Warts it all about
What are warts? How do I know if I have them? How do I avoid getting them? If I already have them, how can I get rid of them? And how do I refrain from infecting others? These are just some of the questions going through people’s minds when they think about the Human Papilloma Virus (HPV), the culprit that causes warts.
There are actually three types of warts in dermatological literature. Two of these are infectious while the other one is, for me, a misnomer because it is that kind of wart which is genetically acquired and not at all infectious.
Verruca Vulgaris or kulugo, technically speaking, is acquired more commonly through prolonged skin-to- skin contact in a susceptible person (those immunocompromised), while genital warts are mostly transmitted through sexual intercourse. Genital wart is considered a venereal disease. Venereal diseases are now designated as STDs (sexually transmitted disease) to suggest a broader scope of the disease, sometimes referred to also as STIs (sexually transmitted infections). STDs are communicable diseases resulting from germs that invade the body. These germs grow and reproduce in tissues where the conditions are warm, moist, and dark such as the cervix, vagina, urethra, mouth, throat, rectum, and conjunctiva or in the blood system. When these germs invade, the body usually responds with symptoms and signs. However, sometimes there may be no visible symptoms and signs, but the germs are still present and can be transmitted to others. This is true with (HPV) infection of the genital area. One can be a carrier of the virus and may not even know it.
Genital HPV is the most common sexually transmitted infection. There are more than 70 distinct HPVs recognized and about 40 of these can infect the genital area of males and females. In 90 percent of cases, the body’s immune system clears HPV naturally within two years, but sometimes, this does not happen and the results are devastating. You could end up having genital warts, recurrent respiratory papillomatosis (RRP) warts in the throat, that can be passed on to children during childbirth, and cervical cancer (others include cancers of the vulva, vagina, penis, anus, oropharynx). And the fact that a person can still have HPV even if years have passed since he/she had sexual contact is really scary.
Warts can appear within weeks or months after sexual contact even if the partner has no signs of genital warts. If left untreated, warts could go away, remain unchanged, or increase in size and number. They will not turn into cancer. It is not the wart but the HPVs in the wart that cause normal cells on infected skin to turn abnormal and become cancerous years after being present in the tissue.
Statistically speaking, in the US alone, around one percent of sexually active adults have genital warts. Each year, around 12,000 women get cervical cancer; 1,500 women get vulvar cancer; 500 women have vaginal cancer; 400 men have penile cancer; 2,700 women and 1,500 men contract anal cancer; 1,500 women and 5,600 men have cancers of the back of the throat, including the base of the tongue and tonsils (although some are related to tobacco and alcohol use) and less than 2,000 children have juvenile onset recurrent respiratory papillomatosis (JORRP). The good news is that genital warts and cancers can be prevented by vaccination nowadays (a quadrivalent vaccine is available) or by practicing safer sex with possibly one sexual partner who is not at high risk (gay population, IV drug users, persons who trade sex for drugs, etc.)
Another wart is the common wart or verruca which is more common in childhood where immature immunologic resistance and frequent skin-to-skin contact with peers increase the likelihood of transmission. When older children or adults have more than 10 warts, the presence of atopic dermatitis should be suspected because atopics have an immunological problem, a T cell (cells that fight off infections) malfunction making them more susceptible not only to viral infection but other infections as well.
Verruca can be removed in many ways: excision, electrodessication, laser or liquid nitrogen, intralesional bleomycin, vesicants, podophyllin, 5 – FU, keratolytic agents etc. Severe cases of verruca may require not only surgical removal but topical and oral medications as well.
Seborrheic wart, on the other hand, is synonymous with aging. Almost all elderly patients have one or more of these. Also known as seborrheic keratosis or basal cell papilloma, they are ubiquitous, benign, hyperkeratotic (thick) lesions inherited in an autosomal dominant pattern. Sunlight appears to play a role in causation. But be wary because 6.4 percent of a series of biopsy specimen sent with a clinical diagnosis of seborrheic warts were malignant tumors. So a piece of advice when you are dealing with skin problems: Better go to an accredited member of the Philippine Dermatological Society. Rarely does a sudden onset or increase in the number of seborrheic warts herald an underlying malignancy (usually an adenocarcinoma of the stomach, colon, or breast). So what may be simple can be complicated and vice versa.
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