What is the treatment?
Human papillomavirus, a sexually transmitted virus cause infection in many people who experience sex at a very early age or have sex with a partner having many partners or have many sex partners and it often gets cleared up without any treatment, without making people fall sick. There are 100 different types of HPV and most of them do not cause serious health issue. In case they persist and cause problems like genital warts, leading to cancer or even precancerous changes, then the symptoms might require treatment. Women may be prescribed to take some tests like Pap test to do a follow up of the affected cells. The analysis tests the presence of there are abnormal changes in the cells due to HPV infection, it could lead to cervical cancer which will need treatment or cervical dysplasia which is a precancerous cell change or another cell defect called cervical entraepitheial neoplasis, both of which get healed on their own. For treatment of these abnormal cells some methods like conisation, laser therapy, loop electrosurgical excision procedure (LEEP) or cryotherapy are used on people. If the infection by HPV type 6 and 11 causes some raised or flat growths on your scrotum or cervix or thigh or groin or on the penis or anus, they are called genital warts and can be treated using Podofilox or Imiquimod cream or Podophylin and trichloroacetic acid, surgical removal.
How is the treatment done?
Only if HPV causes genital warts or cancer in the cervix or anus or penis of individuals, appropriate treatment would be required. To treat genital warts medications like podofilox, podophylin, imiquimod and trichloroacetic acid can be used. Surgical interventions like cryotherapy would involve freezing of the virus infected cells with liquid nitrogen thereby inhibiting their functions by forming a blister around the warts, burning the abnormal cells with electric current, surgical removal of the cells with the help of a scalpel, laser therapy to remove infected cells using intense light rays and LEEP technique is used wherein the abnormal cells are discarded with an electric current. Imiquimod (Zyclara, Aldara) works by boosting up the immune system helping to fight the HPV, podofilox and podophyllin simply destroy the genital wart tissues. In case of cervical cancer also, if the cells are present only on the upper layers and have not migrated into the deeper layers the same surgical treatments can be applied as in case of genital warts. Only if the cancer recurs after other treatments, simple hysterectomy is carried out. Radiation therapy like high dose X-rays is also used to destroy cancer cells, chemotherapy is a common treatment for getting rid of cancer cells. HPV can also cause penile cancer in some men and the treatments include surgery, radiation therapy, chemotherapy and biologic therapy. Surgery can be performed by cutting the tumor from the skin in thin layers using a microscope or by using laser beam to cut the lesions, circumcision that removes the affected foreskin of the penis or even by amputating partial or the whole penis. Radiation therapy uses high-energy X-rays or may be other types of rays to inhibit the growth of cancer cells, chemotherapy uses drugs to kill or stop the cancer cells form growing.
Who is eligible for the treatment? (When is the treatment done?)
Treatment can be given to patients only with visible warts eliminating as many lesions as possible. HIV positive patients or immunosuppressed patients require other treatment methods too for complete eradication. Pregnant women with HPV infection are also eligible for treatment using keratolytics and cryotherapy, even surgical excisions in some.
Who is not eligible for the treatment?
People who do not have visible genital warts are of course not eligible for the respective treatment. If there is presence of mucosal human papillomavirus (HPV) or subclinical anogenital HPV, but there is no co-existence of dysplasia, then treatment cannot be recommended. This is because the latent virus present in the healthy skin beside the lesion may get activated by the treatment causing the condition to recur. Pregnant women cannot be treated with medications like podophyllin, 5-flurouracil and interferon.
Are there any side effects?
There are side-effects of medication and surgery of genital warts. Application of Imiquimod (Aldara) causes redness of the skin along with blisters, body aches, fatigue, rashes and cough. Sinecatechins (Veregan) have side effects on the skin causing reddening, burning, pain and itching. Podophyllin and podofilox can cause mild skin irritation, aches and sores. Also, if too much of the ointment is used or is not let air dried, it could spread to other areas and thereby cause side effects. Laser treatment can cause swelling, itching or pain in the affected area, sores in the treated area, scarring and shedding of tissues, discharge from vagina or penis and even tissues that stick together. Post-surgery you can expect a fever, a severe pain or bleeding continuing for about a week or a foul smell with a yellow discharge thereby giving rise to an infection.
What are the post-treatment guidelines?
Once your warts are treated you need to develop a few good habits to avoid their come back. The foremost step is to maintain proper hygiene, keep the area clean and avoid scratching it. If the area feels swollen or if it hurts then a cold pack may soothe it or over-the-counter medicine can also be taken. You should also wash your hands each time you touch your genital warts and lastly avoid sex if you feel uncomfortable and till they are completely gone. Women must regularly go for Pap tests and should be checked whether vaccine has been taken or not.
How long does it take to recover?
It takes about several weeks to months or even year to completely recover and totally get rid of the warts but they may also relapse which occurs more often. Some people can never get cleared of them in their life. The cancer also takes years to heal completely.
What is the price of the treatment in India?
The normal consultation fees for treatment of genital warts ranges between Rs.200 to Rs.2000. The treatment involves certain tests like PAP Test and HPV Test wherein PAP Test is charged somewhere around Rs. 200 to Rs. 1,500 and the HPV Test cost around Rs.2,000. 12.5 mg of Imiquimod cream cost around Rs. 268. Cost of Cervical cancer treatment ranges between about Rs. 3 lakh to Rs. 5 lakh.
Are the results of the treatment permanent?
The results for genital warts treatment are usually not permanent and have more than 50% chance of getting relapsed. Cervical and penile cancer treatments are generally permanent. But, as the virus cannot be eradicated easily, the condition can prevail.
What are the alternatives to the treatment?
If the symptoms of your HPV or the genital warts are not very prominent and do not cause you much discomfort it is not necessary to get a treatment done. You can maintain simple hygiene, abstain from sexual contact, always use barrier protection like condoms while sex, wash hands every time you touch the warts and avoid rubbing the affected area.
Rs. 300 to Rs.10,000