Persistent Genital Warts: Treatment Challenges and Options

The cauliflower keeps growing?

Hello doctor, I underwent laser surgery for a sebaceous cyst on February 16.
On March 15, I visited the clinic due to discomfort in the vulva, and the doctor diagnosed me with herpes.
On April 10, while examining the wound in the mirror, I noticed small growths in the vulva, which were later identified as warts.
There were about 3 or 4 near the vaginal opening and 2 at the urethral opening.
On April 11, I also had laser removal of the area near the vaginal opening, but the doctor treated a large and deep area.
During my follow-up on May 2, I found that the healing wound was covered with warts, all clustered together.
The two warts at the urethral opening were about the size of mung beans.
Additionally, I discovered one wart on each side of the inner labia and a few more near the inner thigh and perianal area.
On May 3, I was referred to a larger hospital, where the doctor also noted that my lesions were very severe but could only remove the larger warts and extensive areas for now, as the smaller ones had not grown enough to determine if they were warts.
After the laser treatment on May 4, I checked in the mirror and saw that the small warts on the inner labia and near the perianal area were not treated by the doctor.
I am very concerned that by the time I return for my follow-up next week, they may have spread significantly or grown larger, as my warts seem to grow rapidly within a week.
I have been taking B vitamins and vitamin C daily, and I purchased an oral medication called Imiquimod, as well as a topical treatment called Aldara.
The doctor advised me to use Aldara and not to use Imiquimod, but I developed a severe allergic reaction after using Aldara for three days, resulting in redness, swelling, itching, and peeling on both thighs.
The doctor told me to stop the medication.
I asked if I could switch to Imiquimod, and the doctor said they were unsure if I would have an allergic reaction, so I could try it.
I also asked if taking Imiquimod would be effective, and the doctor said it would not.
I inquired whether receiving the HPV vaccine would help suppress the growth, but the doctor said it would not be effective since the condition has already developed.
Since February 16, I have not engaged in any sexual activity, and my lifestyle and diet have been very healthy, yet the lesions continue to grow.
Almost every night after showering, I notice that they have either increased in size or new small growths appear in other areas.
I would like to know why this is happening.
I just had laser treatment yesterday, but there are still very small warts that were not removed.
Can I apply Imiquimod at home? (I am worried that the lesions will grow larger by the time I return for my follow-up next week.) Is taking Imiquimod effective in suppressing warts or not? Am I now limited to continuous laser surgeries, with three surgeries spaced less than a month apart? I am already exhausted from the treatment.

V, 20~29 year old female. Ask Date: 2017/05/05

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Hello doctor, I underwent laser surgery for a sebaceous cyst on February 16.
On March 15, I experienced discomfort in the vulva and saw a doctor who diagnosed me with herpes.
On April 10, while examining the wound in the mirror, I noticed small growths in the vulva, which were later identified as warts.
There were about 3 to 4 at the vaginal opening and 2 at the urethral opening.
On April 11, I also had laser removal near the vaginal opening, but the doctor treated a large and deep area.
During my follow-up on May 2, I found that the healing wound was covered with warts, all clustered together.
The two independent growths at the urethral opening were about the size of mung beans.
Additionally, I discovered one small growth on each side of the inner labia and a few more near the inner thigh and perianal area.
On May 3, I was referred to a larger hospital, where the doctor confirmed that my lesions were very severe but could only remove the larger ones and extensive areas with laser treatment.
The smaller lesions could not be assessed yet as they had not grown large enough.
After the laser treatment on May 4, I checked the areas around the inner labia and perianal region, which the doctor did not address, and I am worried that by the time I return for my follow-up next week, they may have spread or grown significantly.
It seems that my warts grow rapidly, becoming larger and denser within a week.
I have been taking B vitamins and vitamin C daily, and I purchased an oral medication called Imiquimod, as well as a topical treatment called Wart Off.
The doctor advised me to use Wart Off and not to apply Imiquimod, but after three days of using Wart Off, I developed a severe allergic reaction, with both thighs becoming red, swollen, itchy, and peeling.
The doctor told me to stop the medication.
I asked if I could switch to Imiquimod, and the doctor said they were unsure if I would have an allergic reaction, so I could try it.
I also inquired if taking Imiquimod would be effective, and the doctor said it would not help.
I asked if receiving the HPV vaccine could slow the growth of the warts, but the doctor said it would not be effective since the condition has already developed.
Since February 16, I have not engaged in any sexual activity, and my lifestyle and diet have been normal and healthy, yet the lesions continue to grow.
Almost every night after showering, I notice they have either increased in size or new small growths have appeared in other areas.
I am wondering why this is happening.
I just had laser treatment yesterday, but there are still very small growths that were not treated.
Can I apply Imiquimod at home? (I am very concerned that the lesions will grow significantly by the time of my follow-up next week.) Is taking Imiquimod effective in suppressing the warts? Am I now left with no choice but to continue undergoing laser surgeries, with three surgeries spaced less than a month apart? I am already exhausted from the treatment.

Answer: Your situation is indeed quite unusual.
In my opinion, you should seek assistance from a dermatologist (at a medical center).
It may be necessary to perform a biopsy to confirm the diagnosis.

Reply Date: 2017/05/05

More Info

Understanding persistent genital warts, also known as condylomata acuminata, can be quite challenging, especially when faced with recurrent outbreaks and treatment difficulties. Genital warts are caused by certain strains of the human papillomavirus (HPV), which is a sexually transmitted infection. The persistence and recurrence of these warts can be frustrating and distressing, as you've experienced.

From your description, it seems that you have undergone multiple laser treatments to remove the warts, but they continue to reappear. This is not uncommon, as HPV can remain dormant in the body and reactivate, leading to new growths. The fact that you have been diligent about your health, maintaining a healthy lifestyle, and avoiding sexual activity is commendable, but unfortunately, these measures may not prevent the recurrence of warts.

In terms of treatment, there are several options available for managing genital warts:
1. Topical Treatments: These include medications like imiquimod (Aldara) and podofilox (Condylox), which can help stimulate the immune system to fight the virus and reduce wart growth. However, as you mentioned, you experienced an allergic reaction to one of the topical treatments. It's crucial to communicate any adverse effects to your healthcare provider, as they can help you find alternatives that may be more suitable for your skin.

2. Laser Therapy: This is a common method for removing larger or more stubborn warts. While it can be effective, as you've noted, it may not be a permanent solution, as the underlying virus can still remain in the body.

3. Cryotherapy: This involves freezing the warts with liquid nitrogen. It can be effective for some patients and may be worth discussing with your doctor.

4. Surgical Options: In cases where warts are extensive or resistant to other treatments, surgical excision may be necessary. However, this is typically considered a last resort due to the potential for scarring and recurrence.

5. Vaccination: The HPV vaccine (Gardasil) is effective in preventing certain strains of HPV that cause genital warts. However, as your doctor mentioned, if you are already infected with the virus, the vaccine will not be effective in treating existing warts.

Regarding your concerns about the small warts that were not treated during your last laser session, it is essential to follow your doctor's advice. Self-treating with over-the-counter products without medical supervision can lead to further irritation or complications. It would be best to wait for your follow-up appointment to discuss the growth of these small warts and the best course of action.

It's understandable to feel overwhelmed by the frequency of treatments and the persistence of the warts. Managing a chronic condition like this can take a toll on both physical and mental health. If you find yourself feeling anxious or depressed due to this situation, consider seeking support from a mental health professional who can help you cope with the emotional aspects of living with a chronic condition.

In summary, while persistent genital warts can be challenging to manage, there are various treatment options available. It is crucial to maintain open communication with your healthcare provider about your symptoms, treatment responses, and any side effects you experience. They can help tailor a treatment plan that best suits your needs and address your concerns about recurrence and management.

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