Genital warts decrease in girls aged 15-17 by 72%
These are current - 2016 - UK statistics! What an impressive achievement!
As a sexual health doctor, I know that genital warts used to be one of the most common and also the most upsetting reasons, for young people to visit the sexual health clinic.
Here's the low down. Genital warts are particularly nasty for the following reasons. Often warts are hidden in the genital tract until they grow big enough to become noticeable. They may have been present for some time, without the young person being aware they were there. Sufferers are also often dismayed to find out that even using a condom correctly, and each and every time you have sex, does NOT guarantee you can't catch genital warts, or pass them on. The virus may be present throughout the genital tract and after all, the condom only covers a proportion of the penis. Warts are spread by both skin to skin contact and by mixing genital secretions.
Once a person knows they have genital warts, the psychological effects are immense. Feeling unclean and ashamed, they may suffer with severe anxiety and depression. This may also seriously affect their sexual function. The repercussions of a diagnosis of genital warts may last for many years. Even with treatment, warts can and frequently do reappear, reinforcing this heartache.
So how is the diagnosis of genital warts actually made? Usually a patient has a test to confirm the presence of an infection. However, there is no commercially agreed medical test for everyday use in a clinic. The diagnosis rests entirely by the opinion of the clinician on the day, usually after a long hard stare at the offending area, and sometimes necessitating the use of a magnifying glass! Soaking the area in diluted acetic acid, using a cotton wool ball may aid diagnosis, as wart infected tissue will turn white.
Having been diagnosed with genital warts, what do patients then say to their sexual partners, about the diagnosis and the chance of passing these on in the future? Current advice is to use a condom when having sex, during and for three months after treatment, but this doesn't seem very robust in the light of the above facts. Many patients remain traumatised by the diagnosis and fearful about their future sexual relationships.
"It's only a wart -' that's often what people say. The causative agent is the Human Papilloma Virus (HPV). There are over 100 different types of HPV. Many strains are indeed innocent, but several sub-types may lead to serious consequences and are termed "high risk."This is because over a long term period, the high risk strains may be a direct cause of cervical cancer and other genital tract cancers. So it may be "only a wart," but warts are potentially a big problem, and very upsetting for the sufferer. It may be comforting however, for those afflicted to know, that visible genital warts are not usually caused by the high risk HPV subtypes.
Here's the question - What do we do when we find an infectious disease with serious medical consequences? Here's the answer - eradicate it of course! And how better to do that than by introducing an HPV vaccine! Which is just what has happened here in the UK. Read on.
There has been a truly fantastic, major turnaround of events.
In 2008, a UK Public Health programme began to vaccinate girls aged 12-13, against the HPV virus. There was also a catch up programme for girls aged up to 18. The first vaccine used, Cervarix, was only effective against two different strains of HPV (16 and 18). Since then the vaccine has been changed to Gardasil, which is effective against four types of the virus (HPV 6 and 11, as well as HPV 16 and 18). These four types of HPV are the four main types which account for the vast majority of cervical/genital cancers and visible genital warts.
Why were boys not immunised? This is because of herd immunity. Immunising the girls, reduces the critical mass of infection and breaks the chain of transmission. Immunisation is interesting as it offers more than just protection to the person who has been immunised. And this does seem to have worked. 2016 statistics showed that diagnoses of genital warts in girls and boys aged 15-17, had reduced since 2009, by a staggering 72% and 62%, respectively.
In Wales there is now an HPV vaccination programme for homosexual men up to age 45. Perhaps the rest of the UK will now follow suit?
Despite this huge reduction in genital warts in young people, it remains important for young women to have cervical smears, when they reach the age of 25, irrespective of whether they have had the HPV vaccination or not. Cervical smears themselves are now tested in the laboratory for the presence of HPV. Smears where high risk HPV is detected are then followed up differently from those smears that are low risk or HPV negative.
Different treatments exist to treat genital warts. However about one third of warts will spontaneously clear by themselves, so one option, sometimes overlooked, is to just wait and see. Podophllotoxin solution 0.5%, or 0.15% cream, are commonly used to treat soft, fleshy warts. For thickened, crusty warts, freezing, known as cryotherapy is frequently used. Good results have been shown using Imiquimod, which is absorbed through the skin and directly stimulates an antibody response to the wart virus. Long term clearance rates may be more frequent using this preparation. None of these treatments provide instant success. The treatments do need to be used regularly over a period of months. Sometimes, if warts are extensive or resistant to topical treatments, various types of surgical excision, or laser treatment may be required.
What else can be done to get rid of warts? The message is - don't smoke! Nicotine by-products become concentrated in the genital tissues and directly impair the antibody response.http://www.medscape.com/viewarticle/719242_2 Stop smoking and allow your body's natural defences to perform their best for you!
Warts are often first diagnosed in pregnancy, and after the pregnancy warts will often disappear by themselves! This is because the body's immune system is focussed on protecting the baby, leaving the mother relatively susceptible to the virus during the pregnancy.
It is also important that when warts are diagnosed, the current or most recent sexual partners are seen in clinic and offered a full STI screen. Most people with STI's have no symptoms. If one STI is present such as a wart, a full STI screen is recommended, for the index patient and their partner.
So - let's wave goodbye to genital warts, with vigour! And say thank you to the HPV vaccine for enabling such an incredible improvement in the nation's sexual health.
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