Thursday, July 24, 2014

Condyloma (Genital Warts)

Definition

Genital warts are a sexually transmitted disease that appears externally on the genitalia, in the anal area, internally in the upper vagina or cervix, and in the male urethra.

The lesion is typically raised and pinkish. This condition may produce no symptoms at all, or cause itching, burning, tenderness, pain during intercourse, or frequent urination.

Description

Some half a million new cases of genital warts are diagnosed in the U.S. each year. Technically known as condyloma acuminata, genital warts are small growths, sometimes resembling cauliflower, that occur on or near the genitals. Like other warts, the genital variety is caused by by the human papillomavirus (HPV). Worldwide, HPV is one of the most common causes of sexually transmitted disease (STD).

The wart itself is actually the "tip of an iceberg" in that the virus lurks in cells of the normal-appearing skin around the visible wart, and possibly also in other uro-genital areas.

The viral nature of the condition also has important implications for transmission and treatment. Many if not most people who harbor the virus do not know it. The virus may infect cells but not cause warts for many years, erupting into visible lesions when the immune system is suppressed.

Because of a wart's location and sexual mode of transmission, it may cause emotional and social problems. Genital warts can inflict extreme psychological turmoil, and those who have them often feel embarrassed, angry, and even guilty.

Concern about genital warts has increased because of an association between HPV and genital cancers. Anyone who has ever had sex is at risk for harboring HPV. The virus seems to cause visible lesions when a person's immune system is suppressed, but many flare up even without an obvious trigger. This may occur because of illness (particularly other sexually transmitted diseases), or from taking certain drugs, such as cancerchemotherapy or drugs to prevent rejection of an organ transplant. Deficiencies of folic acid and vitamin A also may trigger genital warts. Smoking raises risk twofold, partly because nicotine byproducts attack immune system cells in the cervix.

Causes

Genital warts are spread by sexual contact with an infected partner and are very contagious. They often appear within three months of contact. Condoms can help, but do not assure, prevention.

Although much remains to be learned about how the papilloma virus progresses, doctors have observed that the warm, moist environment in the genital area seems to favor wart growth. Outbreaks appear to be exacerbated during pregnancy and in patients with defective immune systems.

Patients with a history of genital warts may be at increased risk for certain types of cancer. The human papilloma virus is associated with up to 90 percent of all cervical malignancies and is also thought may play a role in cancers of the vagina, anus, vulva and penis.

Cervical warts may be transmitted to the newborn via passage through the infected birth canal.

Diagnosis

Finding a cauliflower-like growth on the genitals is reason to see a doctor who can tell if it is genital warts or a different kind of growth.

The practitioner may use a type of microscope called a colposcope to examine a woman's cervix to see if there are internal outbreaks.

When acetic acid (vinegar) is swabbed on the cervix or penis, HPV lesions appear whitish. Colposcopy can be valuable in detecting flat lesions that are not visible to the unaided eye, but only two-thirds of white areas seen in a colposcope are due to HPV infection. Sampling cells with a biopsy and testing for HPV genetic material, may be necessary to confirm a diagnosis.

An abnormal Pap smear can sometimes indicate a cervical HPV infection. Some types of HPV can cause cervical cancer, while others can cause vulvar or anal cancer. With any abnormal Pap smear, a woman should be examined by her doctor.

Treatment

People with genital warts have a variety of treatments to choose from, but none is a perfect cure. The treatments vary widely in cost.

Genital wart treatments fall into three categories: prescription topical preparations that destroy wart tissue; surgical methods that remove wart tissue; and biological-based approaches that target the virus causing the underlying condition. Each treatment must be applied to individual warts - none is taken systematically.

The FDA has approved Condylox (a .5% podofilox solution, applied to the affected area and which should not be washed off) as a topical treatment for genital warts. Some doctors prescribe Podocon-25 and Podofin (a 20% podophyllin anti-mitotic solution, which you can apply and wash off later) or a 5 percent 5-fluorouracil cream Most Condylox users experience a burning sensation, pain, inflammation, itching, or erosion of the affected area. Pregnant women should not use these applications as they can cause birth defects. Also prescribed is Imiquimod, an immune response cream applied to the affected warts, or Trichloroacetic acid (TCA).

Visible genital warts can be physically removed using, cold, heat, or excision by a scalpel or laser. All of these techniques are uncomfortable, and the warts tend to recur because HPV is still present in surrounding cells.

Carbon dioxide laser vaporization and conventional surgical excision are best reserved for extensive warts, especially for patients who have not responded to other treatment. Cryotherapy is performed on less extensive lesions. This method used liquid nitrogen or a device called a cryoprobe to freeze the wart tissue, which then crumbles away. It is inexpensive, does not require an anesthetic, and is less likely to leave a scar than excision using a scalpel.

The viral nature of genital warts suggests that anti-viral therapies may be effective. Standard treatments burn, scrape, freeze, or use a laser to remove affected tissue - some doctors inject alpha interferon directly into the warts, to treat warts that have come back. Interferon therapy attacks the virus, the underlying source of the warts; but it is usually expensive and does not lessen the rate at which the warts return.

Questions

How can these best be removed?

What can I do to prevent spreading them to my partner?