Genital Warts
Appearance
and Cause:
Genital
warts, caused by the Human Papilloma Virus (HPV), occur around the anus and on
the penis, vagina, vulva, cervix and rarely orally. Genital warts are
increasingly common and affect as many as one-third of young women in Canada.
These warts, spread by sexual contact, are often flat, tiny and difficult to
spot and diagnose. There are approximately sixty different strains of HPV and
there is mounting evidence that certain strains of the virus are linked to the
development of cervical cancer. At the present time there is no simple, cost
effective way to differentiate between viral types, therefore all must be
carefully followed even though there are three or four viral thought to be the
most problematic.
Detection:
Most
visible warts are detected by your doctor during routine physical examination
of the genital organs. Physicians may use the "vinegar test" for hard
to visualize warts in which they put mild acetic acid (vinegar) on the penis of
men or the cervix and genital areas of women and observe these areas with a
magnifying glass.
Sexual
partners may also notice the warts. In women, HPV infection of the cervix is
detected by the pap test. For this reason all sexually active women are advised
to have an annual pap smear and gynaecological exam from age 15 to 40 and then
every two to three years until age 60, when women can ask their physician how
often they need testing. Because of the link to cervical cancer the frequency
of pap smears is increased to two to three times per year if HPV effect is
detected on a pap smear.
Removal
of warts is recommended as this is when large amounts of the virus is present
and the virus is highly contagious at this time. Removal of the warts is
thought to reduce the virus load, diminish viral shedding, lessen infectivity
and possible stimulate the immune defences. However, it is often not possible
to remove every virus particle and attempts to do this are not usually
indicated. The development of genital warts may well be the result of a
longstanding latent infection of the virus. HPV DNA can remain
"dormant" in the genital skin for decades and for some unknown
reason, activate at a later date and produce visible warts. So it is highly
possible that in a long-term sexual partnership, one of the partners was a
carrier of HPV that was contracted many years ago, before the current
relationship; then, the virus activated and was transmitted between the two
partners.
Prevention:
To
prevent the spread of genital wart, experts suggest that "safer sex"
be practised and in particular, that condoms be worn for at least several
months after wart removal. Although not fool proof in stopping viral spread,
they may reduce the chance of infecting sex partners. "Safer sex"
includes inquiring about the type of sexual practice and history of previous
STD's of your sexual partner. Avoid having sex with an infected partner or
multiple partners. Condoms are recommended in all cases when you are having
sex. Remember, monogamy still remains the safest way………
Treatment:
There
is no single universal treatment for genital warts and a combination approach
often works best. Your physician will decide on the best treatment based on
your history and clinical symptoms. Some of the common treatment options
include:
Cryotherapy
or freezing, using liquid nitrogen to remove the warts. Multiple freezing
sessions may be needed and there is occasionally some local discomfort although
the genital area generally heals easily and quickly.
Trichloroacetic
acid treatment may help to remove genital warts. Like liquid nitrogen, multiple
treatments may be needed and local discomfort can occur.
Podophyllin,
a natural extract of plants such as the Wild Flower May Apple, arrests cell
division and is used in a 25-50% solution. Petroleum jelly is put onto the
surrounding skin to protect it from the solution, which is precisely painted
onto the wart once a week, left on 2-6 hours, then washed off. As treatment
proceeds, the solution may be left on for progressively longer periods as directed
by your physician, but some blistering may occur and occasionally swelling or
inflammation. Podophyllin should not be used in pregnant women because it
affects fetal development, nor should it be put on the vagina because it can be
absorbed into the blood stream causing nausea and vomiting.
If
the warts or virus are present on the cervix, referral to a gynecologist may be
indicated for a colposcopy where biopsy or laser treatment may be indicated.
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