Genital Warts

By Dr. Diana Sarmiento, The Blogging Doc

Don’t panic!

Genital warts may look and sound scary but they are actually benign … meaning non-cancerous growths on the vulvar, penile or anal area.

The warts are caused by the Human Papilloma Virus (HPV). There are around 130 types of HPV which makes this infection very common. In the Philippines, it is estimated that 4 out of 5 women may already have been exposed or infected by HPV.

HPV is spread by skin-to-skin contact especially if there is a break in the skin. By “skin-to-skin”, it does not mean that HPV is spread only through sexual activity. Rubbing, scratching and stroking the genital areas may spread the virus.

Not all HPV are harmful. Sixty percent of cases infected with HPV will clear out or resolve by themselves. The danger happens when you get infected by the cancer-causing HPV specifically types 16, 18, 45, 31, 33, 58 and 52.

It may take 10-15 years from the time of exposure till you develop early signs of cancer. The cancer may affect the cervix, vagina, oral cavity, throat, conjunctiva of the eyes and anus. The penis is very rarely affected (although men may be carriers of the virus) because the skin of this organ is very thick and it is external to the body which is not ideal for the growth and incubation of the virus.

Because of the high prevalence of HPV in our country, you may choose to be vaccinated to protect yourself from cancer of the cervix. There are two brands currently available: Cervarix P2,500/shot x 3 doses and Gardasil P3,500/shot x 3 doses. Please ask your doctor for all the information necessary so that you will know which one is best for you.

Most laboratories cannot tell you what specific HPV type you have. These tests are only available in research labs. What is available is an HPV DNA test where in a swab of vaginal discharge is submitted to the lab to tell y0u if you do have HPV but not which one. It costs P4,000 at High Precision Laboratories.

As for the genital warts, there are several options to get rid of those ugly lesions:

1. Podophyllotoxin 0.5% gel, cream, or solution (Condylox) – Apply weekly, leave for 1-6 hrs then wash off. If there is no improvement after 6 wk, stop treatment. Avoid excessive application. Avoid contact with eyes and inflamed skin. Not to be used on cervical or urethral warts.

2. Fluorouracil (5%) cream or solution(Efudex) - Apply 1-2 times/day for 2-4 wk.

3. Imiquimod 5% cream (Aldara) - Apply 3 times a wk (prior to normal sleeping hrs). Leave on the skin for 6-10 hr. Max: 16 wk.

4. Interferon, intramuscular or intralesional injection – 3 million units, 3 times per week for 3 weeks

All of the above mentioned methods have to be applied carefully since you may injure the normal skin of the vagina or anus. Please read all instructions carefully.

If you feel that applying these agents and waiting up to 4 months for the warts to disappear is torture for you, you may choose electrocauterization.

This method is quick, less painful but more expensive. In an out-patient clinic, the doctor may charge P5,000-10,000 without sedation, just local anesthesia. In the operating room under general anesthesia (which is the painless way), the package rate would be P25,000-45,000 for the hospital, gynecologist and anesthesiologist “all in” … depending on the hospital, of course.

The other benefit of doing the procedure under anesthesia is that the doctor can get a sample for biopsy and submit it to the lab so that you may know if this really is an HPV infection.

As a final tip, if you are on a tight budget. Its best to spend for the vaccination first. May kulugo ka na. Wala na tayong magagawa dun. Nahawa ka na. It’s not the end of the world. What you have to do now is to protect yourself from cancer. The warts are just ugly and itchy but they will not kill you … cancer will. After a few months, kung nakaipon ka na then you can have it removed or you can apply those creams I mentioned above.

Dr. Diana Sarmiento is a mother of three, part-time doctor, and a full-time wife and mother. The topics closest to her heart are women’s health, parenting, and any new information that she can get her hands on. Read more on her personal blog, Filipina M.D.