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Genital warts

MagazineMay 1998 (Vol. 9 Issue 2)Genital warts

Please find me an urgent cure for the genital wart virus! Every doctor or hospital clinic I have spoken to has told me the same thing: that once you get the virus you cannot get rid of it

Please find me an urgent cure for the genital wart virus! Every doctor or hospital clinic I have spoken to has told me the same thing: that once you get the virus you cannot get rid of it.

I cannot believe that in this day and age, when we have just landed on Mars, we cannot do anything to rid ourselves of what is supposed to be the most common of STDs.

I tried tea tree oil, which made it worse. I've been told that echinacea boosts the immune system, but don't know if it is used specifically for warts. L M, Cheltenham.,.........

If it's any comfort, yours is not an uncommon problem. The genital papillomavirus (HPV) is a highly contagious, sexually transmitted disease. You can also pick it up from objects (medical equipment, say, or even sunbeds) which haven't been properly disinfected.

In a recent study of 608 college women over three years, the cumulative incidence of infection was a whopping 43 per cent (N Engl J Med, 1998; 338: 423-8), with an average annual incidence of 14 per cent. Counting the women who were infected before the study started, some 60 per cent had the virus at some time during the three years it ran. The prevalence, at least in women, is thought to be from 20 to 46 per cent in a number of countries, and as high as 80 per cent in the US.

The received wisdom on the subject is that the virus lives forever once you have it, you never get rid of it. But, a study of college women conducted by the Albert Einstein College of Medicine in New York found that the average duration of new infections was eight months. Dr Charles Lacey, a consultant genito urinary physician at St Mary's Hospital, and Britain's most knowledgeable source on the wart virus, says that it usually disappears within a year of the last wart appearing. Some studies have also concluded that HPV infection is transient; although it should be noted that these have been based on a small number of people who were only checked twice, and most of the studies concerned women (J Infec Dis, 1996; 173: 794-9; Br J Cancer, 1995; 72: 943-5; J Infec Dis, 1994; 169: 235-40; J Pediatrics, 1992; 121: 307-11). It's also been postulated that the older you are, the less likely you are to be infected, possibly because you've acquired immunity to HPV from past exposure (Sex Transm Dis, 1996; 23: 333-41).

Although it's called the human papillomavirus, there may be up to 60 types of viruses, and some (types 16 and 18, primarily) have been associated with cervical cancer. You are most at risk of infection if you are young, of Hispanic ethnic origin or black, have an increased number of sexual partners or high frequency of drinking while having vaginal sex, engage in anal sex or have an increased number of lifetime partners. Those who have the virus persisting for more than six months tend to be older, have the type most associated with cervical cancer, or are infected with multiple types of HPV. The fact that they have multiple types of HPV may mean that they have deficient immune responses to the disease. With some people, HPV acts similarly to the herpes genital virus, reappearing when they are under stress.

According to the New York study, those most likely to recover from infection were those who'd newly acquired it, and the longer you had the infection, the more difficult it was to lose it; some 39 per cent of patients had their infections resolved by the second half of the year they'd acquired it. The likelihood of overcoming the infection fell to 11 per cent by the next six months. The study concluded that HPV infection, in the main, is short lived abnormal lesions in the cervix often spontaneously resolve and so should simply be observed without being cut out.

Some 95 per cent of those infected with the wart virus don't know it, because they have no physical evidence; at most only 3 per cent have visible warts and another 2-3 per cent have flat warts which aren't visible to the naked eye (Alternative Medicine, Burton Goldberg, ed, Washington: Future Medicine Publishing, 1994). If you're a woman with genital warts or have had an abnormal smear, it's important for your partner to be examined, too.

If you don't have any visible warts, your doctor can find out if you are in fact infected by applying a 3 per cent solution of vinegar (5 per cent for men), soaked in dressing gauze and applied to your genitals and anal area for about five minutes. Any white spots, apparent with a magnified hand lens or colposcope, could mean you have the wart virus. However, it's best to have this done by a doctor knowledgeable about HPV, since white spots can also be caused by such conditions as contact dermatitis or candida infection (Contemporary Ob/Gyn, April, 1988: 157-72).

Although there is no such thing as a magic bullet for genital warts, two recent medical treatments have had some success, particularly for those like you who have persistent recurrence. Two recently approved products for home use include a 5 per cent imiquimod cream (an immune response modifier) and a 0.5 per cent podofilox (podophyllotoxin) gel, an improvement in terms of self administration on the podofilox solution.

In one study, half of the patients with multiple anogenital warts given the 5 per cent imiquimod cream had their warts completely clear up, compared with only 21 per cent with the 1 per cent imiquimod cream, and 11 per cent given a placebo cream with no active ingredients (Arch Dermatol, 1998; 134: 25-30).

In another study, 45 per cent of patients given podofilox gel in a three day cycle each week for eight weeks had a complete clearing of warts, compared with 4 per cent given the placebo. But it should be noted that nearly a third of those who responded to the podofilox gel had a recurrence within three months, although the patients in this study had more warts and had them longer than those in the imiquimod study (Arch Dermatol, 1998; 134: 33-8). Both products are available in the US, but not the UK as yet.

The Camden and Islington Department of Genitourinary Medicine uses imiquimod, but has found that results are disappointing and the drug causes side effects.

In America and Europe, doctors have used a cream or topical solution of flourouracin, a chemotherapy drug ordinarily used for skin cancer and moles caused by the sun. Nevertheless, this drug has been linked to a range of side effects, including ulceration, soreness, hair loss, sensitivity to light, miscarriage and birth defects, and even the herpes simplex virus! Injections of fluorouracil, which have also been tried, are highly toxic, and even Roche, the manufacturer in America, admits that the drug has a "narrow margin of safety".

Remember that viruses are not necessarily evil mechanisms that hang around forever after all, the common cold is a virus. Their persistence has mostly to do with the state of your immune system. If you are chronically stressed, you are likely to suffer recurrent infection. Deficiencies in vitamins A and C and folic acid also appear to cause HPV infections to flare up again.

You've been given good advice in pursuing echinacea. This classic herb has been found in lab studies to increase the ability of white blood cells to fight and destroy toxic organisms that invade the body. Scientific studies have shown that echinacea can fight bacterial infections by directly stimulating the body's ability to "eat the offending bugs" (Therapie der Genenwart, 1976; 115: 1072). As far as viruses are concerned, extracts of echinacea injected intravenously can increase blood properdin levels dramatically. Properdin helps to neutralise both bacterial and viral blood toxins, suggesting that echinacea may give the body the boost it needs to clear itself of viruses (Zhurnal Immunitatsforschung, 1958; 115: 169-76).

In America, Dr Tori Hudson, clinical director of the National College of Naturopathic Medicine in Portland, Oregon, has developed an anti viral, immune boosting ointment of vitamin A and the herbs thuja and lomatium. She has patients apply the ointment directly to the wart, which she finds inhibits the virus. Both herbs can also be given orally.

The amino acid lysine, which has been found to be very useful against the herpes virus, has also been used for genital warts, although most of the scientific data available examines its effectiveness against herpes. In vitro scientific studies have shown that lysine has anti viral activity, because it stops metabolism of arginine, another amino acid. We know that the herpes virus requires the synthesis of arginine rich proteins in order to replicate (Chemotherapy, 1981; 27: 209-13) and that high levels of lysine lower levels of arginine. It's worth trying taking lysine tablets orally and applying the cream locally on the warts. London's NutriCentre recommends 500 mg lysine capsules four times a day in acute flare ups and two times a day as maintenance, plus lysine cream applied five times a day. High concentrations of glycyrrhizic acid, a component of liquorice root, have also been shown to inactivate herpes simplex virus in in vitro studies (Experientia, 1980; 36: 304), so a cream might be useful. The NutriCentre stocks Licrogel (glycyrrhizic acid ointment), which they recommend that you apply twice a day (NutriCentre, 0171 436 5122).


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