Genital wart is one of Sexually Transmitted Diseases that caused by the Human Papilloma Virus and occur most frequently in young adults and HPV can be found worldwide. There are 100 types of HPV, of which at least 13 are cancer-causing. Most people are infected with HPV shortly after the onset of sexual activity.
There are 13 types of HPV are cancer-causing. Two HPV types (16 and 18) cause 70% of cervical cancers and precancerous cervical lesions. Cervical cancer is the second most common cancer in women, with more than 270 000 women die in every year from cervical cancer; more than 85% of these deaths are in low- and middle-income countries.Vaccines against HPV 16 and 18 have been approved for use in many countries.
Human papillomaviruses are DNA viruses that infect basal epithelial (skin or mucosal) cells.
SITES OF INFECTION :
- Male : Penis, around anus and rectum.
- Female : Vulva, the area surrounding the anus, and the vagina.
SIGNS AND SYMPTOMS :
- Soft, fleshed colured, broad based or pedunculated (on stems) warts of variable size, often with a cauliflower-like appearance.
- Ulceration, can be found secondary infection.
Symptoms of cervical cancer may include:
- Irregular, intermenstrual (between periods) or abnormal vaginal bleeding after sexual intercourse.
- Back, leg or pelvic pain.
- Fatigue, weight loss, loss of appetite.
- Vaginal discomfort or odourous discharge.
- A single swollen leg.
- Visual Inspection.
Indication for biopsy :
- Uncertain diagnosis
- The lesions do not respond to standard therapy.
- The disease worsens during therapy.
- Atypical lesion.
- The patient has comprised immunity.
- Pigmented warts, indurated, fixed, bleeding, or ulcerated.
HPV AND CANCER :
- High risk genotype that can lead to cervical cancer, and are associated with other mucosal anogenital and head and neck cancers. : genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 66.
- Other genotype, termed as Low Risk can cause benign or low-grade cervical tissue changes and genital warts (condyloma acuminata), which are growths on the cervix, vagina, vulva and anus in women and the penis, scrotum or anus in men.
- Podophyllin 10–25% in compound tincture of benzoin, applied carefully to the warts, avoiding normal tissue. After 1-4 hours, you should to washing the applied area. It can be repeated weekly.
- Podophyllotoxin 0,5%. Imiquimod 5 %, Sinecatechins 15 % ointment.
- Trichloroacetic Acid 80-90% : External genital and perianal warts.
- Cryotherapy with liquid nitrogen, solid carbon dioxide, or a cryoprobe. Repeat applications every 1–2 weeks . Cryotherapy is non toxic, not required anesthetic, and not scarring if carried out properly.
- Solid carbon dioxide or Cryopribe.
- Electrosurgery or surgical removal.
Vaginal Wart :
Recommendation of treatments are :
- Cryotherapy with liquid nitrogen or;
- Podophyllin 10–25%. Allow to dry before removing speculum, or;
- TCA 80–90%.
Cervical Warts :
Recommendion of treatments :
- Management should include consultation with an expert.
- Pap Smears.
- No TCA or podophyllin.
Meatal and Urethral Warts :
Recommendation of treatment :
- Chryotherapy or Podophyllin 10-25%.
PREVENTING HPV :
HPV Vaccines are made from live-biological products or DNA that is empty protein shells called virus-like particles (VLP). Current HPV vaccines are designed to protect against HPV 16 and 18; the quadrivalent vaccine also protects against low-risk genotypes 6 and 11.
Primary prevention begins with HPV vaccination of girls aged 9-13 years, before they become sexually active.
Other recommended preventive interventions for boys and girls as appropriate are:
- Warnings about tobacco use, which often starts during adolescence, and which is an important risk factor for cervical and other cancers;
- Education about safe sexual practices, including delayed start of sexual activity;
- Promotion and provision of condoms for those already engaged in sexual activity; and
- Male circumcision.
- Media Center : Human papillomavirus (HPV) and cervical cancer; WHO.
- Human papillomavirus and HPV Vaccines in Bulletin of the WHO, WHO
- Guidelines for the Management of Sexually Transmitted Infection, WHO 2003.
- Genital Warts in STD Treatment Guidelines 2010, CDC.
- International Medical Guide for Ships, WHO 2007.