Anal (Genital) Warts

Anal Warts

This is the most common sexually transmitted disease. It is estimated that one per cent of adults who are sexually active have warts in the genital or anal area. In the U.S. alone, one million people will develop genital warts each year. Of these, 25 per cent will have recurrent warts. And that is frustrating for the patient and the doctor.

Genital warts are also called condylomata acuminate or venereal warts. The warts are benign and are caused by human papillomavirus (HPV). There are at least 60 types of HPV. Genotypes six and 11 are found in over 90 per cent of cases of genital warts and genotypes 16 and 18 cause cervical cancers.

The virus is transferred from person to person or from contact with something someone has touched. In women, genital warts can grow on the outside or inside of the vagina, on the cervix, in the urethra or around the anus. In men, warts can grow on the tip or shaft of the penis, on the scrotum, in the urethra or around the anus.

How do you get genital warts?

Most, but not all, genital warts are sexually transmitted. Generally speaking warts are more common amongst people whose immune system is poor. But most people who get warts are healthy and well.

How do you know you have genital warts?

Most people with genital warts have no symptoms. By the time a person is infected and by the time the warts appear may be many months or years. The good news is most of those who get infected never develop warts.

The warts are soft fleshy lumps on or near sex organs or anus. Some people have itching or burning. Warts may be hidden in the vagina or anus.

What are the implications of the disease for patients?

The lesions are benign but they do cause psychosocial distress and may affect relationships as the warts are disfiguring and can be transmitted sexually. Genital warts also increase the incidence of cancer in the genital and anal area. Practicing safe sex is important. It is advisable to use barrier protection with new sexual partners. Condoms can reduce the risk of getting genital warts but warts can spread from areas not covered by a condom. Patients who are in stable relationship may not need barrier protection because the partner is already exposed to infection by the time patient sees a doctor.

How do we manage warts?

No specific treatment is appropriate for all patients and a person will need more than one treatment to clear the warts.

Most treatment plans will achieve clearance of virus within one to six months. In 20-30 per cent of patients new warts will occur over months or even years. Patients can treat themselves with podophyllotoxin (0.5 per cent solution or 0.15 per cent cream) and imiquimod (5 per cent cream). Imiquimod is expensive and podophyllotoxin takes longer to cure the condition.

Physicians can treat warts in the office by using trichloroacetic acid or by physical removal using cryosurgery (liquid nitrogen), electrosurgery and excision or laser treatment. In my surgical practice I use electrosurgery and/or excision.

The US Food and Drug Administration (FDA) has approved a new indication for a quadrivalent recombinant vaccine (Gardasil, Merck & Company, Inc) for the prevention of genital warts caused by human papillomavirus (HPV) types 6 and 11 in boys and men aged nine through 26 years. Since the vaccine does not cover all the viruses, about 30 percent of cervical cancers and 10 percent of genital warts will not be prevented by the current vaccines.

The HPV vaccine will not have an impact on an existing infection or any consequences of infection, such as anal and genital warts and cancerous or pre-cancerous changes that you may already have. It is very important to practice safe sex with your partner.

Examining Anal Warts

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Genital Warts Can Be Difficult To Eradicate

This is the most common sexually transmitted disease. It is estimated that one per cent of adults who are sexually active have warts in the genital or anal area. In the U.S. alone, one million people will develop genital warts each year. Of these, 25 per cent will have recurrent warts. And that is frustrating for the patient and the doctor.

Genital warts are also called condylomata acuminate or venereal warts. The warts are benign and are caused by human papillomavirus (HPV). There are at least 60 types of HPV. Genotypes six and 11 are found in over 90 per cent of cases of genital warts and genotypes 16 and 18 cause cervical cancers.

The virus is transferred from person to person or from contact with something someone has touched. In women, genital warts can grow on the outside or inside of the vagina, on the cervix, in the urethra or around the anus. In men, warts can grow on the tip or shaft of the penis, on the scrotum, in the urethra or around the anus.

How do you get genital warts?

Most, but not all, genital warts are sexually transmitted. Generally speaking warts are more common amongst people whose immune system is poor. But most people who get warts are healthy and well.

How do you know you have genital warts?

Most people with genital warts have no symptoms. By the time a person is infected and by the time the warts appear may be many months or years. The good news is most of those who get infected never develop warts.

The warts are soft fleshy lumps on or near sex organs or anus. Some people have itching or burning. Warts may be hidden in the vagina or anus.

What are the implications of the disease for patients?
The lesions are benign but they do cause psychosocial distress and may affect relationships as the warts are disfiguring and can be transmitted sexually. Genital warts also increase the incidence of cancer in the genital and anal area. Practicing safe sex is important. It is advisable to use barrier protection with new sexual partners. Condoms can reduce the risk of getting genital warts but warts can spread from areas not covered by a condom. Patients who are in stable relationship may not need barrier protection because the partner is already exposed to infection by the time patient sees a doctor.

How do we manage warts?

No specific treatment is appropriate for all patients and a person will need more than one treatment to clear the warts.

Most treatment plans will achieve clearance of virus within one to six months. In 20-30 per cent of patients new warts will occur over months or even years. Patients can treat themselves with podophyllotoxin (0.5 per cent solution or 0.15 per cent cream) and imiquimod (5 per cent cream). Imiquimod is expensive and podophyllotoxin takes longer to cure the condition.

Physicians can treat warts in the office by using trichloroacetic acid or by physical removal using cryosurgery (liquid nitrogen), electrosurgery and excision or laser treatment. In my surgical practice I use electrosurgery and/or excision.

The US Food and Drug Administration (FDA) has approved a new indication for a quadrivalent recombinant vaccine (Gardasil, Merck & Company, Inc) for the prevention of genital warts caused by human papillomavirus (HPV) types 6 and 11 in boys and men aged nine through 26 years. Since the vaccine does not cover all the viruses, about 30 percent of cervical cancers and 10 percent of genital warts will not be prevented by the current vaccines.

The HPV vaccine will not have an impact on an existing infection or any consequences of infection, such as anal and genital warts and cancerous or pre-cancerous changes that you may already have. It is very important to practice safe sex with your partner.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Genital Warts

Dear Dr. B: Can you please write a column on genital warts?

Answer: Sure, why not? This is the most common sexually transmitted disease. So let’s talk about it.

Genital warts are also called condylomata acuminate or venereal warts. It is estimated that one per cent of adults who are sexually active have warts in the genital or anal area. The warts are benign and are caused by human papillomavirus (HPV). There are at least 60 types of HPV. Genotypes six and 11 are found in over 90 per cent of cases of genital warts and genotypes 16 and 18 cause cervical cancer.

The virus is transferred from person to person or from contact with something someone has touched. In women, genital warts can grow on the outside or inside of the vagina, on the cervix, in the urethra or around the anus. In men, warts can grow on the tip or shaft of the penis, on the scrotum, in the urethra or around the anus.

How do I get genital warts?

Most, but not all, genital warts are sexually transmitted. Generally speaking warts are more common amongst people whose immune system is poor. But most people who get warts are healthy and well. We are all exposed to wart virus but nobody knows why certain part of our body accepts wart virus at a certain time. Therefore, prevention becomes difficult except in cases of genital warts where safe sex practice helps.

How do I know I have genital warts?

Most people with genital warts have no symptoms. By the time a person is infected and by the time the warts appear may be many months or years. The good news is most of those who get infected never develop warts.

The warts are soft fleshy lumps on or near sex organs or anus. Some people have itching or burning. Warts may be hidden in the vagina or anus.

What are the implications of the disease for patients?

The lesions are benign but they do cause psychosocial distress and may affect relationships as the warts are disfiguring and can be transmitted sexually. Practicing safe sex is important. It is advisable to use barrier protection with new sexual partners. Condoms can reduce the risk of getting genital warts but warts can spread from areas not covered by a condom. Patients who are in stable relationship may not need barrier protection because the partner is already exposed to infection by the time patient sees a doctor.

How do we manage warts?

Management of warts can be quite frustrating for patients and doctors. No specific treatment is appropriate for all patients and a person will need more than one treatment to clear the warts.

Most treatment plans will achieve clearance of virus within one to six months. In 20-30 per cent of patients new warts will occur over months or even years. Patients can treat themselves with podophyllotoxin (0.5 per cent solution or 0.15 per cent cream) and imiquimod (5 per cent cream). Imiquimod is expensive and podophyllotoxin takes longer to cure the condition.

Physicians can treat warts in the office by using trichloroacetic acid or by physical removal using cryosurgery (liquid nitrogen), electrosurgery and excision or laser treatment. In my surgical practice I use electrosurgery and/or excision.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Problems of Hands and Feet

There are numerous minor but common conditions of the hands and feet which bother people. Most people do not understand why they get them. The conditions are not life threatening but they are a nuisance. I will describe few conditions here and briefly discuss their cause and treatment.

Ganglion: A ganglion occurs mainly in the hand and foot and joint areas. It is a cyst containing jelly like substance. It may be soft or tense. It is usually smooth. It arises from the bursa within the substance of a joint capsule or the sheath covering a tendon. Some times this occurs after an injury. Sometimes it may cause pain.

Treatment: There are non-surgical methods to treat ganglion. But surgery usually provides satisfactory results. Occasionally it may recur at the same site.

Plantar warts: These are same as common warts. They grow on the soles of the feet. They grow into the skin because we walk on them. They can be painful on walking. The virus causing the wart is picked up from walking bare foot in locker rooms and swimming pools.

Treatment: They may spontaneously disappear if you wait long enough – months to years. They can be managed by freezing, scrapping or burning. They can recur.

Plantar fasciitis: Also known as “policeman’s heel”. It is common in men aged 40-60years. Exact cause of the condition is not known. There is pain beneath the heel. It is tender when pressure is applied.

Treatment: Pain can be minimized by padding and/or by cortisone injection. This may or may not work. Pain usually gets better in six to twelve months.

Callus and corns: These are thickened areas on the hands or feet caused by pressure or friction. This is usually related to work or sporting activities. Uneven pressure of body weight during walking or ill fitting shoes can cause calluses and corns on the feet.

Treatment: Wear proper fitting shoes and use corn pads to relieve pressure on the corns. Thick calluses can be sliced down to normal skin over a period of time. If the source of friction and pressure is removed then corns and calluses should not recur.

Toenail problems: Mainly involves the big toe. It may be ingrown or overgrown. Ingrown toe nails are commonly due to ill-fitting shoes pressing on an incorrectly cut nail. Poor foot hygiene encourages infection.

Treatment: In an acute stage antibiotic, painkillers and bathing the foot in warm salt water are necessary. Surgery is required in most cases. The problem can be prevented from recurring by keeping the feet clean and wear correctly fitting shoes. Cut the nail straight.

Fungus infection of the nails: Usually affects toenails. The nail is thickened and discolored. It is usually yellowish. The nail may grow in a twisted manner. The infection is picked up in a public place where it is transmitted from person to person. Poor feet hygiene does not help.

Treatment: Anti-fungal therapy is required – orally and locally for three months. Cure rate is around 80 percent. Ongoing meticulous foot care is very important to prevent recurrence.

Our feet are subjected to more wear and tear and hence they get more problems than our hands. Our natural tendency is to take care of our hands more than our feet. Many of these problems are preventable.

In my view, walking bare feet is the worst thing you can do for your feet. Wash your feet at least once a day (twice if your feet sweat a lot) with soap and water. Dry them well with a soft towel. Wear good quality clean socks and proper fitting comfortable shoes.

If you love your feet then take good care of them.

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