Genital warts (condylomata acuminata or
venereal warts) are caused by only a few of the many types of HPV. Other
common types of HPV infections, such as those that cause warts on the
hands and soles of the feet, do not cause genital warts. Genital warts
are spread by sexual contact with an infected partner and are very
contagious. Approximately two-thirds of people who have sexual contact
with a partner with genital warts will develop warts, usually within
three months of contact. Scientists estimate that as many as 1 million
new cases of genital warts are diagnosed in the United States each year.
In women, the warts occur on the outside
and inside of the vagina, on the cervix (the opening to the uterus), or
around the anus. In men, genital warts are less common. If present, they
are seen on the tip of the penis; however, they also may be found on the
shaft of the penis, on the scrotum, or around the anus. Rarely, genital
warts also can develop in the mouth or throat of a person who has had
oral sexual contact with an infected person. Genital warts often occur
in clusters and can be very tiny or can spread into large masses on
genital tissues. Left untreated, genital warts often disappear. In other
cases, they eventually may develop a fleshy, small raised growth with a
cauliflower-like appearance. Because there is no way to predict whether
the warts will grow or disappear, however, people who suspect that they
have genital warts should be examined and treated, if necessary.
Diagnosis
A doctor usually can diagnose genital
warts by direct visual examination. Women with genital warts also should
be examined for possible HPV infection of the cervix. The doctor may be
able to identify some otherwise invisible changes in the tissue by
applying vinegar (acetic acid) to areas of suspected infection. This
solution causes infected areas to whiten, which makes them more visible,
particularly if a procedure called colposcopy is performed. During
colposcopy, a magnifying instrument is used to view the vagina and
uterine cervix. In some cases, it is necessary to do a biopsy of
cervical tissue. This involves taking a small sample of tissue from the
cervix and examining it under the microscope.
A Pap smear test also may indicate the
possible presence of cervical HPV infection. A Pap smear is a
microscopic examination of cells scraped from the uterine cervix in
order to detect cervical cancer. Abnormal Pap smear results are
associated with HPV infection. Women with abnormal Pap smears should be
examined further to detect and treat cervical problems.
Treatment
Depending on factors such as their size
and location, genital warts are treated in several ways. Although
treatments can eliminate the warts, none eradicate the virus and warts
often reappear after treatment. Patients should consult their doctors to
determine the best treatment for them.
The U.S. Food and Drug Administration
(FDA) has approved imiquimod cream, which the patient can apply to the
affected area, to treat genital warts. Other treatments include a 20
percent podophyllin solution, which the patient can apply to the
affected area and later wash off, and a 0.5 percent podofilox solution,
which also is applied to the affected area, but is not washed off.
Pregnant women should not use podophyllin or podofilox because they are
absorbed by the skin and may cause birth defects in babies. The doctor
may also prescribe 5 percent 5-fluorouracil cream, which also should not
be used during pregnancy, or trichloroacetic acid (TCA).
Small warts can be removed by cryosurgery
(freezing), electrocautery (burning), or laser treatment. Occasionally,
surgery is needed to remove large warts that have not responded to other
treatment.
Some doctors use the antiviral drug alpha
interferon, which they inject directly into the warts, to treat warts
that have recurred after removal by traditional means. The drug is
expensive, however, and does not reduce the rate of recurrence.
Complications
Low-risk papilloma viruses cause warts
but not cervical cancer. High-risk viruses, however, cause cervical
cancer and also are associated with vulvar cancer, anal cancer, and
cancer of the penis (a rare cancer). Although most HPV infections do not
progress to cancer, it is particularly important for women who have
cervical dysplasia to have regular Pap smears. Potentially pre-cancerous
cervical disease is readily treatable.
Genital warts may cause a number of
problems during pregnancy. Sometimes they enlarge during pregnancy,
making urination difficult. If the warts are on the vaginal wall, they
can make the vagina less elastic and cause obstruction during delivery.
Rarely, infants born to women with
genital warts develop laryngeal papillomatosis (warts in the throat).
Although uncommon, it is a potentially life-threatening condition for
the child, requiring frequent laser surgery to prevent obstruction of
the airways. Research on the use of interferon therapy in combination
with laser surgery indicates that this drug may show promise in slowing
the course of the disease.
Prevention
The only way to prevent HPV infection is
to avoid direct contact with the virus, which is transmitted by
skin-to-skin contact. If warts are visible in the genital area, sexual
contact should be avoided until the warts are treated. Using a latex
condom during sexual intercourse may provide some protection.
Researchers are working to develop two
types of HPV vaccines. One type would be used to prevent infection or
disease (warts or pre-cancerous tissue changes); another type would be
used to treat cervical cancers. Clinical trials are in progress for both
types of vaccines.
| Nutrition |
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Some changes you can make in your diet
include the following.
- Eliminate caffeine, alcohol, refined foods, and sugar.
- Avoid saturated fats (animal protein and dairy products).
- Increase whole grains, fresh vegetables, fruits, legumes, and
essential fatty acids (nuts, seeds, and cold-water fish).
-
Vitamin C (250 to 500 mg two times per day), beta-carotene or
vitamin A (100,000 IU per day),
vitamin E (400 IU per day), and
zinc (15 to 30 mg per day) support immune function and
healing. Vitamin E may also be put directly on a wart to treat it.
-
B complex (50 to 100 mg per day) helps reduce the effects of
stress, which can weaken your immune system.
- Folic acid
(800 mcg per day) is recommended for genital warts.
-
Selenium (200 mcg per day) supports immune function.
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