Wart Causes and Treatment
A dense mat of spider webs, held onto the skin by a piece of paper fastened with string. Compresses of castor oil. The milk squeezed from the leaf of a wild lettuce. These are some of the treatments that were in use over a century ago for the age-old and most annoying of skin conditions, warts. There is no evidence that they may be caused by toads.
Warts are divided into three main types: genital warts, skin warts and plantar warts.
Genital Warts (Condylomata Acuminata)
The human papilloma virus (HPV) is responsible for genital wart infections, and it is transmitted from one person to another only by sexual intercourse or other intimate contact. It is not possible to catch it from toilet seats or spa baths.
The obvious result of infection with the human papilloma virus is the growth of warts, sometimes of quite a large size, on the penis in men and in the genital area of women. They may appear as flat, pale areas on the skin, or as the dark-colored, irregularly-shaped lumps more commonly associated with warts. After contact, the incubation period varies from one to six months, but may be even longer.
There are a number of hidden problems with this virus. In men, the virus may be present on the penis, but no warty growths may be obvious. They may only be seen if a doctor stains the area with a special liquid. The wart virus may also be present in the end of the urine tube (urethra) that runs through the penis, and in that position the warts are totally invisible. The warts can also be spread through sexual contact to other parts of the body.
Both men and women can be carriers of the virus from one sexual partner to another without being aware that they are infected. Only when the warts become large and obvious does the victim seek attention.
It is in women that the greatest, and deadliest, problems occur. If a woman is infected by HPV, she may develop genital warts not only around the outside of her genitals, but internally where they are difficult to detect. There may in fact be no warts present at all, but once the virus enters the vagina, it can attack the cervix, which is the opening into the womb (uterus). HPV infections of the cervix are associated with cancer of the cervix. It does not happen immediately and may take some years to develop, but a significant proportion of women with this infection will develop cancer. Cancer of the cervix has few early signs and is often not detected until it is well advanced and difficult to treat.
Every woman should have regular Pap smear tests every year or two while she is sexually active. These tests can detect this type of pre-cancer and cancer, genital wart infections and other gynecological problems at an early stage. When detected early, the cancer can be treated effectively and completely cured. Any woman who knows that her partner has genital warts should be extremely careful to have Pap smear tests, and probably more frequently than normally recommended. Condoms can give reasonable, but not total, protection against catching an HPV infection.
The genital warts themselves, in both men and women, can only be treated by destroying the warts with acid paints or ointments, freezing the warts with liquid nitrogen, or by burning them away with an electric needle or lasers. Depending on the extent of the affected area, treatment with all except the acids and freezing will require either a local or general anaesthetic. Treatment is often prolonged, as the warts tend to recur, but with careful watching and rapid treatment of any recurrence the infection will eventually settle.
Anyone who is treated for genital warts should also have tests performed to check for the presence of other venereal disease, as a person carrying one type of VD could well carry another.
Warts on the skin are caused by a virus, a very slow-growing virus, which may take months or years to cause problems. Only a quarter of the population is susceptible to the wart virus, the rest of us have natural immunity. That is why some people never catch the disease, even though they may come into contact with warts frequently.
Warts are most common in children from 8 to 16 years of age. The virus is caught from someone else who has the disease, and months or years later, the wart develops. People with warts should not be isolated for fear of spreading the disease. The virus is widespread in the community, and isolation of victims is both impractical and ineffective.
Once a wart has developed, it will usually go away by itself without any treatment, but this may take many months or years. The average life span of a wart is about 18 months. The body gradually builds up antibodies against the wart virus, and when they reach a high enough level, the virus and wart are destroyed. Normally that person then has long-term resistance to further wart infections.
The most common sites for warts to develop are the knees, elbows, hands and feet. When warts develop on the soles of the feet they are called plantar warts or verrucae.
Because warts can become both unsightly and painful, many patients wish them to be removed. The medical profession has progressed a bit further than using spider webs and wild lettuce, but the principle of wart removal remains the same. They cannot be cured by tablets or creams, they must be physically removed. The methods available are acid paints that are applied regularly to eat away the wart tissue, freezing the wart with liquid nitrogen to destroy its cells which causes it to fall off after a few days, burning the wart tissue away with a high voltage electric current in a process called diathermy, injecting a cell destroying substance under the wart, or cutting the wart out surgically. All these methods have their good and bad points, and if a wart is more than a few millimeters across, the various options should be carefully discussed with a doctor.
Because warts eventually disappear without any treatment, only those that are causing disfigurement or discomfort should be treated, as a scar may remain after any form of surgery, diathermy or freezing. Warts may also recur after all these forms of treatment.
In the future, it may be possible to have a vaccine against warts to prevent the development of this virus, in the same way that measles and influenza vaccines work today.
If you are not sure whether a lump on your skin is a wart, it should be checked by a doctor, as some forms of skin cancer may mimic a wart in appearance.
Plantar Warts (Verrucae)
Plantar warts (or verrucae) are warts on the soles of the feet, which tend to grow inwards rather than out. They tend to cause more problems than warts in other areas because they become painful with walking and so need treatment at an earlier stage than warts elsewhere on the body.
The treatment of plantar warts is the same as for skin warts, but a far larger hole than expected is usually left in the sole of the foot, as plantar warts tend to be a bit like icebergs, with only a small part showing on the surface. It may take some weeks after the surgery for the hole to heal.
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