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Genital warts
Genital warts are caused by a viral infection. The HPV virus to be precise. These are acquired from direct skin to skin contact through genital, oral or anal sex with an infected partner. I have seen virgins (intact hymen) who have ended up with genital warts from non-penetrative sex. Warts can occur anywhere in the body but when they appear in the genital or anal region, it is almost exclusively through sexual exposure. They could be acquired through infected fomites like infected sex toys etc., but the virus can only survive for a few hours outside the human body.
They can be treated using one among many modalities like topical applications. Imiquimod and Podophyllin is a good option in men and non-pregnant women. Liquid nitrogen freezing also works well, especially in warts which are on the mucosae (cervix, inside the vagina, head of the penis, the clitoris etc.).
They can be burnt using electrocautery or lasers. However that will require anaesthesia, which is tricky to administer in this area. Besides, many patients don’t like the idea. Acid application is not advised in the genital area. Interferons, immunotherapy and even hypnotherapy offer hope in resistant cases. The smaller and fresh warts may fall off using a single treatment with liquid nitrogen or podophyllin, though the larger warts may require anywhere from 2-6 treatment sessions. Warts can also self-resolve in some cases.
But doctors do not generally like to take a wait-and-watch approach with this condition, because if it does not fall of on its own, it may increase in size and number and you could potentially pass it on to someone else, so we prefer to treat it as soon as it is diagnosed. Clearly, 1-2 small warts are easier to treat than 15-20 large warts.
There are over 70 serotypes of HPV, which is why there are no tests to diagnose them. Biopsy is highly traumatic and leaves a scar and is only done when the diagnosis is in doubt. Warts have a characteristic look and doctors only rely on clinical diagnosis which is most accurate when examined by a dermatologist. Only 3 of the 70 serotypes of HPV can lead to cancers like cervical cancer or penile cancer in those who have very frequent recurrences or those who leave there condition untreated for a long time.
Warts have a 30% chance of recurrence post treatment, so you may be back at the doctor’s office for 2 or 3 rounds of treatment before you finally overcome the infection.
One does not develop immunity against HPV. A second unprotected exposure with an infected individual can lead to a recurrence of warts. However, some of us may be genetically less prone to contract the virus. Circumcision also provides men with some protection.
The virus tends to stay back in the system for a very long time and can be shed in the seminal fluid even when you do not have any visible lesions. This is the most unfortunate part of HPV infection, else this is like any other infection (we have all acquired infections of one sort of the other from infected individuals. However since Herpes and HPV is sexually acquired, we stigmatize it). There is no cure for the HPV and no way to know when you are shedding.
This is irrespective of which doctor has treated you and which treatment modality they may have chosen. Only way to prevent it is to get the vaccine done early, choosing your sexual partner with care, and using condoms for protection.
It is best to get the vaccine done before puberty, in order to protect our children from HPV before they become sexually active. Even if you have had genital warts before, you could still get the vaccination done, and it could protect you against the 3 serotypes which are linked to cervical and penis cancer. However, if you HAVE acquired one of the cancer-causing HPV strains, then the vaccine will not provide any protection.
For an uninfected individual, the HPV vaccine is freely available in India and administered by OBGYNs and pediatricians. It takes 6 months to complete the course and provides 90% protection against HPV (and therefore protects women from cervical cancer).
Warts can recur during pregnancy. This is because of the lowered immunity and increased pelvic blood flow during pregnancy. Most treatment modalities are contraindicated in pregnancy as they can be harmful to the unborn baby. In such a case, the baby is delivered through C-Section, else the warts can spread to the baby’s larynx (voice box) and lead to loss of voice.
Laryngeal warts can be acquired by having oral intercourse with an infected individual who was actively shedding the virus. This could lead to hoarseness of voice, even laryngeal cancer.