Warts and all: This nasty problem a real downer

Surprises lurk around each corner. Some surprises are wonderful: flowers on your desk, an unexpected inheritance, Simon Cowell and Paula Abdul back together on The X Factor. Other surprises are not so much: an IRS notice saying you owe back taxes, a fender-bender, Simon Cowell and Paula Abdul back together on The X Factor.

How's this for a big surprise? Finding warts on your genitals and anus.

Clinically known as condylomata acuminata, these warts are #1 viral sexually transmitted disease in the US. Caused by HPV, the human papilloma virus (in particular types 6 and 11), they can occur around the anus, inside the anus (perianal) and on the genitals (i.e. penis, vulva, vagina).

Typically, they are pink or skin-colored warts that usually look like cauliflower or caviar droppings on a cracker. The warts can also be smooth and flat, and may be confused with secondary syphilis.

(Men with an unrelated condition called acral angiofibromas have benign, pearly bumps on the head of the penis that can be confused with genital warts. I have had patients ask me to give them a letter to state their condition is not genital warts. Can you imagine carrying around your driver’s license, credit cards, and a proof of acral angiofibromas?)

The warts we're discussing, however, are usually contracted through sexual or anal intercourse, though sometimes they can be transferred from finger to anus, mouth to anus, mouth to vagina, and finger to vagina. The risk of having anogenital warts increases with the number of sexual partners, as well as being immunocompromised (e.g. HIV+).

The incubation period ranges from three weeks to eight months. Depending on where the warts pop up, the number of warts, and the size of the warts, symptoms can vary. I’ve had patients think they just had a skin tag or hemorrhoid when in fact they were anogenital warts. These warts can cause itchiness, pain, burning, bleeding, and vaginal discharge.

If the condylomata acuminata grows inside the anus, it can block bowel movements. High-resolution anoscopy is the best way to see if any pre-cancerous or cancerous cells develop. Because more than one type of HPV can be contracted along with the condylomata acuminata type, cervical cancer or squamous cell carcinoma on the penis or vulva are possible.

For lucky folks, the warts spontaneously disappear within two years. The problem with anogenital warts is they often come back and recur within six months about 30-70 percent of the time. This is very distressing to patients who want to be free of this highly contagious malady.

Chemical or physical destruction of the warts is usually the first approach, unless they’re too extensive or invasive, in which case surgery is indicated. Chemicals to burn off the warts combined with cryoablation (removal by freezing with liquid nitrogen) are up to 50 percent effective after three months. Because the warts tend to come back, more rounds of treatment are often warranted.

Immunological treatments are being studied and might offer better results. Surgical excision is often done when nothing else is working, though recurrence is still an issue.

Gardisil is a vaccine to help prevent genital warts and reduce the risk of cervical cancer. Since condylomata acuminata occurs in both sexes, and since males give females HPV that can cause cervical cancer, Gardisil might be a way to lower the number of STD “surprises” out there, especially among the young and the restless.
May your surprises be the flowers on your desk and not the warts on your…well, warts.
Dr. Hook cracks a joke or two, but he’s a respected physician with an interesting website, drjohnhong.com. Email him with your questions!