Treatment

HPV is a persistent and hard-to-cure organism, so treatment must usually be repeated. Moreover, an infected woman should be monitored throughout her life for recurrence or development of precan-cerous changes, whether or not warts are apparent. Because the virus remains in the lesions it creates, treatment for HPV consists of controlling infection by removing visible warts or precancer-ous lesions.

They can be removed by surgery, by freezing, or by locally applied chemicals. The method depends on the extent of infection, accessibility of lesions, and malignancy potential.

Surgery is sometimes used to cut away warts if treatment without anesthesia would cause discomfort, or warts are so extensive that simultaneous reconstructive surgery is required. Surgery may permit a more thorough removal of infected sites, although its cost must be weighed against potential benefits and risks. Surgery may either mean an excisional biopsy done as an outpatient procedure or a more involved procedure performed under anesthesia.

In superficial cryotherapy, liquid nitrogen is applied by cotton swab to minor external warts. Extensive lesions can be frozen faster and to a greater depth with a cold cautery device which pinpoints warts. Cold cautery cryotherapy is usually performed within a week after menstruation, and it cannot be used in pregnant women. After cryotherapy women may experience cramping, abdominal pain, infection, or rarely, cervical scarring. Painkillers given before cryotherapy will ease pain, and ice packs applied externally after the procedure will reduce any swelling or inflammation. Considerable watery vaginal discharge for 10 to 20 days after cryotherapy is normal, but fever, pain unrelieved by analgesics, or unusually prolonged discharge should be reported to the doctor.

Laser treatment involves a high-intensity beam of light that vaporizes lesions, particularly those that are external or in less accessible locations. In the hands of a well-trained physician, laser therapy is highly effective in removing multiple lesions. The procedure is usually more expensive than other types of treatment and carries risks of removing too much tissue, and delayed healing, scarring, or pain.

Acids such as trichloroacetic acid (TCA) or bichloroacetic acid (BCA) may be painted on visible warts using a small cotton swab or wooden applicator. To be effective, TCA or BCA must be applied in proper concentrations, but these sometimes cause a burning sensation after treatment. Local and systemic painkillers will help relieve pain. Scarring and chronic pain are potential aftereffects.

5-Fluorouracil (5-FU) cream applied to the vulva on a regular regimen can help control external lesions. However, it should not be used by pregnant women and may cause serious skin irritation.

Interferon, a newer drug approved for injection into a muscle or select lesions, can be used, but it is expensive, has significant systemic side effects, and cannot be used during pregnancy. Podophyllin was once a popular treatment, but it is used less often now because it cannot be used during pregnancy or for most internal lesion sites and because it may cause cancer or toxic reactions.

After any HPV treatment, the treated area should be kept clean and dry with cornstarch dusting, cotton underwear, and loose clothing. Sexual intercourse should be avoided until healing has occurred externally and internally, usually within two to four weeks. Follow-up colposcopy and Pap smears are usually scheduled at three-month intervals after treatment of HPV, and yearly thereafter. These tests monitor that the cervix remains free of precancerous or cancerous tissue. A woman with HPV should notify any sexual partners of her infection, use latex condoms with every partner (unless in a mutually monogamous relationship), and urge that the partner be treated for HPV if his physician has identified HPV lesions.

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