STI-related Genital Warts

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Causes

  • Human papilloma virus

Symptoms

  • Usually no symptoms
  • Small painless swellings in the ano-genital region
  • Itching or discomfort in the genital area
  • May cause increased vaginal discharge
  • Anal or vaginal bleeding during or after sex


Signs

  • Small, flat, papular, pedunculated, flesh-coloured swellings on the skin and mucous membranes of the genitals (penis, vulva, vagina, cervix, urethra, perianal region)

Investigations

Acetic acid solution (vinegar) testTreatment

Treatment objectives

  • To eliminate the warts

Non-pharmacological treatment

  • Protect normal skin with vaseline (paraffin) while applying Podophyllin
  • External genital and perianal warts should be washed thoroughly 1- 4 hours after application of Podophyllin and 6-10 hours after application of Imiquimod.
  • Cryotherapy with liquid nitrogen, solid carbon dioxide, or a cryoprobe. Repeat applications every 1-2 weeks
  • Electrosurgery
  • Surgical removal


Pharmacological treatment
Evidence Rating: [C]

  • Podophyllin 10-25% tincture of benzoin, topical, apply directly to the warts avoiding normal skin tissue.

Protect normal skin with vaseline (paraffin).
Repeat treatment at weekly intervals until complete resolution.


Or

  • Trichloroacetic Acid (TCA) (80-90%), topical, apply carefully to the warts avoiding normal tissue, followed by powdering of the treated area with talcum powder to remove unreacted acid.
    Repeat treatment at weekly intervals until complete resolution.


Or

  • Podophyllotoxin, 0.5%, topical, apply 12 hourly three times a week for 4 weeks


Or

  • Imiquimod, 5% cream, topical, apply three times a week for 16 weeks. Should be washed 6-10 hours after application.

Do not use TCA during pregnancy and lactation.
Do not use Podophyllin or TCA on cervical warts.