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Genital Warts
Genital warts (condylomata acuminata or
venereal warts) are caused by only a few of the many types of HPV.
Other common types of HPV infections, such as those that cause warts
on the hands and soles of the feet, do not cause genital warts.
Genital warts are spread by sexual contact with an infected partner
and are very contagious. Approximately two-thirds of people who have
sexual contact with a partner with genital warts will develop warts,
usually within three months of contact. Scientists estimate that as
many as 1 million new cases of genital warts are diagnosed in the
United States each year.
In women, the warts occur on the
outside and inside of the vagina, on the cervix (the opening to the
uterus), or around the anus. In men, genital warts are less common. If
present, they are seen on the tip of the penis; however, they also may
be found on the shaft of the penis, on the scrotum, or around the
anus. Rarely, genital warts also can develop in the mouth or throat of
a person who has had oral sexual contact with an infected person.
Genital warts often occur in clusters and can be very tiny or can
spread into large masses on genital tissues. Left untreated, genital
warts often disappear. In other cases, they eventually may develop a
fleshy, small raised growth with a cauliflower-like appearance.
Because there is no way to predict whether the warts will grow or
disappear, however, people who suspect that they have genital warts
should be examined and treated, if necessary.
Diagnosis
A doctor usually can diagnose genital
warts by direct visual examination. Women with genital warts also
should be examined for possible HPV infection of the cervix. The
doctor may be able to identify some otherwise invisible changes in the
tissue by applying vinegar (acetic acid) to areas of suspected
infection. This solution causes infected areas to whiten, which makes
them more visible, particularly if a procedure called colposcopy is
performed. During colposcopy, a magnifying instrument is used to view
the vagina and uterine cervix. In some cases, it is necessary to do a
biopsy of cervical tissue. This involves taking a small sample of
tissue from the cervix and examining it under the microscope.
A Pap smear test also may indicate the
possible presence of cervical HPV infection. A Pap smear is a
microscopic examination of cells scraped from the uterine cervix in
order to detect cervical cancer. Abnormal Pap smear results are
associated with HPV infection. Women with abnormal Pap smears should
be examined further to detect and treat cervical problems.
Treatment
Depending on factors such as their size
and location, genital warts are treated in several ways. Although
treatments can eliminate the warts, none eradicate the virus and warts
often reappear after treatment. Patients should consult their doctors
to determine the best treatment for them.
The U.S. Food and Drug Administration
(FDA) has approved imiquimod cream, which the patient can apply to the
affected area, to treat genital warts. Other treatments include a 20
percent podophyllin solution, which the patient can apply to the
affected area and later wash off, and a 0.5 percent podofilox
solution, which also is applied to the affected area, but is not
washed off. Pregnant women should not use podophyllin or podofilox
because they are absorbed by the skin and may cause birth defects in
babies. The doctor may also prescribe 5 percent 5-fluorouracil cream,
which also should not be used during pregnancy, or trichloroacetic
acid (TCA).
Small warts can be removed by
cryosurgery (freezing), electrocautery (burning), or laser treatment.
Occasionally, surgery is needed to remove large warts that have not
responded to other treatment.
Some doctors use the antiviral drug
alpha interferon, which they inject directly into the warts, to treat
warts that have recurred after removal by traditional means. The drug
is expensive, however, and does not reduce the rate of recurrence.
Complications
Low-risk papilloma viruses cause warts
but not cervical cancer. High-risk viruses, however, cause cervical
cancer and also are associated with vulvar cancer, anal cancer, and
cancer of the penis (a rare cancer). Although most HPV infections do
not progress to cancer, it is particularly important for women who
have cervical dysplasia to have regular Pap smears. Potentially
pre-cancerous cervical disease is readily treatable.
Genital warts may cause a number of
problems during pregnancy. Sometimes they enlarge during pregnancy,
making urination difficult. If the warts are on the vaginal wall, they
can make the vagina less elastic and cause obstruction during
delivery.
Rarely, infants born to women with
genital warts develop laryngeal papillomatosis (warts in the throat).
Although uncommon, it is a potentially life-threatening condition for
the child, requiring frequent laser surgery to prevent obstruction of
the airways. Research on the use of interferon therapy in combination
with laser surgery indicates that this drug may show promise in
slowing the course of the disease.
Prevention
The only way to prevent HPV infection
is to avoid direct contact with the virus, which is transmitted by
skin-to-skin contact. If warts are visible in the genital area, sexual
contact should be avoided until the warts are treated. Using a latex
condom during sexual intercourse may provide some protection.
Researchers are working to develop two
types of HPV vaccines. One type would be used to prevent infection or
disease (warts or pre-cancerous tissue changes); another type would be
used to treat cervical cancers. Clinical trials are in progress for
both types of vaccines.
| Treatment Options |
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Medical treatments include drug therapy (usually the
first-line treatment), cryosurgery ("freezing" the
wart to destroy tissue), electrosurgery, lasers, and cutting out
the wart. Unless your wart is causing significant problems, you
should avoid treatments that have risks or could result in
scarring.
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| Drug Therapies |
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Common, flat, and plantar warts: nonprescription preparations
using salicylic acid are available over the counter.
Genital warts: in most cases, your health care provider will
either apply podophyllin weekly or prescribe a podofilox for you
to apply.
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| Complementary and
Alternative Therapies |
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Nutritional and herbal support may enhance immune function
and minimize recurrence of HPV, the virus that causes warts.
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| Nutrition |
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Some changes you can make in your diet include the following.
- Eliminate caffeine, alcohol, refined foods, and sugar.
- Avoid saturated fats (animal protein and dairy products).
- Increase whole grains, fresh vegetables, fruits, legumes,
and essential fatty acids (nuts, seeds, and cold-water
fish).
- Vitamin
C (250 to 500 mg two times per day), beta-carotene
(100,000 IU per day), vitamin
E (400 IU per day), and zinc
(15 to 30 mg per day) support immune function and healing.
Vitamin E may also be put directly on a wart to treat it.
- B
complex (50 to 100 mg per day) helps reduce the effects
of stress, which can weaken your immune system.
- Folic
acid (800 mcg per day) is recommended for genital warts.
- Selenium
(200 mcg per day) supports immune function.
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