Managing Genital Warts: Treatment Options and Side Effects Explained

Cauliflower (Condylomata Acuminata)

Hello Dr.
Wu,
Last May, I was diagnosed with genital warts at the dermatology clinic.
I underwent cryotherapy for about four to five months, but new lesions continue to appear.
Based on the physician's recommendation, I started using a topical treatment, specifically phenol-based medication.
During the first application, I did not experience any issues, but after using it for the second to third day, I developed side effects as described in the leaflet, such as redness, a burning sensation (primarily a feeling of heat), pain, itching, and even severe serous discharge from the skin surface (unsure if it is an ulcer).
Upon seeing this condition, I temporarily stopped applying the medication and returned to the clinic to report my symptoms.
The physician suggested that I try the medication again once my condition improves slightly.
However, after subsequent applications, I experienced the aforementioned side effects the following day after each use.
I would like to ask Dr.
Wu:
1.
Should I continue using the phenol-based medication under these circumstances? I am very concerned that continued use might lead to more severe skin conditions.

2.
After learning about my situation, the clinic physician recommended Adara ointment, which I found out is also known as Aldara.
Is this medication a better option?
3.
Since being diagnosed with genital warts, I have not engaged in sexual activity and have been very careful about hygiene, but it seems I cannot fully resolve the issue.
Is there anything I should be paying attention to that I might have overlooked? (I am feeling quite distressed.)
Thank you for your guidance.

A-Bing, 40~49 year old female. Ask Date: 2021/01/06

Dr. Wu Yuxin reply Dermatology

1.
You should consult your attending physician about this issue, as they are most familiar with your condition.

2.
The mechanisms of action are different, but they all belong to the category of treatments for warts.
If one treatment is not effective, you may consider switching to another medication.

3.
Treating warts is inherently a long-term battle, so it is advisable to cooperate with your physician.

Reply Date: 2021/01/06

More Info

Managing genital warts, also known as condylomata acuminata, can be a challenging process, especially when initial treatments do not yield the desired results. Genital warts are caused by certain strains of the human papillomavirus (HPV), and while they are not life-threatening, they can cause significant discomfort and emotional distress.

Treatment Options
1. Cryotherapy: This is a common treatment for genital warts, where liquid nitrogen is applied to freeze the warts. While effective for many, it may require multiple sessions, as you've experienced.

2. Topical Treatments:
- Podophyllotoxin (e.g., Condylox): This is a plant-derived treatment that can be applied directly to the warts. It works by destroying the wart tissue.

- Imiquimod (e.g., Aldara): This is an immune response modifier that helps the body fight the HPV infection. It is applied to the warts and can stimulate an immune response.

- Trichloroacetic Acid (TCA): This is a chemical treatment that can be applied by a healthcare professional to remove warts.

3. Surgical Options: If warts are extensive or resistant to other treatments, surgical removal may be necessary. This can include excision, laser therapy, or electrosurgery.

Side Effects
Topical treatments like Imiquimod and Podophyllotoxin can cause side effects, including:
- Redness and irritation: This is common and can manifest as burning, itching, or pain at the application site.

- Ulceration: In some cases, the skin may break down, leading to open sores or weeping lesions, which can be concerning.

Given your experience with the side effects of the topical treatment (phenol-based), it is crucial to communicate these reactions to your healthcare provider. If the irritation is severe or if you develop open sores, it may be advisable to discontinue use and consult your doctor for alternative treatments.

Recommendations
1. Continue or Discontinue Phenol-Based Treatment: If the side effects are intolerable and significantly affecting your quality of life, it may be best to stop using the medication. Your healthcare provider can help assess whether the benefits outweigh the risks in your case.

2. Consider Alternative Treatments: The recommendation for Adara (which contains imiquimod) may be a suitable alternative, as it works differently and may have a different side effect profile. However, it can also cause irritation, so monitoring your skin's response is essential.

3. Preventive Measures: While you mentioned practicing good hygiene and abstaining from sexual activity, it’s also important to consider vaccination against HPV (Gardasil or Cervarix), which can protect against the strains that cause genital warts and cervical cancer. Additionally, ensure that any sexual partners are aware of your condition to prevent transmission.

4. Emotional Support: The emotional toll of dealing with genital warts can be significant. Consider seeking support from a counselor or support group to help manage the anxiety and stress associated with this condition.

Conclusion
Managing genital warts requires a tailored approach, and it’s essential to work closely with your healthcare provider to find the most effective treatment while minimizing side effects. If you experience severe reactions to any treatment, do not hesitate to reach out for further evaluation and alternative options. Remember, you are not alone in this journey, and there are effective treatments available to help manage your condition.

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