Managing Genital Warts: Treatment Options and Concerns

Cauliflower treatment

Hello, Dr.
Hsu.
Last month, I discovered I had genital warts and started applying medication.
During the treatment, I experienced some itching, and based on the doctor's comments, it seemed to be a sign of regression.
Later, I self-checked and felt that the warts had shrunk, and the white color was less noticeable.
However, last week, I stopped using the medication due to my menstrual period, and after it ended, I noticed that the warts seemed to have grown back, and the color was more apparent.
Is it possible that they have increased in size and severity?
Since it has been almost a month, I am preparing to return for a follow-up appointment.
Should I continue to patiently use the topical medication, or should I consider direct treatments like electrosurgery or cryotherapy? If I opt for direct treatment, will it immediately eliminate the virus, allowing me to resume sexual activity? I would prefer to continue with the topical treatment and hope for self-resolution, but I am very concerned that it may not improve.
Thank you for your response.

Miss Tang, 20~29 year old female. Ask Date: 2016/03/07

Dr. Xu Wencang reply Urology

If topical medication is ineffective, electrocautery may be considered.
Most lesions will fall off within a week, as the medication can be irritating to the skin.
After that, apply the medication every two to three days for a duration of one month.

Reply Date: 2016/03/07

More Info

Genital warts, also known as condylomata acuminata, are caused by certain strains of the human papillomavirus (HPV). They are a common sexually transmitted infection and can appear as small, flesh-colored or gray swellings in the genital area. In some cases, they may resemble cauliflower, which is why they are colloquially referred to as "cauliflower warts." Managing genital warts involves understanding the treatment options available and addressing any concerns regarding the condition.

Treatment Options
1. Topical Treatments: Over-the-counter and prescription topical treatments are often the first line of defense. Common options include:
- Podophyllin resin: A plant-derived compound that destroys wart tissue.

- Imiquimod: A cream that boosts the immune system's response to the virus.

- Sinecatechins: An ointment derived from green tea extract that can help in reducing warts.

These treatments can take several weeks to show results, and it is essential to follow the application instructions carefully. As you mentioned, you have been using a topical treatment, and it is not uncommon for warts to appear to shrink and then grow back, especially during hormonal changes like menstruation.

2. Cryotherapy: This involves freezing the warts with liquid nitrogen. This method can be effective but may require multiple sessions. It is generally performed in a healthcare provider's office.

3. Electrosurgery: This technique uses electrical currents to burn off the warts. It is typically used for larger warts or those that do not respond to other treatments.

4. Surgical Removal: In some cases, warts may need to be surgically excised, especially if they are extensive or resistant to other treatments.

5. Laser Treatment: This is another option for larger or stubborn warts, using focused light to destroy the wart tissue.

Concerns and Considerations
- Recurrence: Genital warts can recur even after successful treatment because the HPV virus can remain dormant in the body. It is crucial to maintain follow-up appointments with your healthcare provider to monitor the situation.

- Transmission: While treatments can remove visible warts, they do not eliminate the HPV virus from the body. Therefore, it is essential to practice safe sex, including the use of condoms, to reduce the risk of transmission to partners.

- Effectiveness of Treatment: If you notice that the warts have returned or worsened after stopping treatment, it may be time to consider more aggressive treatment options like cryotherapy or electrosurgery. These methods can provide quicker results and may be more effective for larger or persistent warts.

- Sexual Activity: Engaging in sexual activity while warts are present can increase the risk of transmitting the virus to partners. It is advisable to wait until the warts have been effectively treated and cleared before resuming sexual activity.

Conclusion
In your case, since you have noticed that the warts seem to have returned after stopping treatment, it may be beneficial to consult with your healthcare provider about the next steps. They can assess the situation and recommend whether to continue with topical treatments or consider more definitive treatments like cryotherapy or electrosurgery. Remember, patience is key, as some treatments can take time to show results. Always communicate openly with your healthcare provider about your concerns and preferences regarding treatment options.

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