Urethral Warts: Treatment, Risks, and Healing Time

Genital warts in the urethra?

Hello Doctor, I previously had an infection of genital warts, with lesions on the side of the penis and at the urethral opening.
After treatment with a topical wart medication by my physician, the lesions on the side of the penis and near the urethral opening have disappeared.
However, small lesions deeper in the urethra have not healed, and my physician believes that the chance of the lesions spreading deeper into the urethra is low, so there is no need for a urethroscopy.
I have been instructed to continue applying the wart medication, and since June, I have intermittently applied it for about 9 to 10 treatment sessions.

1.
Could this method of medication cause side effects?
2.
Could it lead to skin changes or even penile cancer?
3.
Given my previous medical history, should I seek a second opinion at another hospital for a urethroscopy?
4.
What is the treatment approach for genital warts inside the urethra, and how long does it typically take for the wounds to heal?
Thank you for your response.

Feichang kunhuo de ren!, 20~29 year old female. Ask Date: 2003/10/28

Dr. Cai Bingkun reply Urology

Condylomata acuminata, commonly known as genital warts, are caused by the human papillomavirus (HPV) and can be transmitted through direct or indirect contact.
The incubation period is long, typically ranging from 3 weeks to 8 months.
In men, they are most commonly found in the penile corona, foreskin, glans, urethral opening, and other areas.
Genital warts have recently gained attention in the medical community, primarily because they are the only sexually transmitted infection (STI) that has been definitively linked to cancer.
Prolonged and extensive warts may exhibit cellular dysplasia, often serving as a precursor to squamous cell carcinoma.
A biopsy is usually required, and there is a close association with cervical cancer, vulvar cancer, and vaginal cancer in women.
Urethral warts are mostly concentrated in the distal urethra, typically within one centimeter below the urethral opening, and are usually visible upon inspection.
However, it is still recommended to perform urethroscopy to rule out infections in other parts of the urethra.
Treatment options include electrosurgical excision via endoscopy, and medications can also be instilled into the urethra, such as an anticancer ointment for self-administration.
This method may cause urinary pain and a burning sensation as complications.
Currently, oral antiviral medications have been attempted, but clinical experience is limited.
The duration of treatment and healing time varies depending on the method used.
Regarding the wart treatment ointment you mentioned, it may refer to a product like Wartec, which contains podophyllotoxin.
The typical regimen involves applying it twice daily for three consecutive days, followed by a four-day break, constituting one treatment cycle.
Most side effects are localized irritations, such as redness, swelling, pain, itching, erosion, and burning sensation.

Reply Date: 2003/10/28

More Info

Urethral warts, also known as genital warts, are caused by certain strains of the human papillomavirus (HPV). They can appear on the external genitalia, including the penis and urethra, and can be a source of discomfort and concern for many individuals. Given your situation, where you have been treating visible warts with a topical medication, it is important to address your questions regarding treatment, potential side effects, and the need for further evaluation.

1. Potential Side Effects of Topical Treatment: The topical medications used to treat genital warts, such as imiquimod or podophyllotoxin, can cause local irritation, redness, and discomfort at the application site. Prolonged use may lead to skin changes, including thinning of the skin or dermatitis. If you notice any unusual changes in the skin or increased discomfort, it is advisable to consult your healthcare provider.

2. Risk of Skin Changes or Cancer: While the treatment of genital warts is generally effective, there is a concern regarding the long-term presence of HPV. Certain high-risk strains of HPV are associated with an increased risk of developing cancers, including penile cancer. However, the strains that typically cause genital warts (low-risk types) are not the same as those that lead to cancer. Nonetheless, it is crucial to monitor any persistent lesions or changes in the genital area and to maintain regular follow-ups with your healthcare provider.

3. Need for Urethroscopy: If you have persistent lesions that have not responded to treatment, or if there is any concern about the extent of the warts, it may be prudent to seek a second opinion or request a urethroscopy. This procedure allows for direct visualization of the urethra and can help determine if there are deeper lesions that require different management. Your comfort and peace of mind are important, and if you feel uncertain about your current treatment plan, seeking further evaluation is a reasonable step.

4. Healing Time for Urethral Warts: The healing time for genital warts can vary significantly based on the treatment method used and the individual’s immune response. Generally, with appropriate treatment, external warts may resolve within a few weeks to a few months. However, warts located deeper in the urethra may take longer to heal, and some may require more invasive treatments, such as cryotherapy or surgical excision, especially if they do not respond to topical therapies.

In conclusion, while your current treatment seems to be addressing the visible warts, it is essential to remain vigilant about any changes in your condition. Regular follow-ups with your healthcare provider are crucial for monitoring the situation and ensuring that any deeper lesions are adequately addressed. If you have concerns about the effectiveness of your treatment or the need for further evaluation, do not hesitate to seek a second opinion or request additional diagnostic procedures. Your health and well-being should always be the priority.

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