HPV types 16, 18, 31, 33, and 35 are also occasionally found in anogenital warts usually as co-infections with HPV 6 or 11 and can be associated with foci of high-grade squamous intraepithelial lesions HSILparticularly in persons who have HIV infection. In addition to anogenital warts, HPV types 6 and 11 have been associated with conjunctival, nasal, oral, and laryngeal warts. Anogenital warts Cure genital warts on the anus usually asymptomatic, but depending on the size and anatomic location, they can be painful or pruritic.
They are usually flat, papular, or pedunculated growths on the genital mucosa. Anogenital warts occur commonly at certain anatomic sites, including around the vaginal introitus, under the foreskin of the uncircumcised penis, and on the shaft of the circumcised penis. Warts can also occur at multiple sites in the anogenital epithelium or within the anogenital tract e. Intra-anal warts are observed predominantly in persons who have had receptive anal intercourse, but they also can occur in men and women who have not had a history of anal sexual contact.
Diagnosis of anogenital warts is usually made by visual inspection. The diagnosis of anogenital warts can be confirmed by biopsy, which is indicated if lesions are atypical e. Biopsy might also be indicated in the following circumstances, particularly if the patient is immunocompromised including those infected with HIV: HPV testing is not recommended for anogenital wart diagnosis, because test results are not confirmatory and do not guide genital wart management.
The aim of treatment is removal of the wart and amelioration of symptoms, if present. The appearance of warts also can result in significant psychosocial distress, and removal can relieve cosmetic concerns.
In most patients, treatment results in resolution of the wart s. If left untreated, anogenital warts can resolve spontaneously, remain unchanged, or increase in size or number.
Because warts might spontaneously resolve within 1 year, an acceptable alternative for some persons is to forego treatment and wait for spontaneous resolution. Available therapies for anogenital warts might reduce, but probably do not Cure genital warts on the anus, HPV infectivity.
Treatment of anogenital warts should be guided by wart size, number, and anatomic site; patient preference; cost of treatment; convenience; adverse effects; and provider experience.
No definitive evidence suggests that any one recommended treatment is superior to another, and no single treatment is ideal for all patients or all warts.
The use of locally developed and monitored "Cure genital warts on the anus" algorithms has been associated with improved clinical outcomes and should be encouraged. Because all available treatments Cure genital warts on the anus shortcomings, some clinicians employ combination therapy e.
However, limited data exist regarding the efficacy or risk for complications associated with combination therapy. Treatment regimens are classified as either patient-applied or provider-administered modalities.
Patient-applied modalities are preferred by some persons because they can be administered in the privacy of their home. To ensure that patient-applied modalities are effective, instructions should be provided to patients while in the clinic, and all anogenital warts should be accessible and identified during the clinic visit. Follow-up visits after several weeks of therapy enable providers to answer any questions about the use of the medication and address any side effects experienced; follow-up visits also facilitate the assessment of the response to treatment.
Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy. Imiquimod is a patient-applied, topically active immune enhancer that stimulates production of interferon and other cytokines. With either formulation, the treatment area should be washed with soap and water 6—10 hours after the application.
A small number of case reports Cure genital warts on the anus an association between treatment with imiquimod cream and worsened inflammatory or autoimmune skin diseases e.
Data from studies of human subjects are limited regarding use of imiquimod in pregnancy, but animal data suggest that this therapy poses low risk Podofilox podophyllotoxin is a patient-applied antimitotic drug that causes wart necrosis. Podofilox solution using a cotton swab or podofilox gel using a finger should be applied to anogenital warts twice a day for 3 days, followed by 4 days of no therapy. This cycle can be repeated, as necessary, for up to four cycles. The total wart area treated should not exceed 10 cm 2and the total volume of podofilox should be limited to 0.
If possible, the health-care provider should apply the initial treatment to demonstrate proper application technique and identify which warts should be treated.
Mild to moderate pain or local irritation might develop after treatment. Podofilox is contraindicated in pregnancy Sinecatechins is a patient-applied, green-tea extract with an active product catechins. This product should not be continued for longer than 16 weeks The medication should not be washed off after use. Genital, anal, and oral sexual contact should be avoided while the ointment is on the skin.
Cure genital warts on the anus medication is not recommended for persons with HIV infection, other immunocompromised conditions, or with genital herpes because the safety Cure genital warts on the anus efficacy of therapy has not been evaluated. The safety of sinecatechins during pregnancy is unknown.
Cryotherapy is a provider-applied therapy that destroys warts by thermal-induced cytolysis. Health-care providers must be trained on the proper use of this therapy because over- and under-treatment can result in complications or low efficacy. Pain during and after application of the liquid nitrogen, followed by necrosis and sometimes blistering, is common. Local anesthesia topical or injected might facilitate therapy if warts are present in many areas or if the area of warts is large.
Surgical therapy has the advantage of eliminating most warts at a single visit, although recurrence can occur. Surgical removal requires substantial clinical training, additional equipment, and sometimes a longer office visit. After local anesthesia is applied, anogenital warts can be physically destroyed by electrocautery, in which case no additional hemostasis is required.
Care must be taken to control the depth of electrocautery to prevent scarring. Alternatively, the warts can be removed either by tangential excision with a pair of fine scissors or a scalpel, by carbon dioxide CO 2 laser, or by curettage. Because most warts are exophytic, this procedure can be accomplished with a resulting wound that only extends into the upper dermis. Hemostasis can be achieved with an electrocautery unit or, in cases of very minor bleeding, a chemical styptic e.
Suturing is neither required nor indicated in most cases.
In patients with large or extensive warts, surgical therapy, including CO 2 laser, might be most beneficial; such therapy might also be useful for intraurethral warts, particularly for those persons who have not responded to other treatments. Treatment of anogenital and oral warts should be performed in an appropriately ventilated room using standard precautions https: Trichloroacetic acid TCA and bichloroacetic acid BCA are provider-applied caustic agents that destroy warts by chemical coagulation of proteins.
Although these preparations are widely used, they have not been investigated thoroughly. TCA solution has a low viscosity comparable with that of water and can spread rapidly and damage adjacent tissues if applied excessively.
A small amount should be applied only to the warts and allowed to dry i.
If pain is intense or an excess amount of acid is applied, the area can be covered with sodium bicarbonate i. Less data are available regarding the efficacy of alternative regimens for treating anogenital warts, which include podophyllin resin, intralesional interferon, photodynamic therapy, and topical cidofovir. Further, alternative regimens might be associated with more side effects. Podopyllin resin is no longer a recommended regimen because of the number of safer regimens available, and severe systemic toxicity has been reported when podophyllin resin was applied to large areas of friable tissue and was not washed off within 4 hours Podophyllin should be applied to each wart and then allowed to air-dry before the treated area comes into contact with clothing.
Over-application or failure to air-dry can result in local irritation caused by spread of the compound to adjacent areas and possible systemic toxicity.
The treatment can be repeated weekly, if necessary. Podophyllin resin preparations differ in the concentration of active components and contaminants. Shelf-life and stability of podophyllin preparations are unknown. The safety of podophyllin during pregnancy has not been established. For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated. Most anogenital warts respond within 3 months of therapy.
Factors that might affect response to therapy include immunosuppression and treatment compliance. In general, warts located on moist surfaces or in intertriginous areas respond best to topical treatment.
A new treatment modality should be selected Cure genital warts on the anus no substantial improvement is observed
Cure genital warts on the anus a complete course of treatment or in the event of severe side effects; treatment response and therapy-associated side effects should be evaluated throughout the course of therapy. Complications occur rarely when treatment is administered properly.
Persistent hypopigmentation or hyperpigmentation can occur with ablative modalities e. Depressed or hypertrophic scars are uncommon but can occur, especially if patients have insufficient time to heal between treatments.
Rarely, treatment can result in chronic pain syndromes e. Persons should inform current partner s about having genital warts because the types of HPV that cause warts can be passed on to partners.
Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended. Partner s might "Cure genital warts on the anus" from physical examination to "Cure genital warts on the anus" genital warts and tests for other STDs. No recommendations can be made regarding informing future sex partners about a diagnosis of genital warts because the duration of viral persistence after warts have resolved is unknown.
Podofilox podophyllotoxinpodophyllin, and sinecatechins should not be used during pregnancy. Imiquimod appears to pose low risk but should be avoided until more data are available. Anogenital warts can proliferate and become friable during pregnancy.
Although removal of warts during pregnancy can be considered, resolution might be incomplete or poor until pregnancy is complete.
Rarely, HPV types 6 and 11 can cause respiratory papillomatosis in infants and children, although the route of transmission i. Whether cesarean section prevents respiratory papillomatosis in infants and children also is unclear ; therefore, cesarean delivery should not be performed solely to prevent transmission of HPV infection to the newborn. Cesarean delivery is indicated for women with anogenital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding.
Pregnant women with anogenital warts should be counseled concerning the low risk for warts on the larynx of their infants or children recurrent respiratory papillomatosis. Persons with HIV infection or who are otherwise immunosuppressed are more likely to develop anogenital warts than those who do not have HIV infection Moreover, such persons can have larger or more numerous lesions, might not respond to therapy as well as those who are immunocompetent, and might have more frequent recurrences after treatment Despite these factors, data do not support altered approaches to treatment for persons with HIV infection.
Squamous cell carcinomas arising in or resembling anogenital warts might occur more frequently among immunosuppressed persons, therefore requiring biopsy for confirmation of diagnosis for suspicious cases Biopsy of an atypical wart might reveal HSIL or cancer of the anogenital tract.
In this instance, referral to a specialist for treatment is recommended. Intra-anal warts are observed predominantly in persons who have had Whether the reduction in HPV viral DNA resulting from treatment. Genital warts is a common sexually transmitted infection (STI) passed on through vaginal, anal and, rarely, oral sex. Treatment from a sexual health clinic can. Most anal warts do not require medical treatment, however, if symptoms of pain, Occasionally, anal warts will develop on the skin surrounding the genital area.
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