Genital warts

Dear Dr Mitchell,I’m not a woman but I do have a question about HPV genital warts. Six years ago I got into a relationship with a woman and we were engaging in unprotected sex from the beginning. She was on birth control and said we didn’t need condoms. For the first few months sex happened in the dark because we were still new to each other and she was very insecure about her body. Once I finally saw her in the light naked, I noticed her vagina lips and around that area had 10 to 20 bumps varying in size and colour. I asked what they were and she said they were nothing. Fast-forward two years and I start getting some intense itching in the groin area, and notice bumps of my own. I asked her again and she said they are skin tags and I should have them treated with silver nitrate. The main bump is by all definition wart-looking. I went to a skin doctor and he froze it off, calling it a mole. Just recently I found a stack of papers of my now ex, that were Planned Parenthood documents of hers from a year before we met. There were five different ones from different dates where it is noted that she had HPV condyloma. I again brought it up to her and she said she was tested for STDs when she was pregnant and that she doesn’t have any. I tried to tell her that she can test negative for HPV and still have genital warts which are a lifelong virus. I feel violated that she didn’t tell me in the beginning and feel bad for all her current sexual partners who are also now at risk. I’ve been told she doesn’t make anybody wear protection and doesn’t disclose her condition. Any advice, tips, or wart facts?

Genital warts are very common and are due to the Human Papilloma Virus which is sexually transmitted. HPV is found in over 80 per cent of sexually active women and may be totally asymptomatic.

HPV subtypes 6 and 11 account for over 90 per cent of genital warts. High risk HPV subtypes 16, 18, 31 and 45 account for over 80 per cent of all cases of cervical cancer.

HPV is not necessarily a lifetime disease. Young people under 30 years old tend to have a high incidence of HPV infection which they will tend to clear naturally with time especially if you have a good immune system. Within 18 months most healthy individuals will spontaneously clear themselves of the infection.

Men tend to get rid of HPV infection quicker than women. They can pass the infection on to their partners and then show no signs of the virus with time. The burden of disease in men tends to be significantly less than in women. HPV infection can cause cancer of the penis, anus and oropharynx in rare cases. These cancers are usually due to HPV subtypes 16 and not to low-risk subtypes 6 and 11 which cause genital warts.

Cervical cancer is the second most common cancer in women with a high incidence especially in developing countries, where access to screening with Pap smears is not widely available. Anal cancer and oropharyngeal cancers are also seen in women and are caused by HPV infection. Condom usage will reduce transmission of HPV infection by about 75 per cent. The virus may be present in areas of the genital tract, scrotum and inner thighs where the condom does not cover and transmission can occur despite the use of condoms. Oral sexual activity and any skin contract without penetrative sexually activity can cause the transmission of HPV infection. However, safe sexual practice should still be the way forward since this will reduce the chance of contracting other sexually transmitted infections such as HIV and syphilis.

It is unsafe to have sexual activity with a new partner in the dark because you just never know what you will be exposed to, especially if a condom is not used.

In pregnancy, screening for HPV infection is not routinely done. Women are usually advised to do a Pap smear once they are 21 years old and over. HPV testing is not routinely done in women under 30 years old. The sexually transmitted infections that are routinely screened for in pregnancy include HIV, syphilis, and Hepatitis B infection. You can have a normal Pap smear and still have HPV infection.

HPV infection is really commonplace and you should not allow this to affect your emotional state or future relationships. You should definitely get treatment for the genital warts. Aldara cream (Imiquimod) is effective in getting rid of genital warts, or they can be burnt off using electrocautery or laser vaporisation.

The disease is by no means a lifetime infection. If you have a weak immune system, then the virus may last longer in your system. This is seen in HIV-positive individuals, steroid usage for chronic medical conditions, and some poor individuals with inadequate nutrition. Persistent HPV infection tends to cause cancer of the genital tract. Vaccination is now widely available to prevent HPV infection and genital tract cancer. These vaccines are affordable, safe and effective. This will reduce your risk of contracting HPV infection if you are exposed to the virus in a subsequent relationship.

Do not be overly distressed about the genital warts. Get them treated and also do a blood test to screen other sexually transmitted infections such as HIV and syphilis. Tests for chlamydia and gonorrhoea should also be done. Ask your doctor about the HPV vaccines and protect yourself.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.

DISCLAIMER

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.