Regrets and lessons after genital warts

Dear Dr G,

I am a thirty-year-old man who is recently engaged and planning to marry before Christmas. The revelation of my recent diagnosis has left me devastated, and I hope you don’t mind my remaining anonymous.

A few months ago, I noticed some growths on the head of my penis when I retracted my foreskin. These growths are completely painless, yet raised my concerns. This prompted me to consult a doctor.

The specialist identified them as genital warts, explaining that they are a sexually transmitted infection. He emphasised the need to protect my fiancée.

The doctor offered freezing as a form of treatment, but overwhelmed, I left without undergoing the procedure.

I’m sorry to put Dr G on the spot, but can you shed more light on genital warts? How do you contract them? Are they always sexually transmitted? Besides freezing, what other treatments are available?

Are genital warts curable, or could they lead to cancer?

I’ve heard about a vaccine for genital warts. Would it benefit me? The doctor mentioned the need to protect my fiancée, but how can this be done? And finally, when do you think I contracted the infection? My past relationships are haunting me.

I eagerly await your response.

Regretfully yours, Ronald

Genital warts are either cauliflower-shaped or flat protrusions from the skin surface caused by the Human Papilloma Virus (HPV). They are highly contagious infections transmitted through sexual contact and are often asymptomatic, though some people may initially experience itchiness, discomfort, or redness.

The warts may appear individually or in clusters on the external genitalia, including the penile shaft, scrotum, anus, vagina, and labia. Understandably, their outbreak can lead to significant psychological distress, anxiety, and guilt among those affected.

HPV has various forms. Subtypes 6 and 11 typically result in genital warts, while HPV types 16, 18, 31, 33, and 35 are occasionally found. Virus transmission occurs through direct skin-to-skin contact during genitals penetrative, oral, or anal sex, usually manifesting one to eight months after exposure.

Notably, only 10% of those with HPV will develop visible genital warts, even though it is estimated that up to 20% of the US population carry genital HPV, with a clinical manifestation rate of 1% among the sexually active adult population. The majority of those affected fall within the 17-to-33-year-old age group.

Condom use for preventing HPV transmission has been debated in scientific circles. While recognised for reducing all forms of sexually transmitted infections, the genital areas not covered by condoms remain susceptible to the virus.

Genital warts treatment can be classified into ablative or topical interventions. Removal eliminates visible warts, but it does not guarantee a reduced risk of future recurrence. Physical ablative therapy options include simple excision, liquid nitrogen cryosurgery, electro-cauterisation, and laser ablation intervention, commonly used for patients with hardened (keratinised) warts that are smaller and fewer.

Conversely, topical agent treatments suit those with multiple larger warts, applying agents such as podophyllotoxin, imiquimod, and trichloroacetic acid to erode and destroy the lesions.

The HPV vaccine’s introduction to prevent cervical cancer is believed to impact the future prevalence of genital warts, especially in women. Recent clinical trials have also demonstrated a reduced risk of emergence and recurrence of genital warts in men and women already infected with the HPV virus. Thus, sufferers with repeated outbreaks of genital warts may benefit from vaccination.

The unsightly emergence and recurrence of lesions in private parts can induce feelings of regret and guilt. Although HPV infections are incurable, with genital warts’ recurrence rates as high as 50-75%, there are reports of spontaneous regression as the virus can be cleared by the host’s immunological responses.

Dr G is often put on the spot by remorseful men regretting past sexual experiences that caused their genital warts. His advice is to turn those regrets into lessons of prevention by reducing the number of sexual partners, embracing vaccines, and enhancing health and immunity to fend off future HPV infections or recurrences.