Genital warts - annoyance or serious health burden?
Genital warts, also known as condylomata acuminata are caused by Human Papilloma Virus (HPV) and one of the most frequent STD worldwide. The low-grade HPV group includes types 6 and 11 causes approximately 90% of genital warts. It's reported that there are 6.2 million new cases of genital wart in a year in United States alone and it not only cause a high economic burden to health care system but also a significant public health concern worldwide.
Genital warts tend to affect the moist part of our genital region. It can also develop in the anus, mouth or throat of a person who has had sexual contact with an infected person. It can appear as small, flesh-colored bumps or cauliflower- like shape when cluster together. It's rather painless and can increase in size and numbers quite steadily. Occasionally it may cause itchiness or bleeding.
Genital warts are highly infectious despite use of condom as warts may grow in other parts that are not covered by the condom. Risk factors for developing genital warts are having unprotected intercourse, multiple sexual partner, use of oral contraceptives, past history of smoking and being immunocompromised. On average, the warts may appear 2 to 3 months after initial contact. The virus is capable of lying dormant within the skin cells for prolonged periods of time and remained undetected.
Without treatment, about 30% of genital warts will regress within the first four months of infection. Unfortunately, long-term remission rates are not known and majority of genital warts will recur within three months of infection or even after treatment. The current treatment modalities for genital warts are focus on removal of the wart rather than elimination of the underlying viral infection. HPV vaccination such as Gardasil 9 confers protection that includes against HPV 6 and 11. Treatment includes use of acid, Imiquimod cream, cryotherapy, electrosurgery and CO2 laser. Currently, there are little evidence to suggest one type of treatments as the gold standard but rather it depends on various factors such as cost, need and desires of individual patient and its side-effects. Local treatment often cause irritation to the sensitive genital skin. Treatment of genital warts can be frustating for both patient and doctor due to recurrence of warts despite multiple treatment and inconsistent treatment outcomes.