Penile Warts: Recurrence Rates and Treatment with LedaMed

Q: Penile Warts: Recurrence Rates and Treatment with LedaMed

Hello： Genital warts can recur; they may be treated successfully or enter a latent phase, during which they can reappear at any time (currently, there is no reliable method to determine which state they are in). <br>The latest data shows that Imiquimod has a cure rate of 56-84% w

I would like to inquire about the recurrence rate of penile warts and the use of Aldara?

Hello, doctor.
About six months ago, I had sexual relations with my girlfriend.
Afterward, I noticed a small abrasion on my penis, but I didn't think much of it; it just felt a bit painful.
I applied some Guangdong powder, and it seemed to heal (I really didn't think too much at the time).
After it healed, I noticed that after a while, a small bump that looked like a callus appeared at the site of the initial injury.
At first, I didn't pay much attention to it, but over the course of six months, it kept growing, and it wasn't until March 14 that I finally went to a urology clinic.
As soon as I took off my pants, the doctor told me it was genital warts and that the area was quite extensive.
However, I wondered if the clinic was too small (I later found out online that they seemed to lack cryotherapy or electrosurgery equipment), so I was quite confused at that moment.
Although I had some idea of what it might be before going, the doctor didn't seem to offer any treatment options.
It was only when I asked if there was something like Aldara that I could apply that he mentioned I could use either Aldara or another medication.
I ended up purchasing two packets (costing 400) and started applying it on March 14, Tuesday.
However, the next day, I felt dizzy, weak, and had a loss of appetite, along with some redness.
Is this normal? The doctor told me to apply it every night before bed, which is clearly different from the instructions for Aldara.
Is that acceptable? As of March 16, I've applied it twice, and just this morning, after 10 hours, I washed it off.
I don't know if it's psychological or if there's a real effect, but I started to notice that some areas seemed to have only skin left and were raised, as if certain protruding parts had flattened out.
Additionally, there was a small wart that had red spots on its head.
Does this indicate that the medication is working? The doctor mentioned that the area is quite extensive (the groove on my penis), but when I look at it, it doesn't seem as large as the pictures online; it's about 0.1 to 1 centimeter in size.
Can this be treated with cryotherapy or electrosurgery, or should I continue applying the medication? Also, I want to ask, Aldara is quite expensive, and the doctor instructed me to apply it "every day," squeezing out a small amount to cover the area.
I usually apply enough to ensure coverage; is that sufficient? Lastly, I would like to know if the recurrence rates for genital warts on the penis and labia are the same.
After healing, how long does it take to be considered fully healed? Even if my immune system weakens afterward, will it still not recur? I sincerely ask for your guidance.
My girlfriend and I are monogamous partners, and we don't go to any strange places; she goes home after work, and I am currently a student, mostly staying at home or going out with her.
We only have each other as sexual partners...
I really don't know how this happened, and I'm under a lot of stress every day, often thinking about it to the point of insomnia.
I'm feeling very pessimistic and down, and I hardly talk to anyone.
I earnestly request your help in answering my questions.

Xiansheng, 20~29 year old female. Ask Date: 2017/03/16

Dr. Du Shixi reply Urology

Hello: Genital warts can recur; they may be treated successfully or enter a latent phase, during which they can reappear at any time (currently, there is no reliable method to determine which state they are in).
The latest data shows that Imiquimod has a cure rate of 56-84% with a recurrence rate of 13-16%.
Electrosurgery or cryotherapy has a cure rate of 79-88% with a recurrence rate of 25-40%.
Surgical excision (for larger warts) has a cure rate of 72% with a recurrence rate of 19-29%.
Therefore, any treatment carries the possibility of recurrence.

Imiquimod usage for males: Apply once daily to the affected area.
If a noticeable redness (inflammatory) reaction occurs, discontinue use for 2-3 days, and once the inflammatory reaction subsides, resume treatment three times a week (Monday, Wednesday, Friday or Tuesday, Thursday, Saturday) until the warts disappear.
(If redness occurs, stop for 2-3 days, then use three times a week; some may need to use it for 2-3 months.) The average treatment duration is 8-10 weeks, with those who respond quickly having a healing time of 2-4 weeks.

If you lack confidence in self-application, consider seeking treatment at a urology clinic (many clinics are currently available).
Additionally, your girlfriend should have a gynecological examination, as women can develop warts in the vagina without any symptoms.
Safe sex practices, such as using condoms, are recommended (though they do not provide 100% protection).

[I always tell my patients that if warts reappear after electrosurgery (as they may notice themselves), they should return for another treatment.
If there are no new warts, they should take care of the wound and return for a follow-up with the doctor after three months.
Sexual partners should also get checked.] [Given your situation, it may be advisable to visit a urology clinic not only for treatment but also for some sexually transmitted infection screenings, and to continue follow-up with the same physician.] Thank you for your inquiry.

Reply Date: 2017/03/16

More Info

Penile warts, commonly known as genital warts, are caused by certain strains of the human papillomavirus (HPV). They can appear as small, flesh-colored or gray growths on the genital area, including the penis, and can vary in size and shape. Understanding the recurrence rates, treatment options, and the implications of using medications like LedaMed is crucial for managing this condition effectively.

Recurrence Rates of Penile Warts
Genital warts can recur after treatment due to the nature of HPV. While treatment can remove visible warts, the virus may remain dormant in the skin cells, leading to potential recurrence. Studies indicate that recurrence rates can be as high as 30% to 50% within the first few months after treatment. Factors influencing recurrence include the immune system's strength, the specific HPV strain involved, and the completeness of the initial treatment.

Treatment Options
LedaMed, which contains the active ingredient imiquimod, is an immune response modifier that can help treat genital warts by stimulating the body's immune system to fight the virus. It is typically applied topically, and the recommended usage is usually three times a week for up to 16 weeks, depending on the doctor's advice.
In your case, it seems there may have been some confusion regarding the application frequency. The doctor’s recommendation to apply it every night may differ from the standard guidelines, which typically suggest less frequent applications. It's essential to follow the specific instructions given by your healthcare provider, as they may have tailored their advice based on your individual situation.

Side Effects and Reactions
The symptoms you described, such as dizziness, lack of appetite, and redness, could be side effects of the medication or an indication of an allergic reaction. Imiquimod can cause local irritation, redness, and swelling at the application site, and in some cases, systemic side effects may occur. If these symptoms persist or worsen, it is crucial to contact your healthcare provider for further evaluation.

Efficacy of Treatment
The changes you observed, such as the warts appearing less prominent or changing in texture, may indicate that the treatment is having an effect. However, the presence of blood spots or significant irritation should be monitored closely. If the irritation continues or if new symptoms arise, it would be wise to consult your doctor to discuss whether to continue with LedaMed or consider alternative treatments, such as cryotherapy (freezing) or electrosurgery, which can be effective for larger or more persistent warts.

Comparing Recurrence Rates
Regarding the recurrence rates of penile warts versus warts on the vulva (labial warts), they are generally similar, as both are caused by HPV. However, individual factors such as the immune response, the specific HPV strain, and the treatment method can influence recurrence.

Conclusion and Recommendations
1. Follow-Up: Regular follow-up with your healthcare provider is essential to monitor the effectiveness of the treatment and to make adjustments as necessary.

2. Mental Health: The stress and anxiety you are experiencing are understandable given the circumstances. It may be beneficial to seek support from a mental health professional or counselor to help manage these feelings.

3. Safe Practices: Continue practicing safe sexual behaviors to reduce the risk of transmitting HPV to your partner or acquiring new strains.

4. Education: Educate yourself about HPV and its implications. Understanding the virus can help alleviate some of the anxiety associated with the diagnosis.

5. Healthy Lifestyle: Maintaining a healthy lifestyle can support your immune system, which is crucial in managing HPV.

In summary, while penile warts can be distressing, effective treatment options are available, and with proper management, the recurrence can be minimized. Always consult with your healthcare provider regarding any concerns or changes in your condition.

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