HIV and genital warts

Dear Doctor

I am a 40 year old man. I have noticed that my wife has a collection of very small pimples on her genitals. Both of us do not feel any pain whatsoever.A� I am afraid she may be having genital warts. I have just read a little on them and I will be happy to have more information so that we can seek treatment

From Concerned

Dear Concerned

Genital warts are caused by a virus HPV (human papilloma virus). HPV is caught during sexual contact with someone who is already infected with it. If you develop genital warts, try not to feel too angry, remember they are very common and a lot of people have them, they are not dangerous and there are many effective ways of treating them.

You may feel upset with your wife. But in fact she may not know that she had HPV for the following two reasons.

Firstly, some people carry HPV, but do not have any warts. In fact 15a��40% of people under 40 are carriers of HPV, though it is less common in older people. In most people who carry HPV, it goes away in a year or two. Secondly, a man may not know that he has a wart, because it can be hidden inside the urethral opening. Similarly, a woman can have a wart on the cervix (that is, deep inside the vagina) that she does not know about.

There are over 100 different types of HPV. Most genital warts are caused by just two types of the virus (types 6 and 11). The virus is easily passed from one person to another through sexual contact. But you do not need to have penetrative sex to catch them, as close genital contact (skin to skin) is enough to pass it on. Most people will not develop warts and the virus will go away without treatment. There is a strong link between HPV types 16 and 18 and cervical cancer. In fact, about 70% of cervical cancers are probably caused by HPV 16 and 18. But HPV 16 and 18 do not usually cause visible warts. Therefore if you have genital warts, you are not at a particularly increased risk of cervical cancer.

So what do genital warts look like and how do you know you have them? In women, genital warts begin as small, gritty-feeling growths, which then enlarge and become more frond-like. They can join together so they resemble miniature cauliflowers. Occasionally they are flat, like warts on the fingers. They are not painful, but can feel itchy or vaguely uncomfortable. In men, warts on the scrotum or shaft of the penis usually resemble the ordinary warts that occur on the hands. Under the foreskin and round the anus, they are usually a shiny pinkish-white. A lone wart may also occur inside the opening of the urethra (urination hole); here it will be a pinkish colour and may look speckled.

An individual may have dozens of warts, or just one or two.

There are several treatments for genital warts. The usual treatments because they are simple and effective are podophyllotoxin or imiquimod. These are all prescription medicines and cannot be bought over-the-counter. Other treatments (such as freezing, burning with acid or laser treatment) are sometimes used, depending on the type and size of wart.

Annoyingly, whatever the treatment, there is a 30% chance that the warts will come back usually after a few weeks or months. This is because the treatments destroy the wart itself, but cannot get rid of the HPV in the skin beneath the wart.

Do not try to treat genital warts with any of the wart lotions you can buy from pharmacists; these are for use on the hands only. You need to see a doctor, either your family doctor or a doctor at a sexual reproductive health clinic, whichever you feel most comfortable with. The advantage of going to a sexual reproductive health clinic is that you will have tests for other infections; 1 in 5 people with genital warts has another infection that they are probably unaware of.

There is an HPV vaccine being offered to school-going girls. There are two different vaccines against HPV, Gardasil and Cervarix. Gardasil protects against HPV types 6 and 11 (which cause visible warts) as well as types 16 and 18 (the cancer-causing types). Cervarix protects against only types 16 and 18 which are the cancer-causing types of HPV, but not the types that cause visible warts

Using a condom when having sex offers a degree of protection from infection with HPV, or from passing on the virus to somebody else. However, protection is not complete as the skin around the genital area may also carry the infection.

People who are sexually active are advised to have regular sexual health check-ups, where HPV and other sexually transmitted infections can be tested for. Most HIV treatment centres have an associated sexual health clinic where free and confidential treatment can easily be obtained. .