Treatment of Genital warts
- Genital warts are also known as veneral warts
- It is a sexually transmitted disease caused by Human Papilloma Virus (HPV).
- Transmitted through sexual activity including vaginal, oral and anal sex.
- It may take weeks to months (1-3) before a patient develops visible warts over genital area after sexual contact.
- It affects both men and women.
- Veneral warts are contagious.
- Biggest risk factor for developing warts is unprotected sex.
- They are usually asymptomatic and do not cause any pain, discomfort or itching.
- Larger warts can cause discomfort
- Warts can occasionally bleed due to trauma.
- Incase they secondarily infected the can cause itching or pain.
- They are usually benign, or non-cancerous.
Appearance of Genital warts
- The appearance may vary from patient to patient .
- Size can be pin-head size to pea sized.
- Sometimes, they can be too small to be seen by naked eye.
- The can be solitary or in a cluster to form cauliflower type growth.
- The surface of warts can be smooth or rough.
- Color of genital warts can vary from skin colored to darker.
- Males can get warts over penis, scrotum, groin, thighs, inside and around anus.
- In men generally they first appear on the inner lining of prepuce and frenulum followed by glans, shaft of penis and the scrotum.
- In females genital warts can be inside or outside of vagina, inside or outside of anus and cervix.
- In women common sites involved are posterior part of introitus, labia, perineum and perianal area.
- Genital warts can also occur on lips, mouth, tongue or throat of a person who has had oral sexual contact with infected person.
Diagnosis of Genital warts
- Diagnosis is clinical on physical examination.
- History of unprotected sexual intercourse is positive.
Genital warts can be confirmed by biopsy, which might be indicated
- The diagnosis is uncertain.
- Lesions are atypical.
- Warts not responding to standard therapy .
- Indurated, fixed or ulcerated warts.
HPV DNA testing is not recommended for men, as the test results do not alter the treatment management.
For women PAP smear with HPV DNA test is advised.
- Swab is taken from cervix to obtain cells. These tests are tested for presence of HPV.
- Certain strains of HPV can show abnormal results on PAP smear, which may indicate precancerous changes.
Behavioural Risk factors
- Having unprotected sex.
- Having multiple partners.
- Starting sexual relations at a young age.
- Smoking, Alcohol, IV drug abuse.
High risk sexual practices
- Receptive or insertive ano-genital intercourse.
- Oro-anal or oro-genital intercourse.
High risk groups
- Commercial sex workers
- Restaurant workers
- Prison inmates
Treatment of Genital warts
Topical Imiquimod cream.
- It is an immune response modifier.
- There is no direct anti-viral activity.
- Patient can apply this 5%cream at bedtime, 3 times a week for 16 weeks.
- Treated area is washed with soap and water after 6-8 hours
- It boost up the local immunity and helps in early cure of warts.
- Podophyllin resin 10-25% and TCA are used
- Inhibits mitosis, causes swelling, necrosis and shedding of warts.
- Podophyllin is contra-indicated in pregnancy.
- Repeated sessions are required at a 2 week interval in case of multiple genital warts.
- This procedure should be carried by dermatologist only. Self application is discouraged to avoid harm to surrounding skin and other side-effects.
- Local numbing cream is applied first.
- Freezing of genital warts using liquid nitrogen.
- The freezing process causes a blister formation, as the skin heals the wart is also treated.
- Repeated sessions are required most of the times.
- Safe in pregnancy.
- Uses a low-voltage electrical probe to destroy the wart tissue.
- Local anesthesia is used.
Co2 Laser ablation.
Treatment of Vaginal and cervical warts
- For vaginal warts Cryotherapy , TCA, Podophyllin resin application by dermatologist.
- For cervical warts, surgical removal and histopathology is advised to rule out any pre-cancerous lesions.
- Surgical removal
Complications in Pregnancy
- Hormonal change, immune deficiency, increased blood supply in pregnancy can cause genital warts to grow, multiply or bleed.
- There is a risk of passing infection to the new born in vaginal delivery
- The infants can develop laryngeal papillomas, although this transmission is rare.
- TCA application and cryotherapy is safe in pregnancy.
- Big warts can be removed surgically.
Cesarean delivery is indicated
- Incase the pelvic outlet is obstructed because of the warts
- If warts can cause excessive bleeding.
Prevention of Genital warts
- Use of barrier contraceptives (condom).
- Sexually active people should practice safe sex.
- HPV vaccine is available for men and women. Vaccines can also give protection against the strains of HPV linked to cervical cancer in women.