Cream, which is an immunomodulator, or Condylox™ gel, have been useful in the treatment of resistant lesions. In areas that are extremely resistant to treatment, Dr. Harvey and Dr. Hardy may sometimes ablate the warts with a carbon dioxide laser. As genital warts can cause  one to develop carcinoma of the cervix or penis, it is important that Dr. Harvey and Dr. Hardy examine infected patients and their partners for non healing lesions. If one has both a non healing lesion on the genitals and a personal history of venereal warts, then  it is important that this non healing lesion be biopsied to rule out malignancy.
 
COMMONLY ASKED QUESTIONS ABOUT VENEREAL WARTS

What are the signs that one has contracted HPV?

Warts are clinically apparent as flesh colored papules that erupt on the skin of the genital or  perianal area. They can range in size from 1 mm in diameter to very large growths. One-third of women with external venereal warts also have internal vaginal and/or rectal warts, and, thus, need a gynecologic exam. Venereal warts usually do not have any symptoms, but can occasionally they can bleed or cause pain.

How contagious is the HPV virus?

Little is known about the transmission of HPV.  Risk factors for acquiring the virus include numerous sexual partners, frequent sexual intercourse, and the presence of warts in a co infected sexual partner. Men have been found to have an increased risk developing venereal warts if they fail to wear condoms. Although condoms reduce the transmission of HPV, their use it does not eliminate it completely.

Is HPV curable?

Unfortunately, total eradication of this virus is not possible.  Approximately 10 to 30% of  venereal warts spontaneously resolve within three months. Removal of viral lesions, in theory, should reduce the likelihood of viral transmission, but this has not been proven scientifically.

How are genital warts treated?

As mentioned above, treatment can be a difficult process. The most effective treatment modalities include liquid nitrogen which causes inflammation and the body to control and sequester the wart virus. Other therapeutic modalities include: surgical excision, laser treatment or acid. The choice of treatment utilized should be decided by  Dr. Harvey and Dr. Hardy and the patient because there are several factors such as number and size of lesions which come into play. The newest treatment option for HPV is a drug called Imiquimod (Aldara^™). Imiquimod is formulated as a topical cream preparation. It is designed to stimulate one's immune system by stimulating the chemical protein known as interferon alpha, which has a negative effect on HPV. Initial studies have shown that this treatment is effective in 30% to 50% of patients. Imiquimod has been found to work better in women than in men. Please remember that many treatments are sometimes necessary for HPV control and that recurrence rate is high. Hopefully, in the near future we shall, see an effective cure. Currently, there is active research going on using an HPV vaccine.

What can one expect during HPV treatment?

Many of the modalities discussed above do cause temporary discomfort, i.e., redness, blistering, pain, can be seen. Recurrences occur most frequently during the first three months after therapy has been initiated. As previously mentioned, infected women, should have a full pelvic and cervical examination, because they have an increased risk of carcinoma of the cervix. Men should be examined for dysplasia (precancer or cancer) of the penis. Transmission of HPV during pregnancy may occur in infants who can, if mom has active disease during delivery, can acquire HPV virus in their throat and genital area without a previous history of sexual abuse.

Should you contact past partners?

Yes, because of the slight increased risk of cancer which can occur in both females and males. Examination of previous partners is advised by Dr. Harvey and Dr. Hardy. Education is the only way to reduce the risk of spreading HPV to other people. Because the HPV virus can lie dormant for many years, there is no way to know which sex partner gave you the infection. It is, therefore, sometimes difficult to try to blame a particular partner for giving you the infection.

Dr. Harvey and Dr. Hardy may recommend:

• Tagamet^™ as directed for warts at a dosing of 40mg/kg body weight. Topical treatment may be carried out after being on this medication for 4 weeks.

• Beta Carotene as directed by Dr. Harvey and Dr. Hardy

• Avoid manipulating (e.g. picking) your venereal wart sin order to minimize the risk of spreading the wart virus.

• Aldara^™  Cream-Apply as directed every other day to the wart

• Surgical destruction with the carbon dioxide laser

• Bleomycin injections

• Canthacur PS^™  as directed to warts. Do not break the blister that will form in 5-24 hours. Treat the blister with topical antibiotic salves to promote healing.

• Podophyllin Resin Treatment as directed.

• Condylox^™ Treatment as directed 

• Retin A Cream^™  or Tazarac Gel^™  Applications

• Refrain from sexual activity until three negative check ups are performed by Dr. Harvey and Dr. Hardy

• An OB/GYN Evaluation or Pap Smear to look for atypical cells

• Avoid aspirin or Advil^™  for one week before and 3 days after your scheduled treatment for warts

• Call our office if fever, chills or persistent pain develops after wart treatment

• Tylenol^™  or other analgesics as prescribed by Dr. Harvey and Dr. Hardy

• Regular follow up visits with Dr. Harvey and Dr. Hardy every two to four weeks to optimize your chances for wart eradication

If you have any questions, or wish to schedule a consultation, please call  Ponte Vedra Dermatology & Aesthetic Surgery at (904) 285-7546 or email consultation@pvderm.com.