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genital wart

 
Medical Encyclopedia: Genital Warts
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Definition

Genital warts, which are also called condylomata acuminata or venereal warts, are growths in the genital area caused by a sexually transmitted papillomavirus. A papillomavirus is a virus that produces papillomas, or benign growths on the skin and mucous membranes.

Description

Genital warts are the most common sexually transmitted disease (STD) in the general population. It is estimated that 1% of sexually active people between the ages of 18 and 45 have genital warts; however, polymerase chain reaction (PCR) testing indicates that as many as 40% of sexually active adults carry the human papillomavirus (HPV) that causes genital warts.

Genital warts vary somewhat in appearance. They may be either flat or resemble raspberries or cauliflower in appearance. The warts begin as small red or pink growths and grow as large as four inches across, interfering with intercourse and childbirth. The warts grow in the moist tissues of the genital areas. In women, they occur on the external genitals and on the walls of the vagina and cervix; in men, they develop in the urethra and on the shaft of the penis. The warts then spread to the area behind the genitals surrounding the anus.

Risk factors for genital warts include:

  • multiple sexual partners
  • infection with another STD
  • pregnancy
  • anal intercourse
  • poor personal hygiene
  • heavy perspiration

— Rebecca J. Frey


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Dictionary: genital wart
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Home > Library > Literature & Language > Dictionary

n.
A pointed papilloma typically found on the skin or mucous membranes of the anus and the external genital organs. It is caused by a virus that is transmitted through sexual contact. Also called condyloma acuminatum, venereal wart.


Dental Dictionary: genital wart
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Home > Library > Health > Dental Dictionary

n
condyloma acuminatum

A soft, wartlike growth found on the warm, moist skin and mucous membranes of the genitalia, caused by a virus and transmitted by sexual contact. Also called acuminate wart.

Alternative Medicine Encyclopedia: Genital Warts
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Definition

Genital warts, or condylomata acuminata, are also called venereal warts. These warts are painless, pink or grayish growths on the skin and mucous membranes of the genitals and anal area. They are usually found in clusters. Genital warts are very contagious and spread through sexual contact with an infected person.

Description

Genital warts are the most common sexually transmitted disease (STD) in the general population of the United States. It is estimated that 1% of sexually active people between the ages of 18 and 45 have genital warts; however, studies indicate that as many as 40% of sexually active adults may carry the virus that causes genital warts. Certain strains of the virus that cause genital warts may also cause cervical changes and cancer.

Causes & Symptoms

Genital warts are caused by several subtypes of HPV, the same virus that causes warts on other parts of the body. Symptoms develop about one to six months after being exposed to the virus. Once contracted, the virus remains in the infected person's body. This is true even if the warts are not visible. In addition to the visible warts, symptoms may include bleeding, pain, odor, itching, and redness in affected areas. These symptoms may appear without the warts, and the warts may appear without other symptoms. Stress may contribute to recurrent outbreaks.

Genital warts may be difficult to detect. At any given time, at least a quarter of all HPV infections are in a state of regression, in which the infection remains dormant in the body and there are no outbreaks of warts or other readily detected symptoms. In addition, warts that occur deep inside the vagina, on the cervix, or within the anus may go undetected.

HPV can be transmitted through oral, anal, or genital contact with an infected person, even if warts are not visible. Care must be taken, because the virus may also be transmitted via objects that have been recently exposed to the virus. These may include unwashed or improperly cleaned medical equipment, as well as underwear, tanning beds, and sex toys.

Risk factors for contracting genital warts include:

  • multiple sex partners
  • infection with another sexually transmitted disease (STD)
  • pregnancy
  • anal intercourse
  • poor personal hygiene
  • heavy perspiration

Genital warts vary somewhat in appearance. They may either be flat or resemble raspberries in appearance. The warts begin as small, red or pinkish growths. They may grow in clusters as large as four inches across, and may interfere with intercourse and childbirth. The warts grow on warm, moist tissue. In women, they occur on the external genitalia, the cervix, and the walls of the vagina. In men, they develop in the urethra and on the shaft of the penis. The warts may also spread to the area surrounding the anus.

Diagnosis

Genital warts are usually identified and diagnosed by their characteristic appearance. A sexual history should be taken, and tests for other STDs may be administered. If cervical warts are suspected, a colposcopy exam to view the cervix is necessary for diagnosis. A Papanicolaou (pap) smear may be performed, and the doctor may order a biopsy of the warts to rule out cancer.

Treatment

Genital warts are contagious, and should be assessed and treated under the supervision of a healthcare practitioner. A traditional Chinese medicine practitioner or an acupuncturist will probably recommend treatments to cleanse the liver and enhance immune functioning. A generally recommended homeopathic remedy is the application of a tincture of Thuja occidentalis (common names thuja, northern white cedar, and arborvitae, or tree-of-life) directly to the warts. A homeopathic physician should be consulted for a work-up for further treatment.

The direct topical application of vitamin A, thuja, lomatium (Lomatium dissectum) isolate, or tea tree oil (Melaleuca alternifolia) helps resolve warts and prevent recurrence of outbreaks. With the exception of the tea tree oil, these herbs should also be taken internally in addition to direct application. It has also been noted that deficiencies of folic acid and vitamins A and C contribute to this condition. Such deficiencies may be risk factors for a progression to abnormal cervical cells and cancer; therefore, supplementation is recommended. It should be noted that beta-carotene is often suggested as an alternative to taking high dosages of vitamin A.

Treatments that focus on emotional and psychological factors have been shown to be effective in reducing or eliminating outbreaks of warts. Hypnotherapy and techniques of stress reduction and relaxation are highly recommended.

Allopathic Treatment

There is no cure for genital warts, as the virus cannot be destroyed once it enters the body. The warts themselves may be burned off with electrocautery or lasers; frozen with liquid nitrogen for easy removal; or surgically removed. Podophyllum resin, trichloroacetic acid, interferon inducers, 5-fluorouracil cream, bichloroacetic acid, or trichloroacetic acid can be used as a topical treatment. These medications require several weeks of treatment and may irritate the skin. Pregnant women should be sure to inform their health care provider of this condition, as some of the medications for warts may cause fetal abnormalities. Genital warts can also be treated with injections of interferon, either into muscle tissue or directly into the lesions.

Unfortunately, regardless of the treatment regime, genital warts have a high rate of recurrence. Several courses of treatment may be required. Sexual partners should be diagnosed and treated as well. Because of the connection between certain strains of HPV and cervical cancer, infected women should also have yearly pap smears.

Expected Results

As with many warts, genital warts may spontaneously disappear over time. Although the warts are not cancerous by themselves, HPV infection in women appears to increase the risk of later cervical cancer. Recurrence is common with all methods of treatment.

Prevention

The only reliable method of prevention is sexual abstinence. The use of condoms is often recommended; however, condoms protect only a limited area and should not be relied upon for complete protection from genital warts. Circumcision may sometimes prevent recurrence of the visible warts.

Resources

Books

Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life Books, 1996.

Rakel, Robert E., ed. Conn's Current Therapy. Philadelphia: W. B. Saunders, 1998.

Tierney, Lawrence M., M.D., et al., eds. Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1998.

Other

"Genital warts." The Merck Manual Online. http://www.merck.com/pubs/mmanual/section13/chapter164/164l.htm.

[Article by: Patience Paradox]

Wikipedia: Genital wart
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Genital wart
Classification and external resources
ICD-10 A63.0
ICD-9 078.11
DiseasesDB 29120
eMedicine derm/454 med/1037
MeSH C02.256.650.810.217
Severe case of genital warts around the anus
Severe case of genital warts on a female
Severe case of genital warts on a male

Genital warts (or Condyloma, Condylomata acuminata, or venereal warts, also anal wart or anogenital wart) is a highly contagious sexually transmitted infection caused by some sub-types of human papillomavirus (HPV). It is spread through direct skin-to-skin contact during oral, genital, or anal sex with an infected partner. Warts are the most easily recognized symptom of genital HPV infection. They can be caused by strains 6, 11, 30, 42, 43, 44, 45, 51, 52 and 54 of HPV; types 6 and 11 are responsible for 90% of genital warts cases.[1] Less than 1% of those infected develop clinically obvious warts, but those infected can still transmit the virus,[2] although another source states that 70% of those who have sexual contact with an infected partner develop genital warts.[3][dubious – discuss] Other types of HPV also cause cervical cancer and probably most anal cancers.

Contents

Symptoms

Genital warts often occur in clusters and can be very tiny or can spread into large masses in the genital or penis area. In other cases they look like small stalks. In women they occur on the outside and inside of the vagina, on the opening (cervix) to the womb (uterus), or around the anus. They are approximately as prevalent in men but the symptoms may be less obvious. When present, they usually are seen on the tip of the penis. 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 sex with an infected person.

The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years (decades) may occur. HPV can last for several years without a symptom.[4] Having sex with a partner whose HPV infection is latent and demonstrates no outward symptoms still leaves one vulnerable to becoming infected. If an individual has unprotected sex with an infected partner, there is a 70% chance that he or she will also become infected. The immune system eventually clears the virus through interleukins, which recruit interferons, which slow viral replication.[5]

Vaccines

See also: HPV vaccine

Gardasil (sold by Merck & Co.) is a vaccine that protects against human papillomavirus types 16, 18, 6, and 11. Types 6 and 11 cause genital warts, while 16 and 18 cause cervical cancer. The vaccine is preventive, not therapeutic, and must be given before exposure to the virus type to be effective, ideally before the beginning of sexual activity. The vaccine is widely approved for use by young women, it is being tested for young men,[6][7] and has been approved for males in some areas, such as the UK.

Treatment

There is no cure for HPV , but there are methods to treat visible warts, which could reduce infectivity, although there are no trials studying the effectiveness of removing visible warts in reducing transmission.[8] Genital warts may disappear without treatment, but sometimes eventually develop a fleshy, small raised growth. There is no way to predict whether they will grow or disappear. Warts can sometimes be identified because they show up as white when acetic acid is applied, but this method is not recommended on the vulva because microtrauma and inflammation can also show up as acetowhite.[5] Magnifying glasses or colposcope may also be used to aid in identifying small warts.[5]

Depending on the sizes and locations of warts (as well as other factors), a doctor will offer one of several ways to treat them. Podofilox is the first-line treatment due to its low cost.[9] Almost all treatments can potentially cause depigmentation or scarring.[8]

Patient-applied
  • A 0.15% – 0.5% podophyllotoxin (also called podofilox) solution in a gel or cream. Marketed as Condylox (0.5%), Wartec (0.15%) and Warticon (0.15%),[10] it can be applied by the patient to the affected area and is not washed off. It is the purified and standardized active ingredient of the podophyllin (see below). Podofilox is safer and more effective than podophyllin.[10] Skin erosion and pain are more commonly reported than with imiquimod and sinecatechins.[11] Its use is cycled (2 times per day for 3 days then 4–7 days off); one review states that it should only be used for four cycles.[3]
  • Imiquimod (Aldara) is a topical immune response cream, applied to the affected area. It causes less local irritation than podofilox but may cause fungal infections (11% in package insert) and flu-like symptoms (less than 5% disclosed in package insert).[11]
  • Sinecatechins (marked as Veregen and Polyphenon E) is an ointment of catechins (55% epigallocatechin gallate[5]) extracted from green tea and other components. Mode of action is undetermined.[12] It appears to have higher clearance rates than podofilox and imiquimod and causes less local irritation, but clearance takes around longer than imiquimod and sinecatechins.[11]
Doctor-applied
  • Liquid nitrogen cryosurgery is safe for pregnancy. It kills warts 71–79% of the time, but recurrence is 38% to 73% 6 months after treatment.[5] Local infections have been reported.[5]
  • Trichloroacetic acid (TCA) is less effective than cryosurgery,[3] and is not recommended for use in the vagina, cervix, or urinary meatus.[5]
  • Surgical excision is best for large warts, and has a greater risk of scarring.[8]
  • Laser ablation does not seem to be any more effective than other physician-applied methods,[2] but is often used as a last resort and is extremely expensive.[5]
  • A 20% podophyllin anti-mitotic solution , applied to the affected area and later washed off. However, this crude herbal extract is not recommended for use on vagina, urethra, perianal area, or cervix,[5] and must be applied by a physician.[10] Reported reactions include nausea, vomiting, fever, confusion, coma, renal failure, ileus, and leukopenia; death has been reported with extensive topical application, or application on mucous membranes.[5]
  • Interferon can be used; it is effective, but it is also expensive and its effect is inconsistent.[3]
  • Electrocauterization can be used; it is an older procedure but recovery time is generally longer. In severe cases of genital warts,treatment may require general or spinal anesthesia. This is a surgical procedure. More effective than cryosurgery and recurrence is at a much lower rate.
Discontinued
  • A 5% 5-fluorouracil (5-FU) cream was used, but it is no longer considered an acceptable treatment due to the side-effects.[5]

Podophyllin and podofilox should not be used during pregnancy, as they are absorbed by the skin and could cause birth defects in the fetus.

Epidemiology

Genital HPV infections have an estimated prevalence in the US of 10–20% and clinical manifestations in 1% of the adult sexually active population.[3] Incidence of HPV infection has increased between 1975 and 2006.[where?][3] About 80% of those infected are between the ages of 17–33.[3] Although treatments can remove the warts, they do not remove the HPV, so warts can recur after treatment (about 50–73% of the time[13]), and also spontaneously regress.[3] Traditional theories postulated that the virus remained in the body for a lifetime. However, new studies using sensitive DNA techniques have shown that through immunological response the virus can either be cleared or suppressed to levels below what polymerase chain reaction (PCR) tests can measure. One study testing genital skin for subclinical HPV using PCR found a prevalence of 10%.[3]

See also

References

  1. ^ med/1037 at eMedicine
  2. ^ a b O'Mahony C (2005). "Genital warts: current and future management options". Am J Clin Dermatol 6 (4): 239–43. PMID 16060711. 
  3. ^ a b c d e f g h i Scheinfeld N, Lehman DS (2006). "An evidence-based review of medical and surgical treatments of genital warts". Dermatol. Online J. 12 (3): 5. PMID 16638419. http://dermatology.cdlib.org/123/reviews/warts/scheinfeld.html. 
  4. ^ "American Cancer Society: "Can Anal Cancer Be Prevented?"". http://www.cancer.org/docroot/CRI/content/CRI_2_2_2x_Can_Anal_Cancer_Be_Prevented.asp?sitearea=. Retrieved 2008-09-10. 
  5. ^ a b c d e f g h i j k Mayeaux EJ, Dunton C (July 2008). "Modern management of external genital warts". J Low Genit Tract Dis 12 (3): 185–92. doi:10.1097/LGT.0b013e31815dd4b4. PMID 18596459. 
  6. ^ Cortez, Michelle Fay and Pettypiece, Shannon. "Merck Cancer Shot Cuts Genital Warts, Lesions in Men". Bloomberg News. (Bloomberg.com) 13 Nov 2008.
  7. ^ HPV Vaccine Gardasil May Help Boys, Men by WebMD Health News, Nov 13, 2008
  8. ^ a b c Kodner CM, Nasraty S (December 2004). "Management of genital warts". Am Fam Physician 70 (12): 2335–42. PMID 15617297. http://www.aafp.org/afp/20041215/2335.html. 
  9. ^ Fox PA, Tung MY (2005). "Human papillomavirus: burden of illness and treatment cost considerations". Am J Clin Dermatol 6 (6): 365–81. PMID 16343025. 
  10. ^ a b c von Krogh G, Longstaff E (December 2001). "Podophyllin office therapy against condyloma should be abandoned". Sex Transm Infect 77 (6): 409–12. doi:10.1136/sti.77.6.409. PMID 11714936. PMC 1744412. http://sti.bmj.com/cgi/content/full/77/6/409. 
  11. ^ a b c Meltzer SM, Monk BJ, Tewari KS (March 2009). "Green tea catechins for treatment of external genital warts". Am. J. Obstet. Gynecol. 200 (3): 233.e1–7. doi:10.1016/j.ajog.2008.07.064. PMID 19019336. 
  12. ^ "Veragen package insert" (PDF). http://www.veregenrx.com/IL331%20Veregen%20PI%20170mm_x_420mm.pdf. Retrieved 2008-08-18. 
  13. ^ CDC. (2004). REPORT TO CONGRESS: Prevention of Genital Human Papillomavirus Infection.

http://picturesofwarts.net

External links


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