Treatment Options for Anogenital Warts
How to Manage the Sexually Transmitted HPV Infection
Oct 19, 2008
Anogenital warts refer to a viral infection of the anal and genital area caused by the human papilloma virus (HPV). The danger of HPV infection lies in the fact that they can cause cancerous changes in the skin and mucous membrane of the genital tract. There are many treatment options for anogenital warts.
Anogenital warts are quite common and current evidence suggests that more than 50% of sexually active adults have been infected with one or more HPV types, which number to more than 150 clinical types of which around 20 infect the genital area. Transmission occurs through sexual contact mainly, and through fingers and during delivery to the newborn. Following sexual contact with an infected person, the warts appear after an incubation period of 3 weeks to 8 months, with an average of 3 months. The chance of getting the disease after sexual contact with an infected person has been estimated to be around 60%.
Anogenital warts can appear on and around the genitals and around the anal opening in both sexes, depending upon sexual preferences. They may also appear inside the urethral opening in both sexes. In females, the HPV lesions can be found inside the vagina as well as cervix. In most patients, however, HPV infection may remain subclinical, meaning without any evident rashes or growths.
Anogenital warts can appear as flesh colored, cauliflower like growths (condyloma acuminata), flat dark brown bumps and fleshy finger like projections.
There are many treatment options for anogenital warts. These can be broadly classified into patient applied and physician administered.
Patient Applied Treatment Options for Genital Warts.
- Imiquimod 5 % Cream: Applied to the lesions on alternate days for a period of up to 16 weeks.
- Podofilox 0.5% solution and gel: Applied to the warts twice daily for 3 days, followed by 4 days rest. Continued for 4 such cycles. Podofilox should not be used in pregnancy.
Physician Administered Treatment Options for Genital warts
- Podophyllin 10-20% in Tincture Benzoin: Apply to the lesions, protecting the surrounding normal skin with Vaseline. Wash off after 1-4 hours. Repeated weekly if necessary. If no results after 6 applications, other treatment options for warts should be considered. Contraindicated in pregnancy.
- Cryotherapy with Liquid Nitrogen: Weekly treatment with cryo-freezing.
- Trichloracetic Acid 50-70%: Applied to warts protecting the surrounding area with Vaseline or baking soda powder.
- Electrodessication or Electrocautery: Highly effective; but cannot be used on glans penis because of the risk of scar formation.
- Surgical Removal: Tangential shave excision, curettage or electro surgery.
- Carbon Dioxide Laser and electrodessication: Useful option in treating extensive anogenital warts.
Cervical Warts
PAP smear and other tests should be carried out to rule out cancer transformation in case of cervical warts.
Follow up
As recurrences are more common during the first 3 months, a follow up should be advised after 3 months or before that if visible lesions reappear.
Prevention
Use of condoms prevents HPV infection to a certain extent, but not always. An HPV vaccine is now available that protects against HPV. The vaccine, Gardasil, is given in three doses over six-months. HPV Vaccine is routinely recommended for girls at the age of 11 and 12. It is also recommended for girls and women aged 13 to 26 who have not yet been vaccinated.
References
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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