GENITAL WARTS:

GENITAL WARTS:

Dear Sumner:

Frank is a 43 year old man who will be calling for an appointment to see you shortly. His problem is that of recurrent warts on the shaft of his penis and under his foreskin. He has been treated with various methods including topical lotions, liquid nitrogen as well as fulguration, but the warts keep returning. He is married and claims to have a monogamous relationship. He is uncircumcised. What would you suggest as the next steps, both diagnostically and therapeutically? Assuming you rid Frank of his warts, what can he do to prevent their recurrence?

Dear Percy:

As you probably know, genital/venereal warts, (also called condylomata acuminata) are caused by the human papillomavirus. They are very contagious and are spread during oral, genital or anal sex with an affected partner, usually appearing within three months after contact. The lesions in Frank were quite apparent on both the shaft of his penis and under his foreskin. I applied some acetic acid (vinegar), which revealed a few other small areas on his penis to whiten, suggesting that these areas were also infected (I routinely apply acetic acid to any male patient when there is a suspicion of genital warts, since this method may reveal otherwise undetected lesions). However, it is often difficult to find the lesions in the woman, since they can occur not only externally, but also deep in the vagina. It is, therefore important that Frank’s wife be examined by her gynecologist who will likely do a Pap smear and maybe even a biopsy.

Now for the important questions: how do we get rid of the warts, and perhaps even more critical, how can we prevent their recurrence? There is a myriad of caustic agents which can be applied locally. If any of the lesions appear atypical, I do a biopsy prior to their destruction. I personally prefer to destroy the lesions with electrocautery, but cryosurgery or laser therapy is similarly effective.

The only way to prevent a recurrence is to avoid direct contact with the virus. This means, of course, that the virus must be completely eradicated in both Frank and his wife (assuming there are no other partners involved), since the virus is transmitted by skin-to-skin contact. Unfortunately, there is still a possibility that the virus may remain in the body even though the external lesions have been eradicated. But, as Frank says, he and his wife enjoy the skin-to-skin contact and have decided to use condoms only if either of them becomes suspicious of a recurrence. I should mention that Frank wishes to keep his foreskin despite the realization that it might harbor the virus, leading to a greater chance of recurrence.

Dear Sumner:

Frank is a 43 year old man who will be calling for an appointment to see you shortly. His problem is that of recurrent warts on the shaft of his penis and under his foreskin. He has been treated with various methods including topical lotions, liquid nitrogen as well as fulguration, but the warts keep returning. He is married and claims to have a monogamous relationship. He is uncircumcised. What would you suggest as the next steps, both diagnostically and therapeutically? Assuming you rid Frank of his warts, what can he do to prevent their recurrence?

Dear Percy:

As you probably know, genital/venereal warts, (also called condylomata acuminata) are caused by the human papillomavirus. They are very contagious and are spread during oral, genital or anal sex with an affected partner, usually appearing within three months after contact. The lesions in Frank were quite apparent on both the shaft of his penis and under his foreskin. I applied some acetic acid (vinegar), which revealed a few other small areas on his penis to whiten, suggesting that these areas were also infected (I routinely apply acetic acid to any male patient when there is a suspicion of genital warts, since this method may reveal otherwise undetected lesions). However, it is often difficult to find the lesions in the woman, since they can occur not only externally, but also deep in the vagina. It is, therefore important that Frank’s wife be examined by her gynecologist who will likely do a Pap smear and maybe even a biopsy.

Now for the important questions: how do we get rid of the warts, and perhaps even more critical, how can we prevent their recurrence? There is a myriad of caustic agents which can be applied locally. If any of the lesions appear atypical, I do a biopsy prior to their destruction. I personally prefer to destroy the lesions with electrocautery, but cryosurgery or laser therapy is similarly effective.

The only way to prevent a recurrence is to avoid direct contact with the virus. This means, of course, that the virus must be completely eradicated in both Frank and his wife (assuming there are no other partners involved), since the virus is transmitted by skin-to-skin contact. Unfortunately, there is still a possibility that the virus may remain in the body even though the external lesions have been eradicated. But, as Frank says, he and his wife enjoy the skin-to-skin contact and have decided to use condoms only if either of them becomes suspicious of a recurrence. I should mention that Frank wishes to keep his foreskin despite the realization that it might harbor the virus, leading to a greater chance of recurrence.