Genital Warts by Marianne Marchese N.D.

Introduction

Genital warts are growths or bumps that appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. They may be flat, dome-shaped papules, have a thick horny layer, and colored gray, pink or red. Warts may occur as a single lesion, multiple lesions and some are clustered together forming a cauliflower-like shape.

Genital warts are a sexually transmitted viral infection caused by specific subtypes of the human papilloma virus (HPV). HPV subtypes 6 and 11 cause most benign warts while subtypes 16,18, 33, and 35 have been strongly associated with genital dysplasia and carcinoma. However, some HPV infections cause no visible warts.   In fact, it is thought that most heterosexual individuals have some of these HPV virus types, but that our immunity keeps most of us from having actually warty lesions.

Symptoms and Clinical Course

HPV and genital warts are usually spread by direct, skin-to-skin contact during vaginal, anal, or oral sex with someone who has the infection. Warts typically appear 2-3 months after exposure to HPV but this varies widely and actual incubation time could be a few weeks to years or longer.

The most common symptom is a visible wart although some people do not notice the lesions thus delaying diagnosis. Individuals infected with HPV but show no visible lesions are considered to have a sub clinical infection. They may complain of itching and tenderness of the tissue around the lesion.

Diagnosis is often made by visual inspection of the characteristic lesions. Atypical lesions may require a biopsy to identify the effects of HPV on the tissues. Subclinical HPV infection of the cervix, vulva, or vagina may be discovered by applying 3%-5% acetic acid to the epithelium. HPV infected cells often turn white in color with the area having irregular borders. Often a colposcope is used to magnify and view the cells changing color.

A pap smear may be used to identify a typical halo appearance around the nuclei of squamous epithelial cells on the cervix that are infected with HPV. Newer DNA probes and technology utilized in liquid pap smear collection methods are now used to identify the subtypes of HPV from cervical samples.

Treatment

Both conventional and naturopathic treatment consists of educating the patient on how to prevent the transmission of HPV through safe sex practices. The goal of treatment is to remove any visible genital warts, reduce or eliminate any annoying symptoms, and prevention of progression to dysplasias and cancer.   A naturopathic approach differs in that local treatment alone may be insufficient treatment in the long term. Think about supporting local and systemic immune system response and local tissue health and resistance to the virus.

Conventional Options

1. Cryotherapy involves freezing off the wart with liquid nitrogen. Repeated applications are necessary every 1-2 weeks.
2. Podofilox   and podophyllin are chemical compounds that can be applied topically to the surface of the wart. Podofilox may be applied by the patient while podophyllin is more toxic and must be applied by a health care provider.
3. 3 % Trichloracetic acid (TCA) is another chemical applied to the surface of a vulvar wart by a physician. Repeated applications once weekly for up to 6 weeks are recommended.  
4. Imiquimod cream is an immune modulating medication for vulvar warts that is an immune modulator. The patient applies this at home.
5. Electrocautery and laser therapy destroys the infected tissue with either a current or laser.
6. 5-FU cream.   This is used mostly for vaginal warts

Naturopathic Options

1. Cryotherapy, Podofilox, Podophyllin, TCA and Imiquimod (use varies by state)
2. Vulvar warts
1. Topical ointment "Papilloderm." Vitamin-A, Thuja, Lomatium
2. Systemically-Vitamin-C, Beta Carotene, Ligusticum, Echinacea, Hydrastis, Thuja, Lomatium Isolate.
3. Podophyllin for raised warts
4. Wart Solution provided by Dr. David Shefrin: Place the following powders in a 2 ounce glass jar: 1tbsp of Shark Cartilage Powder; 1tbsp of Vitamin C Powder. Add 1 ounce of DMSO liquid to the two dry powders to make a watery solution. Once daily, apply the solution (shake before applying) with a cotton swab directly on the warts. Wash warts with soap and water 15 minutes after the solution has been applied.
3. Vaginal warts and cervical warts
1. "Papillo" suppositories
2. Vitamin-A suppositories
3. Systemic treatment as above
4. Cervical Warts
1. Papillo suppositories
2. Vitamin A suppositories
3. Vag Pack suppositories
4. Escharotic treatment
5. Consider homeopathic remedy based on case taking

HPV can persist after treatment because the virus lives inside skin cells. Treatment gets rid of HPV by destroying infected cells but it doesn't always kill all the cells. The virus can lie dormant and return months or years after treatment. The virus can potentially still be transmitted to others during this dormant period. Safe sex practices are strongly recommended.

Dr. Marianne Marchese is a naturopathic physician in Portland, OR at A Woman's Time.

References

1. Leppart PC, Howard FM. Primary Care fro Women. Lippincott Publ. 1997
2. Stenchever MA, et al. Comprehensive Gynecology. Mosby Publ. 4 th ed. 1987
3. Hudson T. Women's Encyclopedia of Natural Medicine. Keats Publ. 1999