Genital Warts

 

Genital Warts

It is not supposed to be this way, but it seems inevitable: genital warts have become endemic in the United Kingdom during the 21st century. Just in England, they are the second most common type of sexually transmitted infection after Chlamydia, with a number of new cases increased by 30 per cent every year. On the other hand, it is estimated that 80 percent of the people in the world will contract one of over a hundred strains of HPV (Human Papillomavirus), many of which cause genital warts.

Beyond the socio-economic impact of such statistics (the large number of people with genital warts results in huge costs to the health system) lies the personal drama of each of the affected. Although often perceived as a non-serious infection, patients regard genital warts as a stigmatising venereal disease. Emotional consequences could be tremendous, sometimes devastating.

The psychological and social effects of having genital warts are interrelated. There is a despair associated to the disease that deeply affects the self-perception of people suffering this condition. But among other ailments it is the sexual -and love- life that suffers most from having genital warts. Different studies have shown that people with genital warts use to describe themselves as repulsive and sexually unattractive. Among other reactions, their libido and sexual initiative decrease considerably, and pleasure and spontaneity is often lost during intercourse because of awareness of the warts. This situation affects steady relationships and, for the single ones, the ambition to find a new partner.

Fortunately, genital warts very rarely pose a significant health risk. And, fortunately, there is now an effective cure for genital warts to both remove them and prevent their spread. Treatments are slow and can be uncomfortable; but with the use of the latest technology and the active collaboration of the patient, the results can be impressive.

Definition

Genital warts are soft masses on the skin and mucous membranes that growths on the genital area, either externally (vulva, anus or penis) or internally (vagina or cervix). These growths, which are usually mild, moist and flesh-colored, appear singly or clustered (often a cauliflower-like appearance) and may be raised or flat, large or small. Less commonly, they can be red or brown. Some warts are so small that they can barely be seen, even if they are in the outer parts of the body.

Being a fairly common condition, genital warts are usually painless and do not pose a serious threat to health; fertility is not affected by this condition. But some types of HPV can cause cancer of the cervix and vulva, being the leading cause of cervical cancer.

There is a specific type of warts for each location. This means that genital warts will not spread to other parts of the body such as the hands, just as warts from the hands will not spread to the genital area. However, hands can be the vehicles to transmit genital warts to another person.

Cause

Genital warts are the result of a viral skin infection caused by the human papillomavirus (HPV), of which more than 100 different types exist. The infection is transmitted from one person to another mainly through sexual contact involving the anus, mouth or vagina. But penetrative sex is not the only way to pass the infection on because HPV is spread by skin-to-skin contact.

The virus can be spread even if the warts are not visible. The use of condom can reduce the risk of infection but it does not provide a complete protection; it is possible for the skin around the genital area to become infected.

Prevention:

Once you have been infected, genital warts spread very easily. Even though the treatments can be effective to eliminate the warts (and thus improving the patient self-esteem) there is little evidence that removing the visible lesion reduces the risk of transmission. In order to avoid further infections and to stop subsequent contagion, it is the patient’s responsibility to comply with the following rules:

  • To practice abstinence during the treatment of the virus.
  • In case of having sexual intercourse, limit the number of sexual contacts to the minimum. Monogamous is the best option.
  • Use a condom for the first six months after the infection. As mentioned before, the condom is not a quite effective protection but it reduces the risk of contagion.
  • Be always honest with your sexual partner. Do not have sexual relations without having explained the situation before. It is your partner’s decision, once they become aware of your condition, whether to proceed with the sexual intercourse or not.

Treatment

The method of treating genital warts depends on the severity of the infection, on what the warts look like, where they are and how many you have. The aim of every treatment is to remove as much warts as possible and to reduce the amount of virus affecting the immune system. It is worth noticing that genital warts are caused by a virus and by not bacteria, therefore antibiotics will not get rid of them. In some cases genital warts will return after treatment, but it is usually an outbreak that will not come back.

There are different treatments to fight genital warts, and sometimes more than one is used at the same time. Genital warts can be removed by chemical methods and by physical removal

Chemical methods:Through the use of medical ointments such as Podophyllotoxin, Imiquimod and Trichloroacetic acid. The creams are applied in the genital area and work by assisting the body’s immune system in fighting the warts. It may take several weeks or months before the warts disappear, and there is a high risk of causing damage to the skin around the affected area. They should not be used if you are pregnant.

Physical removal:

  • Excision: after local anesthesia is applied, the warts are cut off with a scalpel and the wound is stitched afterwards. It can cause scarring.
  • Electrosurgery: a current that pass through a metal loop burns the wart away. It could be very painful, so regional anesthetic is recommended.
  • Cryotherapy: the warts are frozen with liquid nitrogen or dry ice, causing the outer membranes of the warts to split. It can be performed without anesthetic.
  • Laser treatment: it is by large the most effective method of removing genital warts. Different studies have demonstrated the efficacy of the treatment, showing that pulsed dye laser is a simple and safe alternative option to fight warts.

How does the laser works?

The idea is to treat the affected area by using a pulsed dye laser. This kind of laser uses an organic dye mixed in a solvent as the lasing medium. Through a high-energy source of light, the dye solution circulates at a very high speed and the liquid is spurred beyond its lasing threshold. The incoming light excites the dye molecules, creating a wavelength of laser light and stimulates a deep and controlled radiation.

When applied on the skin, the pulsed dye laser works on the principle of selective photothermolysis, that is to say the matching of a specific wavelength of light and pulse duration to obtain optimal effect on a targeted tissue with minimal effect on surrounding areas. This ensures that the impact of thermal energy is limited to the warts without affecting other parts of the body.

Pulsed dye laser against genital warts

The pulsed dye laser emits a beam of light that targets and destroys red blood cells in the wart, depriving the virus of access to oxygen and nutrients without harming the surrounding skin. Since each pulse of the laser can cause a brief sensation of pain, topical anesthetic may be applied to the area. But it is not usually necessary.

Considerations about the laser treatment

  • Although being an effective noninvasive method to remove warts, the pulse dye laser does not provide the same result in every case. All kind of warts can be treated by the pulse dye laser, but it work best on warts that have red dots, are scaly in texture and have not been previously treated.
  • Immediately following treatment, an ice pack may be applied to soothe the treated area.
  • A bandage or patch may help to prevent abrasion on the treated area.
  • During the course of the treatment, patients should protect the area from sun exposure to reduce the risk of post-inflammatory pigmentation.
  • Loose clothing should be worn after the treatment. Swimming, saunas, hot baths and contact sports should be avoided until the treated area is healed.

For more information about treatment for genital warts in London contact us to book a laser consultation

Nurse giving presciption to elderly woman