Treatment Options and Objectives
1. Eradicate the genital warts
Should genital warts be treated?
Reducing the burden of warts certainly increases the comfort and feeling of well-being in most patients. A reduction of symptoms is appreciated. Patients are usually very concerned about passing on the warts to partners so appreciate having them destroyed. The process of eliminating the warts probably increases the patients immune responsiveness to the virus and may enhance the body's ability to "lock-up" the virus. It is thought that an inactive for of the HPV persists log term. It is expected that in this form it is considerably less transmittable to others. In those with the high risk types removing the virus probably does not eliminate the of future cancer risk. Therefore long term testing with cervical Pap smears is highly recommended despite eradication of the warts.
What is the natural history of genital warts?
In the majority of patients, treatment can induce wart-free periods; if left untreated, warts may resolve on their own, remain unchanged, or increase in size or number. Treatment can reduce or eradicate the warts but does not eliminate, HPV virus. The choice of treatment should be guided by the preference of the patient, the available resources, and the health provider's experience. No single treatment is ideal for all patients or all warts. The majority of patients require a course of therapy rather than a single treatment, and improvement will generally be seen within 3 months. The majority of warts will resolve with no risk of future cancer. It is hoped that the future infections with high risk HPV can be eliminated by adoption of the HPV vaccine and good education on safe sexual practice.
2. Discuss advantages and risks of specific treatment options
- Physical destruction +/- immunologic stimulation
- Self-applied treatment
- Physician/nurse applied therapy
- Combination therapy
Most treatment modalities treat the symptom of the disease (warts) versus the disease itself. However, imiquimod, goes further by inciting an immunologic response, thereby providing a field effect in clinical and subclinical HPV.
There are three treatment modalities:
- Destroy or directly inhibit the growth of the warts
- Stimulate the patients own immune attack on the warts
- Combine both strategies
3. Evaluate risk of other sexually transmitted diseases
A discussion with your doctor about testing for other STI( sexually transmitted infections) such as Chlamydia
4. Evaluate risk of cervical or other cancers in the ano-genital tract
Educate of re-einforce the need for cervical smears. Homosexual men with anal warts also should be followed and anal smears taken to rule out squamous cell cancers
5. Educate patient on reducing transmission risk.
- Abstaining from having sex is the most effective way of prevention.
- Practice safe sex. Condoms have been shown to reduce risks of acquiring warts especially for women. Condoms naturally do protect against that are not directly on the genitalia.
- Avoid having sex with individuals who warts.
- Tell your partner that you have warts. Risks of transmission probably reduce significantly once the treated warts have disappeard although it may not be zero risk.
6. Inform about availability of HPV vaccine for young women.
[CDC. Genital Warts Treatment Guidelines 2006. URL: http://www.cdc.gov/std/treatment/2006/genital-warts.htm.]
Before beginning any treatment, it is essential to screen patients for other sexually-transmitted diseases.
Genital Warts Treatment:
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