Genital warts

WhatWartWhat Wart – Anogenital warts: A pictorial guide to diagnosis and management Dr O’Mahony

Dr O’Mahony has produced a book for doctors, nurses and some patients might also find it useful. It contains lots of images of genital warts and before and after cases. Some of the cases are quite severe and should be reassuring to patients who think they have a dreadful condition that actually all of this can be resolved. Download the book: “What Wart? Anogenital warts: A pictorial guide to diagnosis and management.

Colleagues are welcome to download and use the images in Powerpoint presentations. In the book itself there are images, but these are of low resolution, click here for the high resolution images.

What are genital warts?

A virus called human papilloma virus is responsible for all kinds of warts. The virus affects the outermost layer of the skin where it causes growths. These can be anywhere on the genitals – including urethra, vagina and the anus.

How are they detected?

Warts on the genitals are easy to diagnose. It’s simply a matter of looking.
How common are they, and how are they spread?
They are extremely common. The numbers of people with genital warts who attend GU Clinics doubled in recent years. It is mostly through sexual contact, although the possibility of infection by hand warts cannot be completely ruled out. It may be possible for the virus to be present in the skin and cause a wart many years later.

What causes warts to grow?

Once you have been exposed to the virus it can take weeks to months or longer for a wart to develop.

How can they be treated?

There are several ways of treating the warts. Much of the difficulty lies in the fact that the virus is present not only in the warts but in the skin around them. This is one reason why warts may recur and tend to develop right next to the original warts. Only visible warts can be treated. This treatment may be by applying cream at home, by freezing, by surgery or by cautery.

1. Warticon is a cream / lotion that can be used a home.
For more information on Warticon please click here.
2. Cryocautery (freezing) is useful for large single warts or for warts situated in areas unsuitable for painting, ie. The tip of the penis, or those not responding to other treatments. It is usually done weekly.
3. Trichloroacetic acid is another very caustic chemical used to treat warts
4. Imiquimod (Aldara) a home treatment which acts in conjunction with the patient’s own immune system. Treatment can be slow initially, but recurrences are less.
Some patients can become inflamed from the immune reaction but this will settle and then the cream can be reapplied.

Management of Imiquimod Induced Erythema

See the following case report that shows this reaction and how it is managed.
Click Here to View Case Report

SOME PATIENTS CAN DEVELOP VERY LARGE WARTS THAT ARE A MAJOR PROBLEM

These pictures show patients who unfortunately the warts didn’t readily respond to treatment and kept coming back. These patients often require repeated surgery and lots of treatment with the immune response modifier Aldara to try and stimulate the immune response to clear them. Although these pictures are quite alarming, we can reassure all patients that irrespective of the degree and extent of their warts, we can always get a good solution, usually by combining surgery and home treatments.

HPV Vaccine

Unfortunately, the Department of Health initially chose the vaccine called Cervarix which only contains HPV types 16 & 18. This will, of course, be tremendous in the battle against cervical cancer, but did nothing for the vast number of patients who develop genital warts. The other vaccine called Gardasil contains 4 HPV types (6, 11, 16 & 18) and would have massively reduced the number of genital wart cases in the United Kingdom. However from September 2012 all 12 year old girls in the UK will now be offered Gardsil. So, in about 10 years time we will see some reduction in genital warts in young people. Patients can still, of course, go to their GP or a clinic, and get a private prescription and buy Gardasil for themselves or their sons or daughters. Most GU Physicians were dismayed over this decision and Dr Colm O’Mahony wrote an editorial in the journal emphasising that dismay.

Smoking
Research has shown that heavy cigarette smoking, slows the immune system, delays clearance of warts and may increase recurrences.

Treating sexual partners
Genital wart viruses are common. Ask your sexual partner to check himself / herself for genital warts. If they find any, they should attend.

Relapses
There is no wart treatment which kills the wart virus. Further episodes of genital warts are possible, weeks or even months after successful treatment. However, genital warts do always eventually go for good.

Genital warts and cancer of the cervix
In the past, medical research had suggested a link between genital warts and cancer of the cervix. We now know that the types of wart viruses which are linked with cancer of the cervix are NOT those which cause common genital warts. Women who have genital warts are at NO greater risk than other women, and the usual 3-yearly smear tests are all that is recommended.

Wart treatment clinics

After diagnosis by a doctor, there are extra sessions outside of main clinic hours for people attending for regular wart treatments. Generally, people are seen quicker than in the main clinic. Please tell the Receptionist when you book, if you want an appointment for wart treatment only. Don’t worry – studies at this clinic show that most people manage their own treatment at home, and three quarters of patients require only two visits or less.

General Advice

1. Keep the area with the warts as clean and dry as possible. Gentle washing is all that is needed, do not scrub, and blot dry carefully.
2. Try to attend regularly. If the area becomes red and sore then bathe with a salt solution ( 1 teaspoon of salt to a pint of water ). Talcum powder is very beneficial in keeping the area as dry as possible.
3. Condoms may be useful during periods of treatment and for some time after treatment to prevent wart virus infection in your partner. In long term relationships their use is less certain.

Image Gallery

View 2 video clips on wart removal please click here.

Articles

An article written by Dr Colm O’Mahony criticising the Government decision on national human papillomavirus vaccine programme is available Editorial in STI Journal on HPV decision by Dr Colm O’Mahony.

Boys and HPV vaccine O’Mahony bmj.g4783.full   Editorail in BMJ about vaccinating boys also.

See attached PDF: Editorial in BMJ on HPV by Dr O’Mahony, explaining the value of Gardasil (HPV) vaccination in cases of chronic or recurrent disease.