Human Papillomavirus (Venereal Warts): Cause and Treatment
Cause and Manifestation:
According to the Center for Disease Control (CDC), venereal warts, also called condyloma, are a common sexually transmitted disease (STD) caused by the human papillomavirus (HPV) that affects the skin or mucous membranes of various areas of the body.
This virus may cause cauliflower-like fleshy growths that vary in size, are frequently painless, and can be raised, pointed, or flat in appearance, manifesting in moist areas in and around the sex organs, but in many cases, may not visible to the naked eye.
These warts may appear singly or in clusters on the penis, scrotum, inside or outside the anus (of both men and women) inside or outside the vagina, and inside or outside the mouth (in both men and women). In rarer cases, they have been known to manifest on the stomach, inner thighs, eye lids, or other tender areas of the body.
Not limited to a particular age group or sex, any sexually active person can be infected with venereal warts, but most often, venereal warts are found in young people aged 15 to 30 who routinely have multiple sex partners. Those individuals whose immune systems are compromised are more likely to become infected and have a more serious infection than others.
Venereal warts are generally spread through direct skin-to-skin contact during vaginal, oral, or anal sex with someone who is already infected. HPV can also be spread from mother to child (usually found in the child's throat or mouth) during birth.
The average incubation period for the human papillomavirus, which begins immediately after the initial sexual contact with an infected person, is usually two to three months, but can take as long as 20 months to manifest.
However, the virus can also remain inactive or latent for months or possibly years before warts or other signs of HPV infection appear. In couples that have not had sex partners for many years, the woman may develop an abnormal Pap smear because of previous contact.
HPV cannot be cured, therefore, the infected person is essentially contagious for life.
Statistically, approximately two-thirds of the people who have sexual contact with a partner with genital warts will develop this disease. While HPV infection can also be transmitted by people who have no visible lesions, some researchers believe this condition is less contagious when warts are not visible.
Today, treatments commonly used to treat genital warts fall into three basic categories:
1) Doctor-prescribed topical creams that destroy wart tissue
2) Topical creams designed to control the virus that causes the condition
3) Surgical methods that remove the warts.
All three treatments are applied directly to individual warts, and none are available in oral form.
The most popular topical medication used to treat warts is podophyllotoxin, a gel sold under the product name Condylox, which you apply directly to the affected area. Individuals who experience unpleasant side-effects from this cream such as severe burning, inflammation, or itching are sometimes prescribed fluorouracil cream sold as Adrucil, or Podofin (a plant-based, natural product made from the mandrake shrub), which after application can be washed off if necessary without losing effectiveness.
Another topical medication doctors suggest to treat genital warts is imiquimod cream, sold under the product name Aldara. This is one of a new class of drugs called “immune response modifiers,” which helps your body fight off the virus instead of just getting rid of the warts. Doctors sometimes prescribe Aldara after more invasive surgical methods of wart removal to reduce the chance of recurrence.
When topical creams are ineffective against treating venereal warts, the next option is to remove them using extreme cold, heat, or surgical procedures.
These methods are known to be quite painful, and with the exception of laser surgery, are often ineffective since the Human Papilloma Virus (HPV), which is the cause of the outbreak, is still living in the surrounding tissue and often causes the warts to reappear weeks or even months later.
Before suggesting laser or scalpel surgery to remove warts, most doctors try cryotherapy, a method that uses liquid nitrogen to freeze the wart tissue. This method is less expensive than surgery, does not require an anesthetic, and since the warts literally crumble away, is less likely to leave a scar than removing them by laser or scalpel.
But when freezing a wart is unsuccessful, more invasive methods must be used.
The most successful of these more invasive methods is called CO2 vaporization, which uses a carbon dioxide laser beam applied directly to the individual warts.
This is a much more expensive procedure and requires you to undergo an anesthetic (even spinal anesthesia, depending on the location and number of warts), but has a relatively high success rate.
One concern doctors have about using this method, however, is that the smoke produced during this procedure can transmit the HPV through the air, so some choose to use it only for severe infections.
When this technique fails to do the job, only two options remain: electrodesiccation and surgical removal of the warts by scalpel.
Electrodesiccation is a method that burns warts off using an electrical spark, and requires you to be under anesthesia. This is by far the most painful of the procedures, and is generally used only for removing larger warts.
When electrodesiccation is unsuccessful or is not a viable option, surgical removal by scalpel is most often used.
This method requires the individual to be anesthetized (sometimes put under completely), is the most expensive of the options, and often requires you to make several follow-up visits to your doctor. It does, however, have one of the highest success rates of all external wart treatments.
Unlike external warts, warts that appear inside the anal canal or vagina are limited to two options: removal by cauterization, using a small probe with an electric current running through it to burn the infected tissue, or surgical removal by scalpel, both of which require the individual to be under anesthesia and make several follow-up visits with you doctor.
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