The CO2 laser utilizes focused infrared light energy. This energy is absorbed by the tissues, making the tissue water to vaporize. The target area gets void of water, is not viable any longer, so the lesion gets destroyed. Laser allows precise tissue ablation by spatial limitation of thermal damage and effective vaporization.

CO2 laser therapy is a useful treatment method, especially for extensive warts and can be used at difficult anatomical sites. It is typically performed in an office. In some particular cases (large lesions, pediatric patients) anesthesia may be required and therefore this procedure should be done in hospital under general anesthesia. The CO2 laser is very precise and therefore it spares normal tissue, probably it eliminates the infective agent and also has a good cosmetic effect. However, it is considerably more expensive than other destructive methods used for GW treatment (cryotherapy, electrosurgery or surgical excision).

In most of the cases, healing is rapid. The risk of scaring is small but is greater than of cryotherapy. Other side effects are similar to those of surgery. It has been shown that the plume of smoke resulting form laser technique may contain papilloma virus DNA, with contagious potential for operating personnel (infection of the respiratory tract). However, if appropriate equipment is used, the risk for contamination is basically null (Garden JM, 1988; Scheinfeld NS, 2005; Weynandt GH, 2011).
Efficacy and Recurrence
Overall, the clinical studies have shown clearance rates between 23% and 52%, whereas the recurrence rates varied from 60% to 77% over a follow-up period of 3-18 months (International Collaborative Study Group, 1993; Duus BR, 1985; Reid R, 1992; Petersen C, 1991).

A study comprising 208 patients (135 women and 73 men) with vaginal and external anogenital warts was designed to compare the outcomes of electrosurgery and laser therapy. To avoid selection bias, in each patient half of the lesions measuring 2 cm2 or greater total linear area were treated with electrosurgery, and the other half were treated with laser excision. The follow-up was at least 6 months after the last treatment received. Clearance was achieved in 95% of patients with a lesional area of 5 cm2 or less, and 100% of patients with 5 cm2 or larger by the third and sixth postoperative week, respectively. Similar side effects occurred in both groups: severe discomfort (12% of patients), and delayed complications, including vitiligo and scarring (4% of patients). Complete clearance of warts after a single session (51% vs 38%) and multiple treatments (75% vs 64%) were similar for electrosurgery and CO2 laser. In vaginal and external GW electrosurgery and continuous wave CO2 laser seems to be equally effective especially if the lesions are limited to a 5 cm2 or less area (Ferenczy A, 1995).

Another randomized trial in patients with refractory GW also found the carbon dioxide laser did not offer any advantages over traditional surgery, including electrocautery (Duus BR, 1985). No difference between the two treatments was seen in numbers of recurrences, postoperative pain, healing time, and rate of scar formation.
One-hundred-six patients treated with CO2 laser for GW were followed for 6 months. At one month follow-up, clearance was found in 81.2% of cases, recurrence in 12.6% and persistence in 6.6%. Ninety-three percent of patients in remission at one month were still in remission at three months. At six months, 83% of patients were in remission after 1.4 laser treatments. (Aynaud O, 2008).

A case-control study was performed on pregnant women with GW treated with CO2 laser. Two-hundred-eighty women received treatment during pregnancy and 256 women were treated three months after delivery. Recurrence rates over a 2 year follow-up were higher in the women treated in postpartum (p < .01) than in the group treated during gestation (p < .005). Clinical HPV infections treated during the second trimester of pregnancy were associated with a decrease in recurrence rate of infection (Frega A, 2006).

Another study evaluated the complication rate and patient satisfaction in male patients with extensive GW treated with laser or electrosurgery. Questionnaires were used retrospectively in 64 consecutive men (answer rate 60% or 64/107 addressed persons). The mean follow-up was 25 months (range 7-75). The overall clearance rate after 1 session of treatment was 67%. The clearance and recurrence rates were similar for both HIV-positive and HIV-negative groups. However, the cure rate was influenced by localization: endoanal versus perianal: 56 versus 84% (odds ratio = 4.06; p = 0.03). After a second treatment session, the cure rate increased to 79% or higher in all subgroups. Painful defecation for an average of 4-5 weeks was the main postoperative complaint. (Carroza PM, 2002).

It appears that administration of interferon alpha-2b subcutaneously following laser therapy in patients with resistant GW is beneficial. Interferon was fairly well tolerated in a trial and significantly improved the clearance rates: 14/27 patients (52%) cured in the group treated with laser plus interferon, vs 5/22 (23%) patients in laser plus placebo group (Petersen CS, 1991).
In conclusion, laser surgery is as effective as surgical excision at clearing and preventing recurrence of genital warts. Even it was considered at one time the method of choice for treating GW, it has not be proven to be superior to other therapy options.

References

Aynaud O, Buffet M, Roman P, Plantier F, Dupin N. Study of persistence and recurrence rates in 106 patients with condyloma and intraepithelial neoplasia after CO2 laser treatment. Eur J Dermatol. 2008 Mar-Apr;18(2):153-8.
Condylomata International Collaborative Study Group. Randomized placebo-controlled double-blind combined therapy with laser surgery and systemic interferon-alpha 2a in the treatment of anogenital condylomata acuminatum. J Infect Dis 1993;167:824-9.
Duus BR, Philipsen T, Christensen JD, Lundvall F, Søndergaard J. Refractory condylomata acuminata: a controlled clinical trial of carbon dioxide laser versus conventional surgical treatment. Genitourin Med. 1985 Feb;61(1):59-61.

Frega A, Baiocco E, Pace S, Palazzo A, Iacovelli R, Biamontil A, Moscarini M, Stentella P. Regression rate of clinical HPV infection of the lower genital tract during pregnancy after laser CO2 surgery. Clin Exp Obstet Gynecol. 2006;33(2):93-5.
Garden JM, O’Banion MK, Shelnitz LS, Pinski KS, Bakus AD, Reichmann ME, Sundberg JP.: Papillomavirus in the vapor of carbon dioxide laser-treated verrucae. JAMA. 1988;259:1199-202.

Surgical excision usually requires adequate anesthesia (local, regional, or general) and surgical instruments for hemostasis, because large genital warts are very vascular and can heavily bleed.
The side effects of procedure include pain, bleeding/ hematoma, infection, scarring.
Efficacy and Recurrence

Two trials comprising 97 patients found no significant difference between surgical excision and podophyllin in terms of wart clearance (16/18 [89%] with surgical excision v 15/19 [79%] with podophyllin; RR 1.13, 95% CI 0.85 to 1.50 (Khawaja HT, 1989); and 28/30 [93%] with surgical excision v 23/30 [77%] with podophyllin; P = 0.20 (Jensen SL, 1985). However, the recurrence rates over 6–12 months were significantly reduced by surgery compared with podophyllin (19% with surgical excision v 60% with podophyllin, P = 0.05 (Khawaja HT, 1989), and 29% with excision v 65% with podophyllin, P < 0.01 (Jensen SL, 1985). More patients receiving surgical excision than receiving podophyllin had pain (11/18 [61%] with excision v 5/19 [26%] with podophyllin (Khawaja HT, 1989); 25/30 [83%] with excision v 7/30 [23%] with podophyllin (Jensen SL, 1985). More people receiving surgical excision than receiving podophyllin had bleeding (13/30 [43%] with excision v 11/30 [37%] with podophyllin) (Jensen SL, 1985). The statistical significance of the differences was not assessed by these trials.

Overview research to medicine:

Another trial compared surgical excision versus carbon dioxide laser (Duus BR, 1985). The two treatment had similar outcomes, with no significant difference in wart clearance (43 people; RR 1.2, 95% CI 0.6 to 2.4), and no significant difference in recurrence rates. The trial also found no significant difference in postoperative pain, healing time, and rate of scar formation (p > 0.1-0.2), although fewer people having surgical excision developed scars (9% had scars with surgical excision v 28% with laser surgery; P > 0.2).

Excision of extensive anal warts has a high probability of recurrences. However, the risk of developing anal stenosis was low in a study of 41 patients undergoing excision of large anal warts with an average follow-up of 6 months. Recurrent warts developed in 19 patients (46.3%). Bleeding was a complication in 22% of the cases. None of the patients developed postoperative stricturing or anal stenosis at follow-up (Klaristenfeld D, 2008).
A randomized controlled study was carried out in 261 patients with anal warts allocated to surgical excision alone (control group; n = 122) and surgical excision plus postoperative immunostimulation for 30 days with a natural product (STET; study group; n = 139). Six months after surgery, recurrence occurred in 7.2% (10/139) in the study group and in 27.1% (33/122) in the control group (P < 0.0001), suggesting that immunostimulation using a natural product may be used to reduce the incidence of recurrence of anal warts in patients undergoing surgical excision Mistrangelo M, 2010).
Surgical excision was safely and successfully used in a pregnant woman to remove an obstructive urethral wart causing difficulty in urine voiding. (Parnell BA, 2010).

In conclusion, surgical excision is as effective as laser surgery at clearing and preventing recurrence of genital warts, and is more effective than podophyllin at preventing recurrence after 6–12 months. Surgical excision of external GW may cause pain, bleeding and scaring.

References

Duus BR, Philipsen T, Christensen JD, Lundvall F, Søndergaard J. Refractory condylomata acuminata: a controlled clinical trial of carbon dioxide laser versus conventional surgical treatment. Genitourin Med. 1985 Feb;61(1):59-61.

Jensen SL. Comparison of podophyllin application with simple surgical excision in clearance and recurrence of perianal condylomata acuminata. Lancet. 1985 Nov 23;2(8465):1146-8.

Khawaja HT. Podophyllin versus scissor excision in the treatment of perianal condylomata acuminata: a prospective study. Br J Surg. 1989 Oct;76(10):1067-8.

Klaristenfeld D, Israelit S, Beart RW, Ault G, Kaiser AM. Surgical excision of extensive anal condylomata not associated with risk of anal stenosis. Int J Colorectal Dis. 2008 Sep;23(9):853-6.

Mistrangelo M, Cornaglia S, Pizzio M, Rimonda R, Gavello G, Dal Conte I, Mussa A. Immunostimulation to reduce recurrence after surgery for anal condyloma acuminata: a prospective randomized controlled trial. Colorectal Dis. 2010 Aug;12(8):799-803.
Parnell BA, Geller EJ, Jannelli ML. Urethral condyloma accuminata causing bladder outlet obstruction in pregnancy: a case report. J Reprod Med. 2010 Nov-Dec;55(11-12):514-6.

There are many modalities for treating genital warts, depending on the morphology, number and distribution of warts and patient preference. However, none of them provide 100% chance of clearance or 0% chance of recurrence. Also, there is no clear evidence that any one treatment is superior to the others.

Therapy may be applied by the patient or by the provider. A treatment response is usually seen within 3months.

The US latest (2010) guidelines on GW treatment recommend the following options:

External genital warts

Patient-applied therapy:

• Podofilox 0.5% solution or gel or
• Imiquimod 5% cream  or
• Sinecatechins 15% ointment

Provider-administered therapy:

• Cryotherapy with liquid nitrogen or cryoprobe or
• Podophyllin resin 10-25% in a compound tincture of benzoin or
• Trichloroacetic acid (TCA) or bichloracetic acid (BCA) 80-90% or
• Surgical removal by tangential scissor excision, tangential shave excision, curettage, or electrosurgery.

Alternative Regimens

Alternative regimens include treatment options that might be associated with more side effects and/or less data on efficacy. These include:
- intralesional interferon
- photodynamic therapy
- topical cidofovir.

Vaginal warts

• Cryotherapy with liquid nitrogen or
• TCA or BCA 80-90%

Urethral meatus warts

• Cryotherapy with liquid nitrogen or
• Podophyllin 10-25% in compound tincture of benzoin

Anal warts

• Cryotherapy with liquid nitrogen or
• TCA or BCA 80-90% or
• Surgical removal

Because all available treatments have shortcomings, some clinics employ combination therapy (simultaneous use of two or more modalities on the same wart at the same time). Data are limited regarding the efficacy or risk of complications associated with use of such combinations.

Clearance and recurrence rates for individual treatments in the published literature are shown in the following table (according to the UK National Guideline on the Management of Ano-genital Warts, 2007).

*Studies using more than one treatment strength have been grouped together.

It is important to mention that these studies are not comparable in design, methods and endpoints.

References
Genital warts. In: Sexually transmitted diseases treatment guidelines, 2010. Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep 2010 Dec 17;59(RR-12):70-4.

United Kingdom national guideline on the management of anogenital warts. London (UK): British Association for Sexual Health and HIV (BASHH); 2007. 18 p. Clinical Effectiveness Group, British Association for Sexual Health and HIV (BASHH).

PODOPHYLLIN and PODOPHYLLOTOXIN (PODOFILOX, CONDYLOX)

Podophyllin is a resin derived from the rhizome (underground root) of the mayapple (Podophyllum peltatum), a plant that grows wild in eastern North America. Podophyllin  was the first topical treatment ever applied on GW. It is also used nowadays as a 10-25 % suspension in tincture of benzoin (physician applied). Podophyllin is an antimitotic agent that interferes with viral activity by inducing local tissue necrosis.

Applied directly to each genital wart, it is left for six hours and then washed off. This process may be repeated one time per week, for up to 6 weeks or until the warts are gone. Once applied to each wart it should be allowed to air-dry before the treated area comes into contact with clothing; over application or failure to air dry can result in local irritation caused by spread of the compound to adjacent areas. The preparation should be thoroughly washed off 1–4 hours after application to reduce local irritation. In rare cases the use of podophyllin is associated with side effects due to systemic absorbtion and toxicity. To avoid such effects, application should be limited to <0.5 mL of podophyllin or an area of <10 cm2 of warts per session. Also, the area to which treatment is administered should not contain any open lesions or wounds. In very rare cases liver dysfunction, bone marrow suppression, nausea, diarrhea or constipation, abdominal pain, neurological impairment or even psychosis may occur. The safety of podophyllin during pregnancy has not been established.

The resin formula is made a few hours before the appointment. It is unstable so it cannot be stored easily; therefore it must be applied fresh and later disposed in a biohazard bin since it is poisonous.

In terms of relative effectiveness, the study results are conflicting. A randomized study in 60 patients with once weekly podophyllin showed initial complete clearance of 93 percent versus 77 percent for surgical excision. Recurrence rates were 18% for surgical excision and 43% for podophyllin at 3 months, 22% and 56% at 6 months, 26% and 56% at 9 months, 29% and 65% at 12 months (Jensen SL, 1985). In another study (Khawaja HT, 1989) at 6 weeks scissor excision completely cleared the warts in 89% compared with 79 % treated with podophyllin. Recurrence was 19% in the surgery group, compared to 60% in the podophyllin group.

A randomized controlled trial in 97 patients evaluated the efficacy of intralesional interferon 2b and podophyllin versus podophyllin alone for the therapy of anogenital warts. The conclusion was that intralesional administration of interferon seemed to enhance the effect of topical podophyllin (Douglas JM, 1990).

Another study has shown that in a cohort of 409 individuals with new or recurrent warts, randomly allocated to one of 5 treatments on a weekly basis, single therapy with either trichloracetic acid or podophyllin 25% resulted in longer time to wart clearance, and more persistent warts (Sherrard J, 2007).

Thus, the disadvantages to the use of podophyllin include unstandardized preparation, side effects, lower effectiveness, failure to induce lasting remission. It may also contain the mutagenic flavonoid compounds quercetin and kaempherol. Podophyllin preparations vary greatly in their active component and contaminant concentrations.

Podophyllotoxin is the main active ingredient of podophyllin resin that has been purified and prepared to a well standardised concentration. Also known as Podofilox or Condylox (brand name), it is available as cream, gel, or solution preparations that can be self applied by the patient. Because of its purity and ease of use, podophyllotoxin is to be preferred over podophyllin.

Podofilox solution is applied with a cotton swab, or podofilox gel with a finger, to visible genital warts twice a day for 3 days, followed by 4 days of no therapy. This one week cycle of treatment may be repeated until there is no visible wart tissue or for a maximum of 4 cycles. If there is incomplete response after four treatment cycles, it is recommended to discontinue treatment and consider alternative treatment. No evidence suggests that more frequent application will increase efficacy. However, additional applications do increase the rate of local adverse reactions and systemic absorption. The total wart area treated should not exceed 10 cm2, and the total volume of podofilox should be limited to 0.5 mL per day. If possible, the health-care provider should apply the initial treatment to demonstrate the proper application technique and identify which warts should be treated. Mild to moderate pain or local irritation might develop after treatment. The safety of podofilox during pregnancy has not been established.

Eight randomized controlled trials (RCTs), involving   1035 patients compared the efficacy of podophyllotoxin versus placebo (Syed TA, 1995; Greenberg MD, 1991; Beutner KR, 1989; Kirby P, 1990; Tyring S, 1998; von Krogh G, 1992; 1994; Syed TA, 1994). All found that, within 16 weeks of treatment, podophyllotoxin was more effective for clearance than placebo (RRs of clearance v placebo ranged between 2.0 [95% CI 0.9 to 4.3] and 48.0 [95% CI 3 to 773]). RCTs of 0.5% cream or solution found recurrence rates ranging from 4% to 33%. One RCT (57 patients) of 0.5% podophyllotoxin solution as prophylaxis against recurrence of external genital warts found fewer recurrences among people taking placebo.

When comparing podophyllotoxin versus podophyllin, five RCTs found no significant difference in wart clearance (RR values for podophyllin vs podophyllotoxin ranging between 0.7 [95% CI 0.4 to 1.1] (Hellberg D, 1995) and 1.7 [95% CI 0.9 to 3.2]) (Lassus A, 1984). One of these RCTs used a 2% podophyllin solution in a limited study of self-treatment for penile warts, and found no significant difference in clearance between podophyllotoxin and podophyllin (RR for podophyllin v podophyllotoxin 0.6, 95% CI 0.3 to 1.3) (White DJ, 1997). The sixth RCT (358 immunocompetent men and women with genital warts for 3 months or less, 276 [77%] completed) compared podophyllotoxin (self-treatment with 0.5% solution or 0.15% cream twice daily for 3 days with 4 days off) versus podophyllin (25% applied twice weekly at a clinic) (Lacey CJ, 2003). Both treatments were given until warts were cleared, up to a maximum of 4 weeks. The RCT found that podophyllotoxin solution, but not podophyllotoxin cream, significantly increased complete remission of warts at 4 weeks compared with podophyllin (intention to treat analysis: OR 1.92, 95% CI 1.13 to 3.27 for solution; OR 1.17, 95 % CI 0.69 to 2.00 for cream). It found no significant difference between treatments in recurrence of warts at 12 weeks among those with initial clearance (74 people analysed: 15/33 [45%] with podophyllotoxin solution v 12/22 [54%] with podophyllotoxin cream v 5/19 [26%] with podophyllin; P reported as not significant). High withdrawal, and the potential for selection bias among returning people, limit the reliability of these results.

One study comparing podophyllotoxin with topical interferon has found that topical interferon significantly increased wart clearance at 4 weeks after treatment compared with podophyllotoxin (18/20 [90%] with topical interferon v 12/20 [60%] with podophyllotoxin; P = 0.0285) (Syed TA, 1995).

Possible side effects reported with podophyllotoxin are local inflammation or irritation, erosion, burning, pain, itching, and more rarely dyspareunia, bleeding, scarring, and insomnia.

RCTs examined the efficacy of podophyllotoxin solutions more often than cream preparations, but cream or gel preparations may be easier to apply than solutions. This and other differences may cause variable efficacy.

Podophyllotoxin does not contain the mutagenic flavonoid compounds quercetin and kaempherol, which are contained in podophyllin resin preparations.

References

Reutner KR, Conant MA, Friedman-Kien AE, et al. Patient-applied podofilox for treatment of genital warts. Lancet 1989;i:831–834

Bonnez W, Elswick RK Jr, Bailey-Farchione A, Hallahan D, Bell R, Isenberg R, Stoler MH, Reichman RC. Efficacy and safety of 0.5% podofilox solution in the treatment and suppression of anogenital warts. Am J Med. 1994;96:420-5.

W Buck H Jr. Warts (genital). Clin Evid (Online). 2010 Aug 13;2010. pii: 1602.

Douglas JM Jr, Eron LJ, Judson FN, Rogers M, Alder MB, Taylor E, Tanner D, Peets E. A randomized trial of combination therapy with intralesional interferon alpha 2b and podophyllin versus podophyllin alone for the therapy of anogenital warts. J Infect Dis. 1990;162:52-9.

Greenberg MD, Rutledge LH, Reid R, et al. A double-blind, randomized trial of 0.5% podofilox and placebo for the treatment of genital warts in women. Obstet Gynecol1991;77:735–739

Hellberg D, Svarrer T, Nilsson S, et al. Self-treatment of female external genital warts with 0.5% podophyllotoxin cream (Condyline) vs weekly applications of 20% podophyllin solution. Int J STD AIDS1995;6:257–261

Jensen SL, Comparison of podophyllin application with simple surgical excision in clearance and recurrence of perianal condylomata acuminata. Lancet. 1985;2(8465):1146-8.

Khawaja HT. Podophyllin versus scissor excision in the treatment of perianal condylomata acuminata: a prospective study. Br J Surg. 1989;76:1067-8.

Kirby P, Dunne King D, Corey L. Double-blind randomized clinical trial of self-administered podofilox solution versus vehicle in the treatment of genital warts. Am J Med1990;88:465–469.

Lassus A, Haukka K, Forsstrom S. Podophyllotoxin for treatment of genital warts in males: a comparison with conventional podophyllin therapy. Eur J Sex Transm Dis 1984;2:31–33.

Lacey CJ, Goodall RL, Tennvail GR, et al., for the Perstorp Pharma Genital Warts Clinical Trial Group. Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts. Sex Transm Infect2003;79:270–275.

Sherrard J, Riddell L. Comparison of the effectiveness of commonly used clinic-based treatments for external genital warts. Int J STD AIDS. 2007 Jun;18(6):365-8.

Management of genital warts in women with human leukocyte interferon-alpha vs. podophyllotoxin in cream: a placebo-controlled, double-blind, comparative study. J Mol Med (Berl). 1995 May;73(5):255-8.

Tyring S, Edwards L, Cherry LK, Ramsdell WM, Kotner S, Greenberg MD, Vance JC, Barnum G, Dromgoole SH, Killey FP, Toter T. Safety and efficacy of 0.5% podofilox gel in the treatment of anogenital warts. Arch Dermatol. 1998;134:33-8.

Von Krogh G. Topical self-treatment of penile warts with 0.5% podophyllotoxin in ethanol for four or five days. Sex Transm Dis1987;14:135–140.

Von Krogh G. Penile condylomata acuminata: an experimental model for evaluation of topical self-treatment with 0.5–1.0% ethanolic preparations of podophyllotoxin for three days. Sex Transm Dis1981;8:179–186

White, DJ, Billingham C, Chapman S, et al. Podophyllin 0.5% or 2.0% v podophyllotoxin 0.5% for self treatment of penile warts: a double blind randomised study. Genitourin Med1997;73:184–187.

HPV stands for Human Papillomavirus, which is a virus that establishes infections through the skin and mucous membranes. There are about 200 strains of HPV, many of which cause no symptoms at all in humans. Some, however, are known to cause warts, including genital warts, and infections that can lead to cervical and other cancers.

Around 40 HPV strains can be transmitted via sexual contact and certain ‘high-risk’ HPV viruses are thought to be the main cause of cervical cancer in women. They may also cause other genital cancers such as penile, vulvar, vaginal, anal, and cancers of the head and neck. Most infections with these viruses do not, however, lead to serious disease.

Due to intervention of the immune system, 70% of infections by the HPV virus resolve by themselves within one year and 90% resolve within two years. In about 5-10% of infected women, the infection can lead to precancerous lesions or invasive cancer of the cervix. This process is a very slow one, thought to take at least 5-15 years for detectable changes to develop in the cervix.

In most developed countries, women undergo a regular Pap smear test, which involves collecting cells from the outer opening of the cervix. The cells are examined under a microscope to see whether there are any pre-cancerous changes, known as cervical intraepithelial neoplasia or dysplasia, which is usually caused by the HPV virus. If abnormal cells are found, the test is repeated in 6-12 months. If there continues to be an abnormality a colposcopy is recommended. During the colposcopy the cervix is examined visually and a biopsy may be taken. Abnormal areas of cells can be removed using a cauterizing loop or using cryotherapy (freezing). Regular Pap screening allows detection of abnormalities which, if found, can be treated, enabling early detection of cervical cancer and preventing progression to invasive cervical cancer.

During the last few decades, the incidence of severe illness and death from cervical cancer has been substantially reduced by use of the Pap smear, which is considered to be a preventive measure. In the USA in 2008, there were around 11,000 cases and 3,900 deaths from cervical cancer. About 50% of women who develop cervical cancer have never had a Pap smear. In areas of the world where women have reduced access to health care and regular Pap smears, mortality rates from cervical cancer are much higher. Worldwide, there are around 490,000 cases and 270,000 deaths from cervical cancer. Even so, cervical cancer is still a comparatively rare form of cancer.

In recent years two vaccines designed to protect against infection with the HPV virus have been launched onto the market: Gardasil and Cervarix. The pharmaceutical companies that manufacture these vaccines claim that they prevent cervical cancer, but let’s take a closer look at these claims, starting with the first vaccine on the market, Gardasil.

Gardasil
Manufactured by Merck, Gardasil was licensed for use in girls by the FDA in 2006. Also known as Gardisil and Silgard, this vaccine is intended to prevent infection by the sexually transmitted HPV viruses, especially the high-risk strains, 6, 11, 16 and 18. This vaccine is touted as a preventative measure, to prevent infection by HPV and resulting cervical, vulvar and vaginal cancers. However, the vaccine is not effective if the recipient has already been infected by the above HPV strains. Gardasil is administered in 3 x 0.5 ml injections over 6 months, at 2 month intervals. Compliance rates are low, in that only 27% of girls complete the 3-dose regimen. What current recipients of the vaccine are not told is that during the clinical trial for this vaccine, participants were actually given FOUR doses of the vaccine to boost the number of HPV antibodies in the blood. Strangely, Gardasil was ‘fast tracked’ through the federal regulatory system even though it does not meet any of the criteria for fast tracking.

Cervarix
Another vaccine, manufactured by GlaxoSmithKline, and approved by the FDA for use in girls in 2009 is Cervarix. Cervarix is designed to prevent infection by HPV virus strains 16 and 18, which are thought to be responsible for 70% of cases of cervical cancer. The manufacturer claims that Cervarix is superior to Gardasil as it generates a greater antibody response to the virus than Gardasil. After the initial injection, Cervarix is administered by 1 injection a month afterwards, and another 5 months later.

Both these vaccines must be administered before the recipient becomes sexually active.

The FDA has now approved the use of Gardasil in boys. Merck claims that vaccination will prevent them from carrying the cancer-causing strains and infecting women. Gardasil was approved for use in boys in the US in 2009 and in the UK in 2006.

Limitations of these vaccines
There are a few things wrong with this picture …

For a start, the vaccine manufacturers claim that an HPV vaccine can prevent the development of cervical cancer. The HPV vaccines are NOT cancer vaccines. The vaccines only provide limited protection against infection by certain strains of the HPV virus and may only be effective for 3-5 years following vaccination.

Cervical cancer takes an estimated 5-15 years to develop, and the clinical trials carried out by the manufacturers before bringing the vaccines to market only lasted 5-6 years. Therefore, contrary to claims by Merck and GlaxoSmithKline, there is no proof whatsoever that HPV vaccines actually prevent cervical cancer!

Cervical cancer is one of the rarest cancers – in most cases, HPV infection is attacked and destroyed by the immune system before it can develop into cancer.

Federal authorities have decreed that all female immigrants between the ages of 11 and 16 must be vaccinated with Gardasil before entering the country, despite the fact that HPV has a very low infection rate. What could be behind this sinister move?

Side effects of the vaccines
Despite being termed ‘safe’ by the pharmaceutical industry there are serious questions about their safety records, particularly that of Gardasil. A number of serious side effects have been reported following administration of these vaccines. These include life-threatening illnesses, spontaneous abortion, permanent disablement and death.

Gardasil side effects
Minor side effects of Gardasil include dizziness and fainting. These may be categorized as ‘non-serious’, but, read on …. Serious side effects associated with Gardasil include blood clots in the legs, heart and lungs, stroke, heart attack, short-term memory loss, seizures, blindness, paralysis, ovarian cysts, pain, mood changes, movement disorders, speech problems, pancreatitis, and development of Guillain-Barré syndrome. Guillain Barré syndrome is a rare neurological disorder characterized by muscle weakness.

As of September 15th 2011, the CDC reports that there have been 71 reported deaths directly linked to the vaccine, mostly among girls. The true figures may be much higher.

During the clinical trials a number of young women died in car crashes, but Merck does not report whether they were the driver or the passenger. This is critical information in view of the fact that a neurological event such as fainting or seizures could cause a car driver to crash.

In some states, attempts have been made at making vaccination with Gardasil mandatory. This unusual step is explained by the fact that in the state of California alone, 24 legislators are known to have received payments from Merck. The same is doubtless true of other states such as Texas where, happily, attempts at making Gardasil vaccination mandatory ultimately failed.

Gardasil can be considered as one of the most dangerous vaccines ever pushed on young children. All this begs the question: why are these vaccines being promoted by doctors and health authorities alike? The answer may shock you.

Hidden agenda
Part of the answer is about money, of course. Merck has made billions of dollars from selling Gardasil worldwide, although happily sales in the USA have slumped recently due to the number of adverse reports. Even more sinister forces may be at work, however.

According to Dr Joseph Mercola the World Health Organization has a task force uniquely dedicated to developing anti-fertility vaccines. They are not alone. In Brazil a mandatory rubella vaccination program has been instigated, despite the fact that only about 17 children a year are born with birth defects due to the disease. Moreover, free tetanus injections were handed out in Mexico, Nigeria, Tanzania and Philippines. It was later discovered that these vaccines contained human gonadotrophin (HCG) a hormone which causes spontaneous abortions in pregnant women and may lead to permanent infertility.

Gardasil contains Polysorbate-80, a surfactant that helps deliver pharmacological substances across the blood-brain barrier. Polysorbate-80 has been linked to infertility in mice. It decreases the size of the ovaries and uterus and can result in chronic stimulation of cells that produce estrogen.

Another odd ingredient of Gardasil is L-histadine, which has been found to increase blood clot formation when combined with certain surfactants, of which Polysorbate-80 could be one. Death from blood clots within hours or days of being vaccinated with Gardasil is the most common cause of Gardasil-related death in the young women who received the vaccine.

It is bad enough that these dangerous vaccines are touted for girls, but promoting them for use in boys is simply nonsensical. Again, questions remain as to their safety in boys as well as in girls. It is likely they will have many of the same effects in boys as in girls. Parents need to be aware of the likely adverse effects of these vaccines before making crucial health decisions for their children. Forewarned is forearmed.

Genital warts is a health subject that those who are (or who are about to become) sexually active should be familiar with. Genital warts are caused by certain types of Human Papillomavirus (HPV). HPV is a virus that can be contracted by direct genital contact such as vaginal and/or anal sex. The Centers for Disease Control and Prevention (CDC) reports that at least 50% of sexually active people will get genital HPV

The types of HPV that are associated with the visible skin changes known as genital warts fall into the low risk category. This means that genital warts do not put a person at increased risk for cancer. Genital warts are visible growths or bumps that can be raised or flat, small or large, and singular or multiple in number. External warts can be found on the penis, vulva, scrotum, and surrounding skin tissues. Internal warts can be found on the cervix, vagina, urethra, and anus. Often genital warts go unnoticed, but they can be painful, itchy, and bleed easily.

Genital warts can be prevented by abstinence (not having sex). A vaccine is available for women aged 9-26 that prevents certain types of HPV thus reducing the risk of having genital warts. The risk of contracting genital warts can further be reduced by using condoms, and keeping the number of sexual partners you have in your lifetime to a minimum (the partner you select should also have had minimal partners).

While Genital warts may go away on their own, a number of treatment options are available to remove them. When considering the option of having genital warts removed it is important to remember that removal of the wart or warts does not eliminate the HPV infection. Removal also does not prevent the transmission of HPV.

Two self applied treatments that are available are Podofilox and Imiquimod. These medications are well studied and considered easy to use. Podofilox is applied to the warts twice a day for three days followed by 4 days of no medication. This weekly cycle is repeated for up to a month. Imiquimod is applied to warts once a day, three times a week, for up to 16 weeks. Both of these medications can cause local skin irritation and redness with mild to moderate pain during their use. Prior to using these medications a healthcare provider will need to give instructions on their proper application. Alternative provider administered treatments to remove genital warts include cryotherapy, the application of topical medications, interferon therapy, and surgery.

There is a newer third option for self treatment called Wartrol. Wartrol is an alternative treatment  based on homeopathic philosophy. Some studies have shown a positive response from this treatment. More information can be found here.

Cryotherapy is completed with liquid nitrogen or a cryo-probe. Often repeat visits are needed every 1-2 weeks. With cryotherapy over or under treatment is possible. Temporary side effects of this type of therapy include pain, blistering, and an area of blackened dead skin. Cryo-probe use for vaginal warts is not recommended due to the potential for serious complications.

Topical medications a provider can apply to genital warts include Podophyllin resin, Trichloroacetic acid (TCA) and Bichloroacetic acid (BCA). These three topical medications all require weekly applications by the clinician. TCA and BCA are both widely used, but have not been thoroughly studied.

Interferon therapy to remove genital warts has been attempted. Systemic interferon therapy is not recommended as its effectiveness is poor. However, interferon injections directly into the wart itself have proven to be effective. The use of interferon injections requires numerous office visits and is associated with several systemic side effects.

Surgery to remove genital warts can be completed in numerous ways (including via laser) by a skilled healthcare provider. Surgery can be an ideal option for patients with numerous or large warts. Surgery is also the only treatment option that can generally remove a wart with only one visit.

Whatever treatment option is selected follow-up consultation after three months to evaluate effectiveness and assess for reoccurrence is recommended. Genital warts and HPV may not be a subject you feel comfortable discussing, but it is a subject you should educate yourself on. An open discussion with your healthcare provider can help you decide if you want to attempt treatment and which treatment might be best for you.

Genital warts are similar in many ways to regular warts. They are caused by a virus which most people get and fight off eventually on their own. Treatment is also similar, using caustic chemicals, cold or heat to kill off the warts. If you have had warts on your fingers, the main difference between those and genital warts is the area in which they appear and the particular virus that causes them.

Genital warts are caused by a virus called the human papilloma virus or HPV. Papilloma means warts. HPV is a very common infection. It is estimated that most adults who have had sexual contact contract this virus at some time, usually with no apparent symptoms. Some say 80% of adult women have been infected by HPV at least once by the time they are 50 years old, with men similarly affected. Most people with normal immune systems fight this virus off. Many never even have visible warts, but even with warts, most will be rid of the disease in around one to two years.

It is not known why some people have warts and others do not, when infected with HPV. Some may have warts in an area that is not visible (like inside the vagina) or they may have warts that are so small they are not noticed. Having visible warts is not an indicator of any other problem and does not mean the immune system is not normal.

The warts can be found around and in the vagina, the vulva, on the perineum (the area between the vagina and anus), around and in the anus, the penis, and the scrotum. Warts inside the anus (the rectum) usually but not exclusively occur after exposure due to penile penetration. Warts around the anus, usually in a circle, can occur in men or women without anal penetration. The virus just spreads from other genital areas. Genital warts are most commonly found around the vaginal opening, the foreskin of uncircumcised men, and the skin on the penile shaft of circumcised men.

Although it is unusual, genital warts can be found in other places, where there has been sexual contact and the area is moist and warm. This includes the inside of the mouth, the conjunctiva of the eye, the inside of the nose, and the larynx (voice box).

Like common warts that appear on other areas, these warts may be flat or fleshy elevated areas or may look more like skin tags, slightly pink or gray in color. There may be only a few, but there are often many together, such as around the anus, penis or vaginal opening. Most people have less than ten warts.

Warts inside the vagina cannot be seen without a doctors assistance. Warts inside the cervix and warts inside the anus have to be visualized with special instruments. Warts inside the urethra, which is the tube carrying urine and semen out the tip of a man’s penis, cannot be seen. If you have a wart in your urethra, you may notice that your urinary stream is not normal.

Genital warts do not necessarily cause symptoms. Some people experience itching, pain, or bleeding from the warts depending where they are. Many people are very uncomfortable with the appearance of the warts.

It is not known exactly how long a person with warts is contagious, or how long it takes for someone who is exposed to have symptoms. It is believed that the virus can be passed to another person even when there are no visible warts. Since most people are exposed to HPV, it is not recommended to examine or test sexual partners of people with warts, because they have already been exposed. Treatment is only needed if warts appear and the person wants to have them removed.

It is also not known if treatment, by removing tissue with HPV, actually reduces the chance of transmitting the virus.

Genital warts are diagnosed by their appearance. Testing for HPV is not necessary or helpful. Biopsy is only necessary if there is some reason to suspect that the bumps are not venereal warts.

Some doctors use an application of 3% to 5% acetic acid onto the skin to look for genital warts, which turn white. This is not very reliable or necessary, but some doctors believe that they have more success finding all the involved tissue this way.

Human Papilloma Virus and Cancer

There are more than 100 types of HPV. That is one reason why people can get reinfected with HPV. Certain types are most likely to cause genital warts. 90% of genital warts are caused by HPV types 6 and 11. Other types of HPV are associated with certain types of cancer, mainly HPV types 16 and 18.

The most common type of cancer associated with HPV is cervical cancer. Vaccines have been developed to help protect against HPV 16 and 18, and therefore prevent the 70% of cervical cancer that is caused by these two types. One vaccine protects only against these two types, and is called Cervarix. Another vaccine, called Gardasil, includes 6 and 11, which also protects against 90% of genital warts. The other 30% of cervical cancer not caused by HPV types 16 and 18 are caused by so many different types of HPV that a vaccine is not practical.

These vaccines are recommended for adolescent girls before they become sexually active. The first vaccine is recommended at age 11 to 12, but can be given as early as 9 years of age, or later, anywhere between 13 and 26 years of age. The vaccines are not recommended for older women who most likely have already been exposed to the virus. Gardasil is also recommended to protect against genital warts in boys and young men ages 9 to 26 years of age, again, before they become sexually active. There are three doses necessary with each vaccine. The second should be one to two months after the first, and the third should be given six months after the first dose.

Since there is cervical cancer associated with other HPV types, screening by Pap test is still necessary.

Type 16 and 18 HPV, as well as some less common types, are also associated with rectal/anal cancer, as well as cancer inside the mouth. For this reason, Gardasil may also be a good vaccine for adolescent boys and young men, especially men who have sex with men.

Condoms cannot completely protect men or women against HPV because the virus can live on skin not covered by the condom. The only way to prevent HPV absolutely is abstinence.

Treatment of Genital Warts

This section on treatment assumes that you are in general good health. If you have an abnormal immune system because of HIV, cancer chemotherapy or other medication, you need to see the doctor and may need different treatment.
Genital warts themselves are not precancerous and are not dangerous. Treatment is to stop symptoms, and for cosmetic reasons. Since they are not dangerous, the treatment should not be in any way risky. While it is very reasonable to want to get rid of them, no one should undergo treatment in which the cure is worse than the disease.

Most treatments of genital warts are applied directly to the warts. The exception to this is homeopathic remedies which are ingested. All other treatment, in a doctor’s office, at home, by prescription, surgical methods or via alternative medicine involves a way to remove or kill off the affected tissue. The key is to get rid of the areas with HPV and not cause any damage to normal skin. This is not necessarily easy.

Many of the treatments, whether in the doctor’s office or used at home, whether conventional or alternative, have not been subjected to rigorous scientific testing. For the most part they have not been tested against each other in large-scale, placebo-controlled, randomly-assigned trial. No methods are guaranteed to remove all warts. Even if they appear to be gone, they can reoccur. Most methods remove warts about 50% of the time.

If your warts do not go away after an adequate trial of any of these methods, you can switch to a different method. No one method has been proven to be better than any other method.

Your own immune system should eventually get rid of the warts in time. If your warts are not causing symptoms, are not very large or bothersome, and the diagnosis of genital warts is certain, you can opt to wait. When your body eliminates warts there are no side effects.

The most common side effects of all the treatments include:

• Local pain
• Local burning
• Local swelling
• Reoccurrence of warts

The worst complications of all prescription treatments, including those used in a doctor’s office as well as those used at home include

• A change in pigmentation can occur after the warts heal. This depends on the site of the warts, and can be increased or decreased pigmentation.
• Scars, which are rare, but are more likely if there is not enough time for healing in between treatments.
• Severe pain can occur and become chronic either in any treated area
• Pain can occur in the vaginal area which increases with sexual intercourse.
• Pain can occur around the anus which increases when passing stool.

There are almost never any side effects in other parts of the body when treating genital warts with any of these local treatments. Rare reports of problems that may have been caused by podophyllin resin and/or imiquod have been reported. In these cases, large amounts of the chemicals were used.

Treatments in the doctor’s office

There are a number of factors determining the type of treatment given by a doctor. These include the doctor’s preference and what he or she has the most experience with, the patient’s preference, and the availability of the medicines needed to treat the warts.

Treatment with compounds applied to the warts

There are a few chemicals that doctors can apply to genital warts to remove them. These chemicals all damage the tissue, which then dies and falls off. The key is to apply the chemical only to the warts. If there are a lot of warts or if they are very flat and close to normal skin, this is harder than if there are large, visible, discrete warts. Warts in moist, warm areas are best treated by creams or chemicals.

Multiple treatments are usually necessary; 3 months is the length of time it takes for most warts to disappear.

Sometimes petroleum jelly will be applied to the normal skin around the warts to prevent damage if the chemical gets on the skin. The doctor will apply the treatment, and then let you know how long you should leave the chemical on. The length of time will vary depending on the size and amount of warts, the delicacy of the surrounding tissue, and whether or not they have been treated in the past.

The two most commonly used treatments in the office have been podophyllin resin, 10% to 25% strength, applied weekly for up to four weeks, and trichloroacetic acid or bichloroacetic acid, 80% to 90% applied weekly.

Podophyllin is put into a resin to keep it on the skin and prevent it from being absorbed. It should not be used over a very large area. This will usually stay on a number of hours, 6 to 8, and then should be washed off. The warts should shrink. They may form a crust or a scab, and should eventually fall off. Small warts might just disappear.

Unfortunately, there are very few manufacturers of podophyllin resin at this time. Many doctors cannot acquire it. This was a very good treatment which is currently unavailable to many people, leaving the two types of acetic acid as in-office doctor-applied treatments.

Trichloroacetic (TCA) and bichloroacetic acid (BCA) 80% to 90% applied weekly kill wart-containing tissue. Either has to be applied very carefully because it spread onto healthy skin.

The risks and side effects of these treatments are damage to local tissue, and not causing the disappearance of all the warts. Multiple treatments are usually necessary. If chemicals are left on the warts for too long, you can feel burning. You have to wash off the chemicals as instructed. Remaining warts can be treated at another visit. Any damage to adjacent tissue will usually heal well. It is not known if any of these medicines is safe during pregnancy.

Treatment by surgery or energy application

Genital warts can be removed surgically, or destroyed in many ways, by application of heat, cold, and other kinds of energy. Large warts should be physically removed by one of these methods.

Warts can be shaved off with a blade or other types of surgical instruments (called curettage). Warts with thin bases can be cut off with sterile scissors. This type of removal is best for warts that are hanging off of thin bases or otherwise easy to separate from normal tissue. If bleeding results, it can be stopped with chemical cautery, similar to what is in a styptic pencil. A related way to remove warts is with electrocautery. This is delivered by a machine that has a pointed end which heats up. This can destroy the warts at the same time that the heat closes blood vessels so there is no bleeding. Most of these procedures require local anesthetic.

Some doctors have other instruments to destroy warts. Laser therapy (with a carbon dioxide laser) may have a higher success rate and better cosmetic appearance than some of the other methods. In at least one small trial, women treated twice by laser therapy had 100% cure rate with no reoccurrence. The men’s cure rate was slightly lower, at 88%. Most primary care doctors do not have lasers. Dermatologists and plastic surgeons do. If you have large, unsightly warts and you would prefer surgery or laser therapy, you will need to see a specialist.

A method available in almost every primary care doctors’ office is cryotherapy, or freezing. This is usually done with liquid nitrogen. A cold probe or cotton swab is held to each wart until it is sufficiently frozen. This will cause the wart to fall off in 7 to 10 days. Cryotherapy may be the method of choice for many doctors and patients. No anesthesia is needed. There is no bleeding. Although multiple applications are usually necessary, there is no need to put on medication repeatedly or worry about washing it off in time. You need to go back to the doctor after the first treatment to see if there are any small warts that were missed, or any large warts which got smaller but are still there.

All of these methods depend on the skill level and comfort level of the doctor using them. Choice also depends on patient preference. This is something to discuss with the doctor.

The risks and side effects of all these methods are similar. There can be pain, usually very temporary. Normal tissue can be damaged. All of the wart may not be removed, so that warts remain and grow back. Too much cautery, or too deep of a cut that gets into normal tissue will cause more bleeding and potentially cause a scar. Scarring is unlikely in many of the areas where these warts occur. However, very large warts requiring surgery may leave a scar.

Cryotherapy probably has the least risk, and is the most widely available. Multiple treatments are often necessary. If warts are missed, they can be treated at the next visit. Freezing is not the fastest method to get rid of visible warts. Surgical procedures can remove them immediately, but are more painful, cause more bleeding, and have the highest risk of scarring. If done by a doctor skilled in these procedures, surgical removal or laser therapy may be the best choice. Surgery in which anesthesia is used and laser therapy will usually cost considerably more than the other treatments.

Prescription medication to be used at home

Prescription medications to treat genital warts are creams to be applied to the warts that will cause a similar reaction to the medications above. They include podofilox 0.5% solution or gel, imiquimod 5% cream, and sinecatechins 15% ointment. The safety of all of these in pregnancy is unknown. As noted above, the side effects of all creams and gels applied to warts are similar.

Podofilox is generally considered safe. It is made of the active ingredient in podophyllin. It is easy to use and inexpensive to obtain. The solution is applied to the warts twice a day for three days. There are then 4 days when no treatment is done. This cycle can be repeated a total of four times. The prescribing doctor can apply to first treatment to demonstrate, but this is not absolutely necessary. Pain and irritation are side effects. If warts are still there after four cycles of treatment, it is best to switch to another method of treatment.

Imiquimod is an ìimmune enhancerî which causes the body to make chemicals that kill the warts. The cream is applied at bedtime, once a day, three times a week. The cream must be washed off 6 to 10 hours after it is applied, so the following morning. This cream can be used for a maximum of 16 weeks. If warts are still there, a different method should be used. Side effects from imiquimod are somewhat more severe than those with podofilox, and can include irritation, redness, swelling, ulceration of the tissue, and blisters. After healing, there can be a loss of pigmentation. There have been very rare reports of systemic reactions to this chemical which is an immune system activator. It can also weaken the materials that make condoms and diaphragms.

VeregenÆ Ointment 15% is a formulation of sinecatechins from green tea. While it is a prescription medication, it can also be considered alternative treatment because it comes from a natural source. Veregen should be applied three times a day to warts visible on the outside only. It is not to be used for warts inside the vagina or rectum, for example, because you cannot see them yourself to make sure you do not get the cream on normal tissue. You apply it with your
fingers, leaving a thin layer on all warts. It is only approved for 16 weeks of use, which should be enough time to treat warts.

Common side effects are reactions on the skin, including redness, itching, burning, pain, ulceration, swelling, thickening and blister formation.

In trials reported by the manufacturer, Veregen completely clears up warts in approximately 50% of patients. This takes an average 10 to 16 weeks. There is at least one other brand-name, sinecatechin-containing prescription medication.

Previously used medications including 5-fluorouracil and interferon are no longer recommended due to cost and possibly increased side effects with no greater treatment success.

Alternative Remedies

One completely safe alternative remedy is to wait for your body’s immune system to get rid of the warts. You would want to make sure you are eating a good diet with enough nutrients and that you are in generally good health. If you believe you need supplements to maintain good health, continue to take them. For some people, this is the best treatment. It is free of cost as well as free of side effects.

Homeopathy

Homeopathic remedies for genital warts are available. One commonly-used remedy is Thuja alternating with Nitric acid. Ascending potencies of Thuja are given over three to four weeks, after which ascending potencies of Nitric acid are given. This is the treatment suggested by Samuel Hahnemann, the founder of homeopathy, some 200 years ago.
Modern homeopaths suggest that treatment for genital warts actually needs to address more underlying problems, and they have a more complex remedy. Each person’s needs are different, depending on their underlying state of health. The following remedies can be used:

Antimonium crudum  - recommended for swelling and eruptions on mucous membranes
Argentum nitricum  - recommended for pain and sores on genitals
Aurum muriaticum  - recommended for cancerous warts
Aureum muriaticum natronatum – recommended for warts associated with erosions, ulcers, and cancers
Causticum – recommended for some warts along with vaginal discharge
Cinnabaris – recommended for warts including genital and eye. Better than Thuja for some penile warts
Medorrhinum – recommended for general warts with other conditions
Mercurius dulcis – recommended for genital warts, also Mercurius nitrosus or Mercurius precipitatus ruber
Natrum sulphuricum – recommended for warts on hands as well as vaginal pain and discharge
Nitric acid – for all warts plus discharge and pain
Sabina – similar to Thuja and good for large warts
Sarsaparilla – recommended for warts especially with other sexually transmitted diseases
Staphysagria – recommended for genital wars
Thuja – recommended for most kinds of warts (Thuja occidentalis = Arbor Vitae)
In order to get the best homeopathic mix to take for genital warts, seeing a homeopath would be recommended. These kinds of ingredients will be put together so that they can be ingested in very small amounts. Because homeopathy uses such tiny doses of ingredients, it tends to be very safe. Homeopathic treatments are to be taken into the body, not rubbed into the skin.
Tea tree oil has many antibiotic properties. It has been suggested as useful for warts. Baptisia tinctoria has antiviral properties and could also be helpful.
The actual methods of homeopathic diagnoses and treatments are beyond the scope of this article.
The product called Wartrol has most of these homeopathic ingredients.

Home Remedies

Green tea was considered a home remedy until active compounds were found that can destroy warts. There are a variety of slightly irritating or caustic ingredients people have used on genital warts, from lemon juice to garlic. As long as whatever is being placed on the warts does not cause pain or damage normal skin, there is really not much harm in trying. As long as the cure is not worse than the problem, it is probably safe to try.

New and Upcoming Developments

Lasers are being used to treat more and more diseases. Dermatologists, plastic surgeons, and some other kinds of doctors are learning how best to use the lasers. There is more than one type of laser. In addition to the carbon dioxide laser, other lasers may prove useful.

When to See Your Doctor

You should see a doctor when you first discover that you have genital warts, or believe that you do. This is to make sure that your self-diagnosis is correct, and that there is nothing else more serious going on. It is also a time at which the doctor can make sure you don’t have warts in hard to treat places.

You can ask the doctor what he or she recommends, and you can think about what you would like to try based on what your doctor offers, how much the treatments cost, and whether or not you want to try home treatment with a prescription medication, homeopathy, a home remedy, or tincture of time.

If your warts are getting worse or the treatment is causing you pain, you should check back with your doctor. Eventually your warts should go away.

References

Sexually Transmitted Diseases Treatment Guidelines, 2010. Recommendations and Reports. Morbidity and Mortality Weekly Report (MMWR). December 17, 2010 / 59(RR12); 1-110
 HYPERLINK “http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm?s_cid=rr5912a1_w” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm?s_cid=rr5912a1_w
Accessed December 23, 2010.

Human Papillomavirus (HPV). CDC information page.  HYPERLINK “http://www.cdc.gov/hpv/” http://www.cdc.gov/hpv/
Accessed 13.23/2010

Fatemeh Ghaemmaghami, Zeinab Nazari, Nili Mehrdad. Female Genital Warts. Asian Pacific J Cancer Prev, 8, 339-347. 2007.

Reichman Richard C, “Chapter 178. Human Papillomavirus Infections” (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison’s Principles of Internal Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2895508.

CRAIG SCHNEIDER, TIFFANY SEGRE. Green Tea: Potential Health Benefits. Am Fam Physician. 2009; 79(7):591-594.

Kate Birch. Genital Warts. Vaccine Free Prevention and Treatment of Infectious Contagious Disease with Homeopathy. Pages 251-260. 2007. Victoria, BC Canada. Trafford Publishing.

Garg, SC. Essential oils as Therapeutics. Natural Product Radiance. 2005; 4(1): 18-26.

Bergner, P. Antiviral Botanicals in Herbal Medicine. Medical Herbalism (Spring 2005)14(3):1-12.

As Denavir is an antiviral medication, some patients have used it to treat another virus-infected disease of an almost similar nature, which are genital or venereal warts. To examine whether Denavir is effective in treating genital warts, one needs to first develop an understanding about the two diseases including their symptoms and complications before arriving at any conclusion.

Like herpes, genital or venereal warts is a contagious disease that can be transmitted during sexual intercourse. They are both sexually transmitted diseases (STD), and unfortunately cannot be cured.

There are distinct differences between venereal warts and herpes. For one, genital warts are caused by a different virus known as human papillomavirus (HPV) instead of herpes simplex virus which is the virus responsible for herpes.

Another major difference between herpes and HPV lies in their outward symptoms, symptom locations and conditions. Symptoms of genital herpes are the appearances of blisters or sores on the genitals, buttocks and anal area, whereas symptoms of oral herpes are blisters and sores around the lips and face. Blisters and sores caused by herpes are often itchy, swollen and sometimes, painful and they often break out when the patient’s immune system is affected such as during stressful situations or when the body is weakened due to lack of sleep or illness.

HPV on the other hand does not often produce any outward symptoms and if they do, they are known as genital warts which are hard or soft flesh cauliflower-shaped lumps around the genital areas. Due to its general lack of symptoms, patients with HPV sometimes do not realize they are infected.

Can Denavir treat Genital Warts?
Genital warts can be either removed surgically or treated with antiviral cream application. There are currently several antiviral cream products in the market that can be used for herpes as well as genital warps.

So far Denavir has not been proven to treat genital warts. It is an antiviral cream which is manufactured for external application on cold sores caused by the herpes simplex virus; there has not been any claim by its manufacturer that it can treat HPV. Secondly, it is also specifically recommended only for external application on the lips and on the face, and not to be applied inside the mouth, the nose, near the eyes or on genital areas. The latter could cause skin irritation or other side effects.

By following its recommended dosage, Denavir can reduce and contain the outbreak of swollen painful sores caused by herpes simplex virus within a matter of days. However, it can only contain and limit the outbreak of sores but cannot cure or prevent the transmission of the virus. Similarly, Denavir is unlikely to treat or prevent the transmission of HPV virus. Furthermore, genital warts caused by HPV are normally not painful but only cause discomfort and itch. In some cases, they often go away on its own even though no treatment is applied.

Therefore, one should seek medical advice before using Denavir on genital warts as the medication is not meant to fight HPV virus in the first place. However, there may be instances when symptoms are similar and it is essential to receive the right diagnosis in order to receive the right treatment.

Pathology: What’s a Wart?

A wart is a typically benign tumor that appears as the result of contracting a virus known as the Human Papilloma Virus or HPV. HPV is normally transmitted through open cuts or scabs on the skin, and once inside, begins to produce the tumors. In most cases, HPV is simply a cosmetic annoyance. But in rarer cases, HPV can cause certain types of cancer. In order to reduce the risk of contracting a severe case, doctors usually remove the warts with liquid nitrogen or lasers. Not only that, but there has recently been a vaccine that reduces the risk of contracting HPV.

In the case of genital warts, someone who has contracted HPV has sexual intercourse with a non afflicted partner. If unprotected, skin contact with a wart can result in the Human Papilloma Virus spreading to the genital areas. The result is warts in or near the anus, perineum, and the sexual organs.

How Does Condylox Work?

Condylox is a prescription gel-lotion that contains roughly .5% podofilox, a chemical found in rhizome tubers. Seeing that warts are simply cells reproducing at a rapid rate, the goal of the gel is to prevent the cells from dividing. The anti-mitotic agent in Condylox is podofilox, which when applied on the wart, prevents the cells from multiplying, causing them to die.

Note: Condylox is prescribed only for use on genital and perennial warts. Condylox also simply acts as a treatment for when warts appear; it is not a cure.

Benefits

Using Condylox offers a plethora of benefits. These include:

Non-invasive treatment: Instead of removing warts via freezing, electricity, or burning, all of which can be very painful, especially in the sensitive genital areas, Condylox is a simple topical gel that offers the same treatment with little pain. Not only that, but Condylox does not require one to return to their doctor to remove every wart. They must only obtain a prescription from them and visit for check-ups.

Immune Strengthening Method: Condylox appears as a simple topical cream, but when applied, the anti-mitotic chemical podofilox alerts the immune system that there are cells appearing to divide rapidly. This extra “heads up” allows the body to remove the warts quickly and reduces the amount of outbreaks one has.

Side Effects

Although Condylox appears to be the best method for treatment of genital warts, it should be noted that the medication does not work for everyone. Several side effects have known to occur from people using Condylox. These include:

-Itching
-Redness
-Burning sensations at site of application
-Headaches
-Stinging pain
-Inflammation

Fortunately these side effects are relatively mild and are usually caused by an over-application of the gel.

In rarer cases, people who are allergic to Condylox can experience more severe side effects which include:

-Rash
-Hives
-Wheezing/Difficulty breathing
-Tightness in chest
-Swollen face, throat, lips, and tongue
-Severe bleeding and irritation at application site
-Extreme burning sensation found at the application site

Note that these are very rare side effects that occur only if patient is allergic.

With that is mind, there are a number of natural treatment options for warts and genital warts that you may want to explore. They encompass nutritional supplementation, herbal remedies, homeopathy, and other alternative medical interventions.

Almost every lesion in the skin, including genital warts, involves the immune system. Even before the genital wart forms, the immune system is what protects the body against human papillomavirus (HPV) infection. The immune system also has the ability to detect and remove the abnormal skin cells that are rapidly reproducing and growing into a wart. In fact, some of the medical treatments for genital warts include drugs to stimulate or mimic the actions of the immune system. Therefore, natural treatments for genital warts primarily include things that help your body resist or fight HPV infection and to change the way the skin reacts to it.

Diet, nutrients and supplements

Numerous clinical studies have shown a positive link between exercise and the immune system. A person that exercises for 30 minutes per day, three to five times a week has a much stronger immune system than someone that leads a sedentary life. The type of exercise is not critically important, but you should get your heart pumping and try to break a sweat each time you exercise. While it is not clearly known how exercise boosts the immune system, it clearly does. Regular exercise can equip your body in the fight against genital warts (and many other diseases).

Another helpful intervention is to remove the things that may be taxing your immune system unnecessarily. Allergies drive the immune system—in fact, they put the immune system into overdrive and serve no known useful purpose. Identifying and eliminating allergens from the environment and from the diet can reduce the burden on the immune system.

Dust, molds, mites, and other microscopic substance can lead to allergic reactions and breathing problems. Using filtration devices (one brand name is a Hepa filter) can remove particles from circulating air. Make sure heating vents are clean, mattresses and bedding do not harbor allergens and that carpets are routinely cleaned (or avoided when possible). Animal dander is difficult since we love our pets, but it is just as easy to love a pet that has less dander or no dander; this should be considered before you get your next furry family member.

People often seem to underestimate the role of food allergens in health and disease. Since food allergens rarely lead to stuffy nose, sneezing, and breathing problems, most people do not seem to think of food as stoking up an allergy. In truth, doctors are recently beginning to appreciate the near-epidemic of food allergies. Food allergies cause upset stomach, headache, and, less frequently, they cause some more serious consequences. One common food allergen is milk, which can be an allergy to a protein in milk or lactose intolerance. Lactose intolerance is not an “allergy” but is caused by the inability to digest a sugar in milk. Another common food allergen is wheat or gluten. There are wheat allergies and the more serious celiac disease, which is a serious reaction to gluten in the gut. Aside from these examples, there are a large number of possible food allergens. It may be reasonable to be tested for the presence of food allergies if you are particularly sensitive.

Despite their robust reaction to foreign invaders, the cells of the immune system are fragile entities. In order to keep these important cells as healthy as possible, it is critical to give them a good home. Where is the immune system’s home? Their home is in blood, lymph nodes and other lymph tissues, mainly. The way to give them a good home is to protect them from destructive molecules, like free radicals and reactive oxygen species. Vitamins C and E are excellent antioxidants. Coenzyme Q10, resveratrol, and N-acetylcysteine are also very powerful at neutralizing reactive oxygen species.

Veregen is a green tea extract that has been developed into a medical treatment for genital warts. Veregen is prescription cream that is placed on genital warts, but green tea extract is available as a supplement without a prescription. The supplement is called Camellia sinensis and can be taken up to 250 to 500 mg per day to fight genital warts.

If you want to take the fight directly to the HPV, grapefruit seed extract (Citrus paradisi) has antiviral properties. Grapefruit seed extract comes in 100 mg capsules or can be added to beverages. Cat’s claw (Uncaria tomentosa) has both antiviral properties and can boost the immune system. Cat’s claw can be taken as a 20 mg supplement, three times per day. Olive leaf (Olea europaea) is another antiviral and immune system enhancer. Like the green tea extract, it comes in 250 or 500 mg doses but can be taken up to three times per day. Finally, 150 to 300 mg of Reishi mushroom (Ganoderma lucidum) can be taken up to three times daily for virus-fighting, immune-improving power.

For those that want a topical ointment for genital warts, you should avoid some of the natural remedies that are used for plain warts since these are ineffective and may not be safe for use near the genitals. These ineffective agents include banana peel patch and garlic patch. A topical treatment that is safe and may be helpful is to coat the genital warts in vitamin A (retinoic acid) or beta-carotene up to two times a day. For an added boost, you can add tea tree oil (Melaleuca alternifolia) and/or Echinacea to the treatment.

Homeopathic Remedies

Homeopathic remedies should only be used under the direct supervision of a trained homeopath. In addition to using the ingredients listed, the dilutions and the process of dilution of homeopathic treatments are very important according to homeopathy theory. Note that homeopathy should not be used instead of treatment by a trained medical doctor (allopath) but may be used to supplement traditional treatment.

A homeopath may recommend the use of Causticum for the treatment of genital warts. This agent may be best suited for fleshy warts. Another option is Nitricum acidum. In fact, Nitricum acidum might be the homeopathic treatment of choice for genital warts. It can be used on warts located on the genitals or anus (external use only). The third homeopathic treatment option is Thuja. Thuja is used for painful or bleeding warts of all kinds, including genital warts that cause pain or bleeding.

Acupuncture

Acupuncture is a therapeutic intervention that is derived from Traditional Chinese Medicine. It employs the use of thin metal needles placed in specific points across the body along meridians. Along these 14 to 20 meridians flow the life force known as qi. According to Traditional Chinese Medicine, health and disease are determined by the flow of qi along these meridians in the body. If qi is blocked or stagnant, disease follows. Acupuncture seeks to locate and relieve these blockages and improve flow.

Doctors of Traditional Chinese Medicine may use acupuncture, along with other remedies to treat genital warts and to improve the immune system in general. Acupuncture may take up to ten sessions, each lasting about an hour, to treat genital warts. In addition to needling, moxibustion and cupping may be added to the treatment plan. Moxibustion is the burning of dried herbs (moxa) near the skin. Cupping is the application of heated half-spheres to the skin to create a vacuum.

It is important to mention every skin lesion, including genital warts, to your acupuncture practitioner. Needles should not be applied to or near any skin lesion as this may push HPV deeper into the skin and into the bloodstream.

Massage therapy

While massage therapy is not a direct treatment for viral infection, it can create deep relaxation and stress relief. Since stress can interfere with the proper functioning of the immune system, massage therapy can be used to boost the immune system.

There are various forms of massage therapy. Many forms have the potential to be helpful, but for stress relief it is best to choose one that is less stimulating. For example, Thai traditional massage is more invigorating than relaxing. This form of massage is actually a series of forced yoga poses and may not be the best choice for genital wart treatment.

Of the Eastern traditions of massage therapy, Tui Na and Reiki may be the most appropriate. Considering the approach of Western massage techniques, any that primarily employ effleurage would be applicable. Effleurage is the form of Western massage in which the practitioner uses gliding hands. Effleurage may be more appropriate than deep friction approaches or percussion techniques (tapotement).

Please note that for any massage therapy style that requires nudity or near-nudity and the use of oils, it is critical that you mention your genital warts to the practitioner. This is especially true if you have symptomatic or broken skin lesions. You do not want to risk infection or inoculation of the massage therapist with human papillomavirus (HPV). While infection in this way is very unlikely, it should still be mentioned.

Yoga

Performing yoga serves two important functions in the fight against genital warts. First, it is an extremely good form of exercise. Yoga poses require strength, stamina, balance, and flexibility. Second, yoga can be both relaxing and energizing. Recent research suggests that yoga can improve or undo the damage that stress and harmful emotions can wreak on the immune system. Actively participating in yoga can influence the axis which is the system in the body that responds to stressors by releasing adrenalin and other factors into the blood.1 Yoga also may change neural pathways involved in acute and chronic stress.

There are several ways to incorporate yoga into your life. Videos and television programs now teach yoga poses and exercises. However, many yoga poses are tricky and should be performed properly to avoid injury. It may be best to seek out a class or a professional yoga instructor to demonstrate the proper technique before you go about it on your own.

Mediation

Many of the stresses that affect us in our daily lives—work, school, finances, family—can slowly eat away at our immune system. This gives genital warts a foothold and then a stronghold. Removing this stress from our lives is often as simple as setting aside some quiet time each day for personal reflection. In more formal terms, this “rebooting” is called meditation.

People tend to shy away from many meditation traditions because of the associated mysticism and religious affiliations. In truth, many forms of mediation are devoid of mystical or religious practices and these can be avoided altogether and still receive many of the benefits of meditation. If you are looking for spiritual mediation techniques, these certainly exist as well, but are beyond the scope of this article.

Meditation can be as simple as being quiet and alone for a period of time. The length of time that people can devote to meditation varies, but you should try to set aside 20 minutes at the very least in order to realize the healing benefits of meditation. This time can be increased, but, as you become better at meditation, you may not need more than 20 minutes per day.

In the simplest form, meditation involves clearing the mind of all distractions and thought. It should be done in a quiet, softly lit or dark room. The goal is not to sleep but to remain conscious and awake during meditation. One easy meditation technique is to pick a neutral, two-syllable word and repeat it in your mind. As thoughts of the day and life try to invade your attention, elevate the “volume” of your mind’s voice to overcome the intrusion. “Say” the word faster in your mind. As the impetuous thoughts start to quiet, you can lower the mental volume and slow down the speed of the syllables. Towards the end of the 20 minutes you should have cleared your mind and, perhaps surprisingly, you will feel refreshed and rejuvenated.

Reference List
(1) Kulkarni DD, Bera TK. Yogic exercises and health–a psycho-neuro immunological approach. Indian J Physiol Pharmacol 2009;53:3-15.

Despite the various locations that can serve as a reservoir for human papillomavirus (HPV) and its DNA, the lion’s share of the virus and, by extension, the greatest chance for infection, is in the genital wart itself. Therefore most of the therapeutic interventions are designed to remove the wart and destroy the virus contained inside of them.

Not all treatments are equally effective at clearing the wart and not one is 100% effective. However, in some clinical studies, certain treatments were as high as 90% effective at eradicating the genital warts. Among the most successful treatments are cryotherapy, interferon placed on the wart, electrosurgery.

The various clearance rates of selected therapies are shown in the table. Note that there is significant discrepancy in the clearance rates listed for topical interferon (placed on the wart). The range of clearance rates across studies is 6 to 90%. In other words, while this may be a potentially successful treatment approach, it may not be terribly reliable and is not often used.

• Cryotherapy 63–88%
• Electrosurgery 61–94%
• Imiquimod 37–56%
• Interferon (topical) 6–90%
• Interferon (intralesional) 17–63%
• Laser surgery 23–52%
• Podofilox 45–77%
• Podophyllin 32–79%
• Surgical excision 35–72%
• Trichloroacetic acid 50–81%
• Placebo or no treatment 0–56%