Dear Dr G,
I have an embarrassing problem and I hope you don’t mind if I remain anonymous!
I recently noticed some growth on the head of my penis when I retracted my foreskin during shower. As the growth was getting bigger, I started being concerned and went to a doctor.
The specialist told me these are genital warts. He said it was sexually transmitted and incurable.
The doctor told me he could treat me with freezing devices. I got worried and left without treatment.
I am sorry to put Dr G on the spot, but how did I get genital warts?
I only have two previous sexual partners in my life, how can I tell who infected me with the disease?
Apart from freezing, what are the other ways for me to have the warts treated?
I heard there is a vaccine recently developed for genital warts. Will I benefit from the vaccine?
Finally, I understand that Michael Douglas announced that he had throat cancer which may be related to genital warts. Will I also get throat cancer in the future?
Looking forward to your response.
Genital warts are technically a contagious virus infection and transmitted by sexual contact.
The vast majority of Human Papilloma Virus (HPV) transmitted will not manifest in warts, and only 10% of those infected would suffer genital warts.
It is estimated that up to 20% of the population in the United States have genital HPV infection, and this has clinical manifestation of genital warts in 1% of sexually active adult population.
About 80% of those who are infected fall in the age group of 17 to 33.
HPV can exist in different forms and subtypes six and 11 commonly result in genital warts through direct skin-to-skin contact during genital penetrative, oral or anal sex.
Once infected, the genital HPV infection is incurable. As a result, genital HPV can recur despite ablative or surgical removal.
Although the recurrence rate of genital warts can be as high as 50-75%, there are also reports demonstrating spontaneous regression, with or without interventions.
The scientific data support the existence of HPV virus remaining in the body for a lifetime.
Most cases of HPV infections are asymptomatic. Sometimes, warts can initially present with itchiness, discomfort and redness.
When genital warts occur, they may present singly or in clusters.
The lesions commonly emerge on the external surface of the genitalia including the penile shaft, scrotum, anus, vagina and labia.
Needless to say, the outbreak of warts often result in psychological distress, anxiety and guilt in many sufferers.
The treatment of genital warts can be classified into ablative or topical interventions.
The removal of the warts eliminates the visible presence of the warts.
However, there is no evidence to suggest the removal of visible lesions reduces the risks of future recurrences.
The physical ablative therapy can mean a simple excision, liquid nitrogen cryosurgery, electro-cauterisation and laser ablation intervention.
The ablative treatment is commonly provided for patients with smaller and fewer hardened (keratinised) warts.
On the other hand, topical agent treatments are more suitable for sufferers with multiple larger warts.
Agents such as podophyllotoxin, imiquimod and trichloroacetic acid can be applied to the affected areas, ensuring erosion and destruction of the lesions.
The introduction of HPV vaccines for the prevention of cervical cancer is believed to have an impact in the prevalence of genital warts in future years, especially in women.
In recent years, clinical trials also demonstrated the reduction of risk of emergence and recurrence of genital warts even in men and women already infected with the HPV virus.
Therefore, sufferers with repeated emergence of genital warts may also benefit from vaccination.
When Wall Street actor Michael Douglas announced that he had throat cancer, he regretted the habit of drinking and smoking.
More interestingly, Douglas raised awareness of the association of HPV with cancers when blaming the throat cancer on his habit of cunnilingus.
However, whether Douglas is truly a victim of too much oral sex remains a subject of intense media scrutiny.
When dealing with sexual health issues in the clinic, it is evident that genital warts cause significant distress in couples.
The unsightly emergence and repeated recurrence of the lesions in the private parts often induces the feeling of helplessness and guilt.
When Dr G is put on the spot to deal with the troubling problem of genital warts, his advice is simply: “Don’t look back, and get the jab!”
> The views expressed are entirely the writer’s own.
Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. The column “Ask Dr G” is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at firstname.lastname@example.org