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Warts on pines: an update on their evaluation and management

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an update on their evaluation and management

The diagnosis is mainly clinical, based on the history and physical findings. Dermoscopy and in vivo reflectance confocal microscopy help to increase the diagnostic accuracy.24 The morphological features may vary from finger-like, knob-like, to mosaic-like pattern.24–26 Among the vascular features, glomerular, hairpin, and dotted vessels are commonly seen.26 Papillomatosis is a constant feature.4 Some authors suggest the use of acetowhite test to aid the diagnosis of penile warts. While the sensitivity of acetowhite test is high for hyperplastic penile warts, the sensitivity is low for other types of penile warts and subclinically infected areas. Skin biopsy is seldom warranted but should be considered for atypical features (e.g., atypical pigmentation, induration, fixation to underlying structures, hard consistency, ulceration, or bleeding), when the diagnosis is in doubt or for warts recalcitrant to various treatment modalities. Although some authors suggest HPV DNA test to show the type of HPV that may affect the risk of malignant transformation, HPV typing is generally not recommended for routine diagnosis and not easily obtained.13

Differential diagnosis

Differential diagnosis includes pearly penile papules, Fordyce spots, acrochordons, condylomata lata of syphilis, molluscum contagiosum, granuloma annulare, lichen nitidus, lichen planus, seborrheic keratosis, epidermal nevus, lymphangioma circumscriptum, lymphogranuloma venereum, scabies, syringomas, traumatic neuromas, schwannomas, bowenoid papulosis, and squamous cell carcinoma.7

Pearly penile papules typically present as asymptomatic, small, smooth, soft, yellowish, pearly white, or flesh-colored, conical- or dome-shaped papules 1–4 mm in diameter ().27 The lesions are usually uniform in size and shape and are symmetrically distributed.27 Typically, the papules occur in single, double, or multiple rows circumferentially around the corona and sulcus of the glans penis. The papules tend to be more prominent on the dorsum of the corona and less prominent towards the frenulum.27

Pearly penile papules presenting as flesh-colored papules circumferentially distributed on the corona of the glans penis.

Fordyce spots are enlarged sebaceous glands. On the glans and shaft of the penis, Fordyce spots appear as asymptomatic, isolated or grouped, discrete, creamy yellow, smooth papules 1–2 mm in diameter ().28–30 On the penile shaft, these papules are more obvious during penile erection or when the foreskin is stretched.28,30 A thick chalky or cheesy material can sometimes be expressed by squeezing the lesion.28

Fordyce spots presenting as discrete, creamy yellow, smooth papules.

Acrochordons, also known as skin tags, are soft, flesh-colored to dark brown, sessile or pedunculated skin growths with a smooth contour ().31,32 Occasionally, the lesions may be hyperkeratotic or have a warty appearance.33 Most acrochordons are 2–5 mm in diameter, although often larger in the groin. 32 They can appear in almost any part of the body but are more frequently seen on the neck and intertriginous areas.31,32 When they occur on the penile area, they can mimic penile warts.

Acrochordons presenting as soft, flesh-colored skin growths with a smooth contour.

Condylomata lata or condyloma latum are cutaneous lesions of secondary syphilis caused by the spirochete, Treponema pallidum.34,35 Clinically, condylomata lata manifest as moist, gray-white, velvety, flat-topped or cauliflower-like, broad papules or plaques.36 They tend to develop in warm, moist sites of the genitals and perineum.36 A nonpruritic, diffuse, symmetrical, maculopapular rash on the trunk, palms, and soles is characteristic of secondary syphilis.34 Systemic manifestations include headache, fatigue, pharyngitis, myalgia, and arthralgia.34 Alopecia, erythematous, or leukoplakic lesions on the oral mucosa and generalized lymphadenopathy may be present.36

Typically, molluscum contagiosum presents as discrete, smooth, firm, dome-shaped, yellow, pearly white or skin-colored, waxy papules with characteristic central umbilication ( and ). 37–39 In the pediatric age group, lesions are most commonly seen on the trunk and intertriginous areas, whereas in adults, lesions are more commonly seen on the lower abdomen, upper thighs, and genital area ().39 The size of lesions ranges from 1 to 5 mm in diameter and the number of lesions is usually less than 20.38,39

Molluscum contagiosum presents as discrete, smooth, dome-shaped, pearly white papules on the penile shaft.

Examination of a molluscum contagiosum lesion under a dermatoscope shows a discrete dome-shaped papule with central umbilication.

Granuloma annulare is a benign, self-limited inflammatory disease of the dermis and subcutaneous tissue. The condition is characterized by asymptomatic, firm, brown violaceous, erythematous, or flesh-colored papules, typically arranged in an annular, circinate configuration.40 As the condition progresses, central involution may be noted.40 The ring of papules often becomes coalescent to form an annular plaque. Granuloma annulare typically involves the extensor surfaces of the distal extremities but may also involve the shaft and glans of the penis. 41,42

Lichen nitidus is a chronic inflammatory dermatosis characterized by numerous, asymptomatic, discrete, flat-topped, flesh-colored, shiny, pinhead- to pinpoint-sized papules ().43,44 The abdomen, chest, extremities, and penis are sites of predilection.43–45 The lesions are usually arranged in groups.43

Lichen nitidus presenting as multiple discrete, flat-topped, fleshed-colored papules on the penile shaft.

Cutaneous lichen planus is a chronic inflammatory dermatosis characterized by six Ps: pruritic, purple (violaceous), planar (flat-topped), polygonal, papules/plaques that affect the skin ().46 Sites of predilection include the flexor aspects of the wrists, dorsa of hands, trunk, shins, ankles, and glans penis.47 Approximately 25% of the lesions occur on the genitalia.47

Lichen planus presenting as purple, planar, polygonal papules on the glans penis.

Seborrheic keratosis typically presents as an asymptomatic, well-demarcated, round or oval, brown plaque with a ‘stuck on’ warty appearance (). 48 Often, lesions may appear shiny and oily and, hence, the misnomer ‘seborrheic’ (greasy) keratosis.48 Sites of predilection include the face, chest, back, and extremities. Occurrence on the penis is rare but has been reported.49 HPV is found in approximately 70% of cases of seborrheic keratosis in the genital area versus 5% in nongenital areas.49

Seborrheic keratosis presenting as a well-demarcated, oval, brown plaque with a ‘stuck on’ warty appearance.

An epidermal nevus is a hamartoma arising from embryonic ectoderm that differentiates into keratinocytes, apocrine glands, eccrine glands, hair follicles, and sebaceous glands. The classic lesion is a solitary, asymptomatic, well-circumscribed plaque that follows Blaschko lines. The onset is usually within the first year of life. The color varies from flesh to yellow to brown. The lesion may thicken and become more verrucous with time.

Lymphangioma circumscriptum is a benign saccular dilatation of the cutaneous and subcutaneous lymphatics. 50 The condition is characterized by clusters of vesicles resembling frog spawn (). The color depends on the content: whitish, yellow, or light tan coloration is due to color of the lymph fluid while reddish or blue color is due to the presence of erythrocytes in the lymph fluid as a result of hemorrhage.51 The vesicles may undergo verrucous changes and have a warty appearance.50 Sites of predilection include the extremities and, less commonly, the genitalia.52

Lymphangioma circumscriptum presenting as clusters of small firm dark-red blisters with warty surface on the distal penis, resembling frog spawn.

Lymphogranuloma venereum is a sexually transmitted disease caused by Chlamydia trachomatis.34 The condition is characterized by a transient painless genital papule and, less commonly, an erosion, ulcer, or pustule followed by inguinal and/or femoral lymphadenopathy with a characteristic ‘groove sign’ known as buboes.34,53

Human scabies, caused by the parasite mite Sarcoptes scabiei var hominis, is characterized by burrows, erythematous papular eruption, and intense pruritus (often worse at night). 54 The papules, caused by a hypersensitivity reaction to the mite, are erythematous and usually 1–2 mm in diameter ().54

Human scabies presenting as erythematous papules, which are intensely pruritic.

Typically, syringomas present as asymptomatic, small, soft to firm, flesh- to tan-colored papules usually 1–3 mm in diameter.55 The lesions are usually found in the periorbital areas and on the upper cheeks.55 However, syringomas may appear on the penis and buttocks. When located on the penis, syringomas may be mistaken for penile warts.

Traumatic neuromas are nerve sheath tumors in which the ratio of axons to Schwann cell fascicles is approximately equal.56,57 The condition results from regenerative proliferation of traumatized or injured nerve fibers.56,57 Penile traumatic neuromas may result from trauma to the penis, such as circumcision or penile dorsal neurotomy to treat premature ejaculation.56–59 Clinically, penile traumatic neuromas present with skin-colored or erythematous papules or nodules on the glans or penile shaft. 56–59

Schwannomas are neoplasms originated from Schwann cells.60 A penile schwannoma typically presents as a solitary, asymptomatic, slow-growing nodule on the dorsal aspect of the penile shaft.60,61

Bowenoid papulosis is a premalignant focal intraepidermal dysplasia that typically manifests as multiple red to brown papules or plaques in the anogenital area, such as the penis.62 The condition corresponds to in situ squamous cell carcinoma. Progression to invasive squamous cell carcinoma occurs in 2–3% of cases.62

Typically, squamous cell carcinoma of the penis presents as a nodule, ulcer, or erythematous lesion.63 The lesion may appear warty, leukoplakic, or sclerotic.63,64 The most common site is the glans penis, followed by the prepuce and shaft.63

How Do You Prevent Genital Warts?

You get genital warts by having sexual contact with someone who has the virus. Getting the HPV vaccine and using condoms helps to lower your chances of getting or spreading genital warts.

How do I avoid getting genital warts?

First thing, talk to your doctor about getting the HPV vaccine — most vaccine brands protect you against the types of HPV that cause most cases of genital warts. That’s the best way to avoid any HPV-related problems, including genital warts.

Genital warts are spread from sexual skin-to-skin contact with someone who has it — including vaginal, anal, and oral sex. So the only surefire way to avoid getting genital warts and other STDs is to not have any contact with another person’s mouth or genitals.

But most people have sex at some point in their lives, so knowing how to have safer sex is important. Using protection like condoms and dental dams when you have sex really helps to lower your risk of getting any STD.

You can also avoid sex with someone if you see warts on their genitals or anus, because that’s when they spread the most easily. But remember, it is possible to get them or spread them when there are no visible warts, so it’s important to use condoms and dental dams even if everything looks totally OK.

And while there’s no genital warts test, getting tested for STDs at routine checkups with a doctor or nurse is a part of keeping yourself healthy.

How can I prevent spreading genital warts?

If you find out that you have genital warts, try not to freak out. There are a few ways that you can stop it from spreading to your partners.

  • Encourage your partner to talk with a doctor or nurse about the HPV vaccine. Most brands can protect against some types of the virus that cause most cases of genital warts.

  • Always use condoms and dental dams during oral, anal, and vaginal sex.

  • Don’t have sex when you have visible warts, even with a condom. There may be warts on places the condom doesn’t cover.

  • Stop smoking. If you smoke, you may have a bigger chance of getting warts than people who don’t smoke, and warts are more likely to come back if you smoke.

  • Always tell your sexual partners that you have genital warts before you have sex, so you can work together to prevent them from spreading.

How do I talk to my partner about having genital warts?

Telling someone you have an STD can be hard, but genital warts are common and they don’t lead to serious health problems. So try not to be too embarrassed or stressed out about it.

There’s no one way to talk to a partner about having an STD, but here are some basic tips that may help:

  • Keep calm and carry on. Lots of people have genital warts, and plenty of them are in relationships. For most couples, having genital warts isn’t a huge deal. Try to go into the conversation with a calm, positive attitude. Having genital warts is simply a health issue — it doesn’t say anything about you as a person.

  • Make it a two-way conversation. Remember that STDs are super common, so who knows? Your partner might have genital warts, too. So start by asking if they’ve ever been tested or if they’ve had an STD before.

  • Know your facts. There’s a lot of misinformation about STDs out there, so read up on the facts and be prepared to set the record straight. Let your partner know there are ways to avoid passing genital warts during sex. And you can also remind them that genital warts aren’t dangerous and don’t cause cancer or any other serious health problems.

  • Think about the timing. Pick a time when you won’t be distracted or interrupted, and find a place to talk that’s private and relaxed. If you’re nervous, you can talk it through with a friend first, or practice by talking to yourself. It sounds silly, but saying the words out loud can help you know what you want to say and feel more confident when you talk to your partner.

  • Safety first. If you’re afraid that your partner might hurt you, telling them in person might not be safe. You’re probably better off with an e-mail, text, or phone call — or in extreme cases, not telling them at all. Call 1-800-799-SAFE or check out the National Domestic Violence Hotline for help if you think you might be in danger.

So … when’s a good time to tell your partner about those genital warts? You might not need to bring it up the very first time you hang out, but you should let them know before you have sex. So when the relationship starts heading down that path and you feel like you can trust the person, that’s probably a good time.

It’s normal to be worried about how your partner’s going to react. And there’s no way around it: Some people might freak out. If that happens, try to stay calm and talk about all the ways there are to prevent spreading genital warts. You might just need to give your partner a little time and space to process the news, which is normal. And lots of people know that genital warts are common and not a big deal.

Try not to play the blame game when you talk to your partner. If one of you gets genital warts for the first time during the relationship, it doesn’t automatically mean that somebody cheated, or that one of you got them from the other. Warts can take weeks, months, or even longer to show up after you get the infection. So it’s usually really hard to tell when and where someone got them. The most important thing is that you both get checked out. If it turns out only one of you has genital warts, talk about how you can prevent passing them on. Tell your past partners too, so they can get checked out. 

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Genital Warts and HPV

Warts are caused by viruses and can appear anywhere on the body. Those that show up in the genital area are caused by the human papillomavirus, commonly called HPV, and are easily transmitted by sexual contact.

HPV infection is the most common sexually transmitted disease (STD) in North America. Certain forms of the virus can cause cervical, rectal, vulvar, vaginal, and penile cancer. According to the CDC, at least 50% of sexually active men and women will get a genital HPV infection at some point in their lives.

After a person has been infected by HPV, it may take one to three months (or longer in some cases) for warts to appear. Some people who have been infected never get warts.

What Do Genital Warts Look Like?

Genital warts look like small flesh-colored, pink or red growths in or around the sex organs. The warts may look similar to the small parts of a cauliflower, or they may be very tiny and hard to see. They often appear in clusters of three or four, and may grow and spread rapidly. They usually are not painful, although they may cause mild pain, bleeding, and itching.

Genital Wart Symptoms

Like many STDs, HPV does not always have visible symptoms. But when symptoms do occur, warts may be seen around the genital area. In women, warts can develop on the outside and inside of the vagina, on the cervix (the opening to the uterus), or around the anus. In men, they may be seen on the tip of the penis, the shaft of the penis, on the scrotum, or around the anus. Genital warts also can develop in the mouth or throat of a person who has had oral sex with an infected person.

Because there is no way to predict whether the warts will grow or disappear, people who have been infected should be examined and treated, if necessary.

Genital Wart Testing

Your doctor may perform the following tests to check for genital warts and/or related STDs:

  • An examination of visible growths to see if they look like genital warts
  • Application of a mild acetic acid (vinegar) solution to highlight less visible growths
  • A complete pelvic exam and Pap smear (for women)
  • A specialized test for high-risk HPV (low risk should not be screened for), collected in a way similar to a Pap smear
  • Biopsy of cervical tissue ( if abnormal pap smear or visible abnormality) to make sure there are no abnormal cells that could develop into HPV-related cervical cancer; a cervical biopsy involves taking a small sample of tissue from the cervix and examining it under a microscope.
  • Examination of the rectum

 Female patients may be referred to a gynecologist (a doctor who specializes in female reproductive health) for further testing and biopsy.

Genital Wart Treatment

Unfortunately, no treatment can kill the HPV virus that causes the genital warts. Your doctor can remove the warts with laser therapy or by freezing or applying chemicals. Some prescription treatments are available for at-home use. Surgery may be necessary for genital warts that are large or difficult to treat. Still, recurrence remains a problem. You may need to return to your doctor for more treatment.

What Should I Do While I Have the Warts?

If you have genital warts:

  • Keep the area as dry as possible.
  • Wear all-cotton underwear. Man-made fabrics can irritate the area and trap moisture.

 

What Happens If I Don’t Get Treated?

Unfortunately, despite treatment, having high-risk HPV can increase your risk of cervical, rectal, and penile cancer. But not all forms of the virus are associated with these cancers. If you have genital warts, it is important to get annual check-ups to screen for cancer.

HPV and Genital Wart Prevention

Anyone who’s sexually active can get or spread HPV. Some things can make you more likely to get genital warts, including:

  • Having more than one sex partner (or a partner who does)
  • Being pregnant
  • Having a weakened or damaged immune system
  • Smoking

Your best bet at preventing HPV infection and genital warts is to abstain from sex or limit sexual contact to one uninfected person. If that is not an option, condoms may provide some protection, but condoms are not 100% effective, because they do not cover the entire penis or surrounding areas.

There are three vaccines approved to protect against HPV. Gardasil protects against infection from four strains of the HPV virus and offers modest protection against genital warts.Two of these strains, HPV-16 and HPV-18, account for about 70% of cervical cancers. The other two strains covered by the vaccine, HPV- 6 and HPV-11, account for about 90% of genital warts. The vaccine is approved for 9- to 45-year-old females and males.

Gardasil-9 has been proven as effective as Gardasil for the prevention of diseases caused by the four shared HPV types (6, 11, 16, and 18). It also protects against five other strains of HPV virus (31, 33, 45, 52, and 58). It is 90% effective in protecting against cervical, vaginal and vulvar cancers in females, and anal cancer in females and males as well as protecting against genital warts.

Cervarix is given only to females and also protects against HPV-16 and HPV-18.

These vaccines do not treat pre-existing conditions.

Genital Warts in Babies and Children: Causes and Treatment Options

Genital warts are common skin-colored, often painless growths that appear in the genital area. In males, they can occur on the penis or around the rectum. In females, they can occur around the opening to the vagina or around the rectum. Genital warts are caused by the Human Papilloma Virus (HPV). These warts can be large or small. They can be flat and hard to see. Sometimes they can cause itching and irritation. They can grow rapidly.

In adolescents and adults, genital warts are often spread by sexual contact. However, young children often get them in other ways. Babies and children most often get genital warts:

  • Before or during birth (from the mother who has the virus)
  • While having diapers changed (from the hands of someone with the virus)
  • During bathing (from towels that have been used by someone with the virus)
  • By spreading their own warts (from their hands to another part of the body)

Treatment

There are different treatments for genital warts. More than one treatment is often needed.

Freezing with liquid nitrogen: This is done in the dermatology office. The doctor carefully applies liquid nitrogen to the warts to freeze them. This often causes some irritation to the area within 24 to 48 hours. It can be uncomfortable or painful.

Topical medicine: Your child’s doctor may prescribe a cream called imiquimod to put on the warts. This medicine has been approved for treating genital warts. It is applied every other night (3 times per week) and washed off in the morning. Other topical medicines may also be used to treat the warts.

Keeping warts from spreading: Make sure anyone who bathes or diapers your child knows that the child has genital warts. All caregivers should wash their hands well with soap and warm water for at least 20 seconds before and after:

  • Bathing the child
  • Diapering the child
  • Applying medicine.

If you have questions, be sure to ask your child’s doctor or nurse. If anyone in the family is concerned about sexual abuse, please call the Child Assessment Center at The Center for Family Safety and Healing. The phone number is (614) 722-3278. They can talk to you and evaluate the situation. Though this is rare, any concern should be addressed right away.

Genital Warts in Babies and Children (PDF)

HH-I-398 1/16 Copyright 2016, Nationwide Children’s Hospital

How to Remove Genital Warts

Treatment for Genital Warts

Genital warts may be new, recurrent or have been present for many years. 

Treatment for genital warts is optional. Even though there are many good treatments for genital warts, most genital wart infections will clear up spontaneously sooner or later. However, many people want to have them treated as the warts can be unsightly and/or uncomfortable.

The goal of treatment should be to remove visible genital warts and relieve annoying symptoms.

There are several available treatments, and no one treatment is ideal for all people or all warts.

Factors that might influence the choice of treatment include size, location and number of warts, changes in the warts, patient preference, the cost of treatment, convenience, possible adverse effects and the health care provider’s expertise.  

All treatment options involve some drawbacks, such as pain, possible scarring, and expense. Additionally, some of the warts which were cleared initially may, in some people, have recurrences which means going back for further treatment. 

If there is no significant response to the HPV treatment within 4–6 weeks, an alternative diagnosis, change of treatment modality, or onward referral should be considered.

Whatever the treatment option is, here are some important points to remember:

  • It is advisable to seek medical advice before starting treatment for genital warts.
  • Ask the doctor for an explanation of the treatment, including the costs and likely benefits as well as any side effects.
  • Be sure to understand the follow-up instructions, such as what to do about discomfort and when to seek help.
  • Be patient – treatment often takes several visits and a variety of approaches.
  • If pregnant, tell the doctor so they can choose the right treatment.
  • Don’t use over-the-counter treatments which are not specifically for genital warts (for example remedies for warts on the feet or hands). These are not meant for sensitive genital skin and can do more damage to your skin.
  • It is recommended to avoid sexual contact with the infected area during treatment, to protect the treated area of skin from friction and help it heal.
  • Salt water baths help soothe and heal the genital area during treatment. Two handfuls of plain salt per bath or two tablespoons in a large bowl, preferably twice daily.
  • Xylocaine (2% lignocaine gel) is a useful local anaesthetic to put on raw areas two minutes prior to passing urine or having a bowel motion.
  • Thrush (yeast) infection is common, especially when the genital area is raw, and it is often helpful to treat the thrush at the same time as the warts are being treated.

Options for removing genital warts

Remember that not all of these treatment options may be available, and a treatment plan needs to be discussed with the doctor or health care specialist.

Whatever the choice, remember that weekly treatments are usually needed, and it may be some time before the warts clear. No treatment at present can guarantee that warts are gone forever. Also keep in mind that warts would usually go away over time without treatment. 

  • Podophyllotoxin (Condyline™) solution is a patient-applied treatment for external genital warts, recommended for external penile skin only as it can irritate if applied to skin folds such as under the foreskin on the penis or vulval skin (the area around the vaginal opening). It is contraindicated in pregnancy.
  • Imiquimod (Aldara™) cream is a patient-applied treatment for external genital and perianal warts. It is easy to use and safe if instructions are followed. If other treatments are unsuitable, Aldara is available by fully subsidised prescription from your doctor. Not recommended in pregnancy.
  • Cryotherapy (freezing off the wart with liquid nitrogen) can be done by a trained health practitioner.
  • Trichloroacetic acid (TCA) is a chemical applied to the surface of the wart by a trained health practitioner. It is unavailable in some DHBs.
  • Laser therapy (using an intense light to destroy the warts) or surgery (cutting off the warts) has the advantage of getting rid of the warts in a single visit. Laser treatment can be expensive and the health care provider must be well trained in these methods. It is only available in a few centres. Recurrences may occur.

Follow-up after treatment

After visible genital warts have cleared, a follow-up evaluation is not necessary.

Recurrences (a return of the warts) occur most frequently during the first 3 months. A follow-up evaluation 3 months after treatment may be useful for reassurance that there are no persistent or new warts. Regular cervical screening is recommended for everyone with a cervix, regardless of whether they have genital warts or not.

Anyone with genital warts should discuss with their doctor the possibility of other sexually transmitted infections being present, and take the opportunity to have a full sexual health check.

Genital warts pamphlet

Some Questions and Answers about HPV and Genital Warts

What You Should Know About Genital Warts

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education website.

Information from Your Family Doctor

 

Am Fam Physician. 2004 Dec 15;70(12):2345-2346.

What are genital warts?

Genital warts are small, skin-colored bumps that look like tiny cauliflowers. They can be on or inside the genitals. The genital area includes the vagina, vulva, cervix, urethra, penis, scrotum, and anus. These warts are not the same as warts you may find on other parts of your body.

Genital warts are caused by a virus called human papillomavirus (say: “pap-uh-lo-mavie-russ,” or HPV). There are many kinds of HPV. Not all of them cause genital warts. People usually get genital warts by having sexual contact with someone who has them.

Who gets genital warts?

HPV infections are common, but most people do not know they have the virus. Studies have shown that up to three fourths of Americans between 15 and 49 years of age have been infected with HPV. But many people who have the infection do not get warts.

You can get HPV infection by having oral, vaginal, or anal sex with someone who is infected. HPV can live inside the body for weeks, months, or even years before warts appear.

How can I tell if I have genital warts?

Talk to your doctor if you see small, skin-colored bumps on your genital area. Your doctor will check you and decide if the bumps are warts. Genital warts usually do not hurt.

Sometimes an abnormal Pap smear is the first sign that a woman has an HPV infection. A Pap smear is a simple test in which your doctor collects cells from the cervix. The cervix is part of your uterus (womb).

How are genital warts treated?

Genital warts must be treated by your doctor. Do not try to treat the warts yourself. Remember, genital warts are not the same as warts you may get on your hands and feet. Your genital area is sensitive, and you need special treatment that only a doctor can give you.

There are many ways to treat genital warts. Your doctor might freeze the warts with chemicals. Some chemicals make the area blister and cause the wart to fall off. This can hurt. Other chemicals can dissolve the warts. Your doctor might want you to use a special cream to get rid of the warts.

Another way to remove genital warts is to burn them. Your doctor will numb the area before using heat on the warts. Your doctor also might use a laser to take off genital warts. This method is good for areas that are hard to reach, such as the cervix. Laser therapy also is good if you have a lot of warts.

Even after the wart is taken off, HPV stays inside your body. This means warts can come back, and you might need to have them taken off again.

What if I do not get my genital warts treated?

Genital warts can grow if they are not treated. If this happens, warts will be harder to take off. You also risk infecting others if you have oral, vaginal, or anal sex and do not get treated for warts.

Certain kinds of HPV can cause abnormal cells to grow in the cervix. These cells can sometimes turn into cancer if they are not treated. Some kinds of HPV can cause cancer of the vulva, vagina, anus, and penis. But these kinds of cancer are much less common than cervical cancer.

What about HPV and cancer?

Certain kinds of HPV may increase a woman’s risk of getting cervical cancer. Other things that increase this risk include having another sexually transmitted disease, having many different sex partners, having sex at an early age, or smoking. Pap smears can find changes of the cervix so that they can be treated early. This lowers the risk of getting cancer. Women should ask their doctor how often they should have Pap smears. HPV infection increases men’s risk of getting cancer of the penis or anus.

What can I do to keep from getting genital warts?

The only sure way to prevent genital warts is to not have sex. If you are sexually active, having sex with only one person who has sex with only you also will lower your risk of getting genital warts. Use a condom every time you have sex to lower your risk.

If your doctor tells you that you have genital warts, your sex partner should be checked, too. Even if your partner does not have warts, he or she still may be infected with HPV.

Genital Wart (Condyloma Acuminatum) in Adults: Condition, Treatments, and Pictures – Overview

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Images of Condyloma Acuminatum (Genital Wart, HPV)

Overview

Genital warts (condyloma acuminata) are caused by the human papillomavirus (HPV), which has over 100 different strains. Subtypes number 6 and 11 cause 90% of genital warts and are considered low risk because they very rarely will cause genital or anal cancer. On the other hand, subtypes 16 and 18, for example, are considered high risk because, although they rarely cause genital warts, they can lead to cervical or anal precancer and cancer.
 
HPV is spread by skin-to-skin contact during sexual activity; there does not need to be vaginal or anal intercourse to spread the infection. Most people who become infected with HPV will not have symptoms and will clear the infection on their own. For people who do develop genital warts, there are many options for treatment, all of which are meant to remove the visible warts. There is no cure for genital warts.
 
Gardasil® is a vaccine that protects against the 4 strains of HPV that cause 70% of cervical cancers and 90% of genital warts. In the US, Gardasil is approved for girls/women and boys/men ages 9–26. In 2011, Health Canada approved the vaccine for women up to the age of 45.

Who’s at risk?

Genital warts are the most common sexually transmitted disease and affect millions of people throughout the world. It is estimated that 75–80% of sexually active men and women will be infected with HPV at some point in their lives. Approximately 15% of the United States population is infected with HPV. HPV infection occurs in people of all ages and both sexes. Your risk of acquiring the virus is higher if you have had many sexual partners and if you first had sexual intercourse at a young age. Over 50% of girls will get HPV within 2 years of becoming sexually active.

HPV is spread through skin-to-skin contact and does not require actual intercourse to be passed from one person to another. A person can be infected without any visible signs of infection and, therefore, can pass the infection on without knowing it. Condoms can decrease the risk of spreading the virus, but they do not completely prevent transmission.

Signs and Symptoms

Genital warts appear as flesh-colored, round bumps of varying sizes.  They can be smooth and flat or cauliflower-like with a small stalk. They can be seen on the labia, vagina, penis, scrotum, anus, skin around the anus, and urethra. Warts usually do not cause any symptoms, although the warts can bleed and become painful with intercourse if they are located within the vagina.

Self-Care Guidelines

You can decrease your risk of getting genital warts by using condoms, having few sexual partners, or by abstaining from sexual activity. Unfortunately, condoms do not completely protect against HPV, and an infected person can spread the virus even if he/she does not have any visible warts.

When to Seek Medical Care

Many people with a healthy immune system who get genital warts will clear the virus on their own without treatment. However, this does not occur immediately. If you have visible warts, see your doctor for treatment to remove the warts and to reduce the chance of passing the virus to other partners.  Also, if your partner has been diagnosed with genital warts, you should be checked for infection.

For women, it is important to have a Pap smear and general gynecologic examination, usually every year, to look for any signs of abnormal cervical cells, which can be the first sign of cervical cancer.

Treatments Your Physician May Prescribe

There is no cure for genital warts. The goal of treatment is to remove visible warts and decrease the risk of spreading the virus. There are many different treatments that your doctor may recommend, none of which are 100% effective. Most treatment types will get rid of the warts in 60–90% of cases, however.
 
Some treatments are applied by the patient. These include the following:

  • Imiquimod 3.75% cream (Zyclara®) – Imiquimod works by boosting your immune system to kill the virus. Apply once daily for up to 8 weeks. This medication may weaken condoms, and you should avoid sexual activity while the cream is on your skin. Do not use imiquimod during pregnancy.
  • Imiquimod 5% cream (Aldara®) – Apply once daily (at bedtime) 3 times a week for up to 16 weeks.
  • Podofilox 0.5% gel or solution (Condylox®) – This should not be used during pregnancy.

Treatments applied by a physician:

  • Podophyllin resin, 15–25% solution – This should not be used during pregnancy.
  • Trichloroacetic acid
  • Cryotherapy – Liquid nitrogen is used to freeze the warts.
  • Surgical removal – This may need to be performed by a specialist with local anesthesia; usually for large amounts of warts.
  • Laser treatment – Carbon dioxide laser treatment is useful for a large amount of urethral or vaginal warts.

Most of these treatments require multiple applications. If there is no improvement after 3 treatment cycles or if the warts are not gone after 6 treatment cycles, your doctor will usually switch you to a different medication. Common side effects of all treatments include skin irritation and redness. Some people may also develop scars at the site of the warts.

In 2006, the FDA approved the first HPV vaccine (Gardasil®). It protects against the high-risk strains, 16 and 18, that can cause cervical cancer and the low-risk strains, 6 and 11, that cause most genital warts. The HPV vaccine is a series of 3 shots over a 6-month period. In the US, Gardasil is approved for girls/women and boys/men ages 9–26. In 2011, Health Canada approved the vaccine for women up to the age of 45. The vaccine is most effective when given before an individual becomes sexually active, but it can be given after sexual activity has begun.

Trusted Links

MedlinePlus: Genital WartsClinical Information and Differential Diagnosis of Condyloma Acuminatum (Genital Wart, HPV)

References

n L., ed. Dermatology, pp.1224-1228, 1698-1699. New York: Mosby, 2003.

Cutts FT, Franceschi S, Goldie S, et al. Human papillomavirus and HPV vaccines: a review. Bull World Health Organ. 2007 Sep;85(9):719-26.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6th ed, pp.1086, 2121, 2440, 2460. New York: McGraw-Hill, 2003.

Kodner CM, Nasraty S. Management of genital warts. Am Fam Physician. 2004 Dec 15:70(12):2335-42.

Ogunmodede F, Yale SH, Krawisz B, Tyler GC, Evans AC. Clin Med Res. 2007 Dec;5(4):210-7.

Rosen T. Sexually transmitted diseases 2006: a dermatologist’s view. Cleve Clin J Med. 2006 Jun;73(6):537-8, 542, 544-5.

Widdice LE, Kahn JA. Usine the new HPV vaccines in clinical practice. Cleve Clin J Med. 2006 Oct;73(10):929-35.

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  • Allergology

    Eosinophilic cationic protein (ECP)


    990 rubles

  • Get tested – Nadezhda Medical Center

    In our medical center you can undergo an examination, take tests and get specialist advice.

    We perform 91,199 more than 2,500 different types of analyzes , and send the results by email – this allows our patients not to waste time on the road.

    Dear patients!
    From November 1, at the MC Nadezhda on Magistralnaya 10a, an office will open for taking tests for Covid-19. There is a separate entrance from the parking lot. Biomaterial sampling will be carried out daily from 8.00 to 15.00 . The result will be ready within 24 hours.

    During a pandemic, we have special prices for analyzes of Covid :

    Coronavirus Covid-19 SARS-CoV-2, RNA nasal / pharyngeal swab (real-time PCR) – RUB 1,600.

    Antibodies IgG to Covid-19 – 1000 rub.
    IgM antibodies to Covid-19 – 750 rub.

    Biomaterial sampling for Covid-19 (nasal / pharyngeal swab) – 150 rubles.
    Biomaterial sampling for Covid-19 (blood for IgG and IgM antibodies) – 100 rubles.

    In addition, every day from Mon – Fri from 8.00 to 20.00, and Sat – Sun from 8.00 to 16.00 visit patients to take
    tests at home .

    You can leave a request for taking tests at home today, and tomorrow our specialist will be with you.

    Service cost:

    Visit of a specialist at home (across Tambov) – 500 rubles.
    Departure of a specialist at home (out of town up to 50 km) – 1,500 rubles.
    Departure of a specialist at home (out of town from 50 to 100 km) when ordering from 10,000 rubles. – 3,000 rubles.

    For a preliminary application, call: 8 (4752) 55-99-89; 8 800 200-40-68.

    For legal entities: 8 (4752) 55-99-85

    After completing the application, expect a call from our operator to agree on the time of arrival.Without this agreement, departure is not carried out.

    To prepare for testing RNA nasal / pharyngeal swab , we recommend:

    3-4 hours before taking nasal / nasopharyngeal swabs, do not instill drops / sprays or rinse the nose.
    Do not eat, drink, brush your teeth, rinse your mouth / throat, chew gum, or smoke at least 2-3 hours before taking oropharyngeal (pharyngeal) swabs.

    You can check the cost of other studies with the administrators by calling 8 (4752) 55-99-89 ; 8 800 200-40-68 ,

    or see below.

    LAZURIN pine essential oil, 10 ml

    Cosmetics and hygiene items

    Used for air freshening and room disinfection, aroma lamp or for adding to water during wet cleaning.

    Cosmetic product enriched with pine essential oil is recommended for the care of oily and acne skin and to prevent itching of problem skin. Has disinfecting properties, tones, refreshes, invigorates.

    LAZURIN pine essential oil, 10 ml

    1.72 €

    2,29 € *

    1. 72
    2.29
    EUR

    1.72 €

    2,29 € *

    one.72
    2.29
    EUR

    Warnings: Do not use in case of hypersensitivity to the product, do not use for children under 12 years of age, pregnant women.
    Effect: Softens

    Refreshes

    Cleans

    For use: Daily
    Product type: Butter
    Skin type: Oily / problematic
    Suitable for: For teens and adults

    For external use: use only diluted. For aromatherapy and air freshening: add 1-2 drops of essential oil to the water of the aroma lamp.
    Massage: Add 2-5 drops of essential oil to 50 ml of base oil.
    Wet cleaning of premises: Add 1-2 drops of essential oil to the water for cleaning the premises.

    Pinus sylvestris essential oil

    Red Data Book view | SPNA of Russia

    Edition Chereshnev IA, Andreev AV, Berman DI, Dokuchaev NE, Kashin VA, Polezhaev AN (2008) Red Data Book of the Magadan Region: Rare and Endangered Plant and Animal Species. Administration of the Magadan Region, Department of Natural Resources; Institute of Biological Problems of the North, Far East Branch, Russian Academy of Sciences 430 PDF
    Taxon is listed as Amanita rubescens
    Category 3: Rare species.
    Morphological description The cap is up to 20 cm in diameter, weakly sticky, dark brown at the crown, lighter on the edge with reddish hair, not ribbed on the edge.Warts (scraps of bedspreads) on the cap are grayish from small to large, delicate consistency. The plates are free, white. The leg above the ring is white with a vaguely cracked surface, under the ring is brownish-grayish, at the base it is rusty, scaly-cracked, thickened, swollen, without prominent warts. The ring is white with a slight yellowish lemon tint. The pulp is reddened, or rusty-reddish, especially at the base of the leg. The base is very fragile, often wormy. Mushroom without a special smell.Spore powder is white. Spores are ellipsoidal, colorless, amyloid.
    Distribution Multi-regional (Europe, Asia, North and South America) species, common, but not abundant in the zone of the middle and southern taiga. In the Magadan region, it is located at the limit of its northern distribution border. There are regular, but single finds in the vicinity of Magadan, on Nagaevskaya Sopka (2). Edible.
    Lifestyle Mycorrhizal forming agent, enters into symbiosis with pine and birch (1), is found in various types of forest.In the Magadan region, it grows exclusively in slope stone birch forests with dwarf cedar, in July-August.
    Limiting factors Not studied.
    Security measures Keeping known locations and searching for new locations to develop specific protection measures.
    References 1. Shubin, 1988; 2. Sazanova, 2005
    Compilers N. A. Sazanova

    Ceylon Cinnamon – Olioseptil

    Latin name: Cinnamomum zeylanicum

    Family : Laurel

    Origin : Sri Lanka, Madagascar, India, China

    Part used: Bark

    Aromatic molecules : Cinnamaldehyde (cinnamal)

    Cinnamon is nothing more than the inner surface (0.5 mm) of the bark of a small tree grown in the tropics.In aromatherapy, its oil is used for its versatile antiseptic, anti-infectious, antibacterial and general stimulating properties. Often directly indicated for atony and gastrointestinal spasms.
    Cinnamon extracts and essential oil have earned a reputation as a valuable ingredient in cold medicines. Cinnamon oil is also used in warming-irritating ointments, but its concentration in them is limited. Cinnamon bark is widely used as a spice, and Ceylon cinnamon bark is more prized as a spice than Chinese cinnamon.It is mainly used in cooking as a condiment or flavoring agent. For medicinal purposes, the essential oil of Chinese cinnamon (cassia), on the other hand, has more uses.
    Evergreen tree, more often a shrub in cultural cultivation.

      Properties:

    • Broad spectrum antibacterial: antifungal, antiviral, antibacterial, antiparasitic
    • Stimulating immunity
    • Digestion stimulating
    • Fortifying, tonic.

    Applications :

    • Immunity Problems: Fatigue, tropical diseases (amoebiasis, typhoid fever),
    • Digestive problems: Bloating, aerophagia, colitis, colic, constipation, abdominal cramps, intestinal cramps, infectious diarrhea, difficult or slow digestion, intestinal infection (streptococcus, staphylococcus, E. coli, candidiasis …), lack of appetite ( in children and adults),
    • Respiratory problems (ENT): Bronchitis, flu, colds,
    • Uro-genital problems: Urinary tract infections (cystitis…) genital infections,
    • Skin Problems: Warts,
    • Regulation of psycho-emotional background: Anxiety, physical and / or mental asthenia, excitability (individual or group), latent depression, obsessive thoughts, frigidity, impotence, mental inhibitions (complexes), drowsiness.

    Cosmetic liquid Home first aid kit Supercleaner 3ml

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    Present

    Nun Silkworm

    A butterfly with chalky-white wings and numerous dark transverse wavy stripes and spots. Hindwings are grayish-white with small dark spots along the margins. This butterfly is characterized by a high variability of color from the described basic form to completely dark-colored (sometimes even black) individuals.

    The female has a wingspan of 45-55 mm, has a short saw-shaped antennae and a pointed reddish posterior end of the abdomen with black spots.

    The shape of a seated butterfly resembles an isosceles triangle. The male is smaller and reaches a wingspan of 35-45 mm; antennae are feathery, abdomen is evenly finished, grayish-black; in outline, the seated male resembles an equilateral triangle.

    Caterpillars of the first instar are mostly black, covered with rather long hairs 3-4 mm long. An adult caterpillar is 30-35 mm long.

    Basic color from light green to dark; each segment has six blue warts covered with gray hairs. The first thoracic segment is attached to the head by a straight line. On the second segment, a dark dorsal stripe begins, which is interrupted from half of the seventh to half of the ninth segment by a characteristic light spot. The dark streak ends at the eleventh segment.Pupa brown, shining with light brushes of hairs, which are steel-bluish on the dorsal side. Pupa length 18-20 mm. By the shape of the antenna base and the features of the future genitals on the underside of the abdominal segments, the sex of the future butterflies can be distinguished.

    Eggs are orange-brown at first, later brown with an opal sheen.

    The nun silkworm is distributed throughout Europe, and partly in Asia to the south from 60 parallel, so it is found from Portugal to Japan.It was also registered in the Himalayas. The southern border of its distribution in Europe stretches from the Iberian Peninsula towards the Balkans. In Russia, the nun silkworm is found in the forest zone and in the forest-steppe of the European part (very rarely in the south), was recorded in the Crimea and the Caucasus (including the Transcaucasus), in the Urals and the Volga region, in the forest-steppe of western Siberia, in Altai , in the Baikal region and the Far East (Amur region, southern Primorye, southern Sakhalin). Areas of outbreaks in Russia, in addition to the coniferous forest zone of the European part, are Altai, southern Primorye and Sakhalin.

    In the south, the nun silkworm rises higher and, in addition to conifers, is often found on deciduous species. In the north, it also lives on the plains, mainly on spruce and pine.

    Silkworm nun moths appear in nature depending on the weather, different geographic location and altitude from the second half of July to August. Like all moths, they appear at nightfall, mainly between 21 and 24 hours or before dawn. Fertilized females lay eggs in heaps of 20-50 between or under the scales of the bark of trees, and the eggs are very well hidden.In total, one female lays approximately 200 eggs. The eggs overwinter and the caterpillars hatch next spring. The release is very temperature dependent: in central Europe it usually begins at the end of April, in mountainous regions and more northern regions in May.

    Caterpillars stay together, forming a so-called “mirror”. Only a few days later, they begin to eat the young blossoming needles of spruce shoots, as well as old pine needles. In some places they bite out the blossoming leaves of deciduous trees.Starting from the second instar, the caterpillars are very voracious, and they begin to bite into the older needles of the spruce. If they develop on deciduous trees, only a part at the median vein is left at the leaf blade. In the same period, new pine shoots are already being eaten on the pine.

    Caterpillars pass 5-6 instars during their development. The first lasts an average of 18 days, from the second to the fourth – each for one week, and the last is again longer – about 2 weeks. The duration of individual periods is highly dependent on temperature, and at the same time on the weather.All development lasts at least 52 days, but takes about 9 weeks on average. Adult caterpillars stop feeding, leave shoots and look for suitable places for pupation, most often between the scales of the bark of trees or in the whorls of branches. Pupae attach to trees with just a few threads. The pupal period lasts 8-14 days. The first butterflies to emerge are males; females gradually appear. Adults do not feed and live only 10-14 days. The nun silkworm is a dangerous pest of spruce and pine plantations.It is also found on deciduous species, especially if these species are an admixture in infected coniferous stands or are in their immediate vicinity (e.g. beech, hornbeam, birch, maple, pedunculate oak, small-leaved linden, hazel, as well as aspen, alder, etc.) .). In the centers of mass reproduction and with a lack of food, the caterpillars descend onto the grassy cover and eat, for example, blueberry leaves, etc.

    Outbreaks of mass reproduction of nun silkworms occur in Central Europe in homogeneous and even-aged spruce and pine-spruce stands at the age of 40-60 years, most often, however, in areas outside the indigenous spruce forests 400-600 m above sea level.at. m. In especially favorable and warm years, outbreaks of mass reproduction were observed in spruce forests above 1000 m above sea level. at. m. In Central Europe, pandemics of the nun silkworm are known.

    The adult insect has a rusty-brown or dark brown flat body with an elongated head, antennae somewhat longer than the head. The edges of the shield are rounded and widened. The body is strongly flat, widened posteriorly, with a noticeable edge of the abdomen. The female reaches a size of 4.5-5 mm, has ocher rusty-brown color, its number in the population is 60-70%.Females have two morphologically different forms: 1.macropter – winged females, which are rather small in number under optimal conditions of development (only about 2%) and represent a morphological and ecological type of adaptability, since with deteriorating living conditions, their number in the population increases sharply; 2. females are wingless – brachypterous, which have only rudimentary hind wings – elytra, so they cannot fly.

    .