What Is HPV?
It stands for Human Papilloma Virus. Many HPV has been recognized to this date . Each of them has location preference means they have specific affinity to certain part of the body and It is considered a sexually transmitted disease (STD). It is responsible for genital and anal warts. There is no FDA approved HPV test for males to this date. After the eradication of warts there is no way to determine if a patient is HPV free nor is there a way to guarantee the removal of the virus. In other words, an experienced clinician may destroy and treat specific genital warts in one or more attempts but he or she can not assure that the patient will not get new warts some place else. The behavior of this virus depends on many variables such as the strength of a patient's immune system, whether or not the patient is a smoker, or the level of aggression of his or her HPV. We will address all these issues on your visit.
What Are Genital Warts?
They are skin growth with different size, color and shape. Visible genital warts usually are caused by HPV. HPV is a virus and the wart is the outcome, however, remember that not every growth in the genital area is a genital wart caused by HPV. It must be diagnosed by your medical doctor only. HPV is very common in sexually active men and women and can sometimes have serious health consequences. About 20 million Americans are currently infected, and about 5.5 million people become newly infected each year.The virus can infect the genital skin and the linings of the vagina, cervix, rectum, and urethra.
What Are Anal warts?
Visible anal warts usually are caused by HPV. HPV is a virus and the wart is the outcome, however, remember that not every growth in the perianal and anal is anal warts by HPV.
Anal warts is not just a skin condition because anus is part of digestive system and HPV in anus increase the chance of carcinoma. It is imperative that physician with experience to evaluate and make aforementioned diagnosis. It must be diagnosed by your medical doctor only. Various Diagnostic instrument might be used to visualize Anal warts. Beside visual diagnosis, tissue biopsy and pathology is important aspect of diagnosis.
It is a type of genital warts usually caused by HPV 6 or 11. It is the most responsible wart on genital.
It is a type of wart usually caused by HPV 1,2,4,7. If your partner carries verruca vulgaris or HPV 1,2,4,7 then you might be at risk to get that on your genital.
This should not be mistaken by Verruca Plantaris (plantar wart). It is a type of wart usually caused by HPV 3,10,28,41. The other common name for it is "flat wart". They are 1-3 mm smooth somewhat raised. They are common around mouth, face, hand and arms. If your partner carries verruca Plana or HPV 3,10,28,41 then by skin to skin contact you could get infected with that. For example, If you receive oral sex by infected person with verruca plana on his/her perioral area then you may get verruca plana warts on your genital.
Double stranded Human Papilloma Virus enters the skin and passes its DNA to the proliferative layer of the skin genome and as a result, undesirable proliferations will occur which appear as warts. Inoculation without manifestation of warts may take from a week to 18 months or more. It means you may have been infected with HPV but won't develop a visible wart until a much later time. This is the reason why we ask our patients to return to the clinic for a re-evaluation after 6 months and 2 years to make sure that they don't have a new wart. Some individuals are naturally resistant to HPV viruses and don't become infected as easily as others. HPV warts are a contagious infection and spread easier by manipulation such as scratching or shaving.
Not every growth on the genitalia is a genital warts by HPV. It must be diagnosed by an experienced medical doctor. Diagnosis could be confirmed by a biopsy as well, the physician may decide for biopsy, for example, if the size of the warts are big and bleeding. We provide a diagnostic service after initial consultation and evaluation. Acetic acid application ( vinegar test) is not sensitive and not a reliable test. One of the best methods of diagnosis is by visual inspection by an experienced physician.(Please Click here for our special page with pictures of genital Anal warts for your self evaluation and education.)
Experience is major factor in diagnosis warts early and treating them immediately for more successful outcome. If you have genital warts and it is spreading then you need to make diagnosis quickly and initiate treatment asap. There is no blood test for HPV or genital warts, so we can't tell the overall status of an individual's HPV. The virus does not circulate in blood and that is why we do not do blood test for the diagnosis. There is limited testing for female consisting of an element of typing for cervix but not for men. If the HPV causes visible genital skin growth, then the doctor examination is the most important factor.
Pap Smear / HPV Test
HPV test and Pap Smears are primarily for evaluation of cervix such as detection of cervical cancer or any abnormality. This would not tell you if you have external genital, anal or perianal warts or not. For example, you could have a HPV warts on your labia majora of the vagina, anal or perianal warts and yet have normal Pap Smear with no HPV. However, if you are diagnosed with external genital warts then we always recommend you to get Pap Smear to make sure that you do not have anything internally. If your doctor gets suspicious of genital anal warts which are spreading then he/she would consider treatment as this could be extended internally (vaginal, anal, urethral) with possible later complication. On the other hand there is a possibility that your warts go away on their own, but you must consult with your MD. In conclusion the following are real possibilities:
- You have Anal, perianal or genital warts and you have normal Pap Smear with Negative HPV DNA Test
- You have Anal, perianal or genital warts and you have abnormal Pap Smear results with Negative or Positive HPV DNA Test
- You have no Anal, no perianal and no genital warts and you have abnormal Pap Smear results with Negative or positive HPV DNA Test
STD Test and Genital Warts / HPV
Whenever you get one STD then you might be at risk of others. Lets say you get genital warts, we know you have got that through sexual contact. It is visible and that is how you found out, at this point you must think about other STD, then what about STD which might not always have symptom (such as HIV). Once you have one STD, then you have to be careful for others. You could ask your doctor to screen you for common STDs. We have capability to test you for various STDs on the same day of your visit with same day test result, [CaliforniaSTD.com]
. As we do the surgery to remove your warts for you our lab works on your specimen for STD detection. The STD test result would be discussed by the time we have finished removing your genital warts. If there is any abnormal test we would provide you with the treatment on the same day. Remember Genital warts are red flag for possibility of other hidden STD.
Get tested by your doctor. Please refer to following page for our STD department for further information about other STD: CLICK HERE FOR STD TESTING
Visible STD, Anal / Genital Warts Psychology
Many patients with genital warts have anxiety, worry, and feel guilty or unclean. Some are afraid that they will be asked by their sexual partner about their visible genital wart. Needless to say, the majority of our patients have obsessed about their genital warts for weeks, months or even years as repetitive treatment has proven to be a failure in the past. Their obsession to overcome this challenging battle could make them try alternative methods. Self manipulation and destruction with sharp objects, freezing, remedies, internet creams, various acid, tea tree oil or silver compound application with undesirable effects are very common. As genital warts increase in intensity, size and number, the feeling of failure can continue to impact the patient psychology. We understand the difficult circumstances surrounding genital warts.
The first step to removing the psychological impact is to remove these visible STDs successfully.
Cosmetic Concern: Most of the infected genital wart patients are anxious about the cosmetic aspect of their genital wart. Nobody likes to have disfiguring growth, especially on his/her genitalia. Many patients worry about explaining their genital warts when meeting new partners. Genital warts are noticeable and not avoidable. It is the most common sexually transmitted disease and we understand the psychological aspect of this disfiguring infection. We always keep the cosmetic of genitalia in mind while treating these difficult lesions.
Please Click Here To See Our Before & After Pictures
Location of Genital Warts:
This effects both females and males. In addition to the scrotum, the penis, vulva, perineum, and perianal skin, genital warts can also occur on the cervix, uterine in the vagina, urethra, anus, and mouth. Intra-anal warts are seen predominantly in patients who have had receptive anal intercourse; Anoscopy or anal Pap Smears might be needed for these patients. These warts are distinct from perianal warts, which can occur in both men and women who have never had anal sex. We diagnose and treat most of those external wart.
How about Condoms?
Although condom use is a must it unfortunately does not protect you totally from genital warts. Condoms provide protection above the base of the penis but does not provide protection for your penile base (where there is no condom coverage), pubic area and scrotum area. Many patients have their original genital warts in those areas but the disease can spread to the penile shaft later.
According to CDC, While available scientific evidence suggests that the effect of condoms in preventing HPV infection is unknown, condom use has been associated with lower rates of the HPV-associated diseases of genital warts and cervical cancer.
"The available scientific evidence is not sufficient to recommend condoms as a primary prevention strategy for the prevention of genital HPV infection. There is evidence that indicates that the use of condoms may reduce the risk of cervical cancer."
HPV and Oral Sex
Many people falsely believe if they just have oral sex then they don't get STD such as HPV which is inaccurate. Performing oral sex on infected person carries significant risk of HPV infection. I have placed some oral HPV pictures in our photo page for your review. Remember HPV increase the chance of head and neck cancer, so be very careful of your encounter.
I Have Persistent Warts, What Do I Do Now?
Life is filled with beauty and darkness. We fight to win, sometimes victorious and sometimes not, but the point is that we get up and fight again learn a life time experience and put it behind us. However, as human we go to fight to win and not to lose and that is why we stop fighting if there is no chance of wining at all. If you want to win then you need to have the right tools and preparation. You need all your strength and you must have excellent knowledge of your enemy's behavior. Genital warts are product of the virus which work from your own body cells. First, you need your immune system as strong as it can be. If you are worried or depressed then your immune system may weaken. Get educated and read about your condition. I have tried to cover all the aspect of genital warts and give you detailed information from my clinical experience. The more you read, the more prepared you are. Do not scratch or manipulate your warts. Do not smoke. Do not use any over the counter remedies such as non-prescription creams, gels, sprays which could stimulate the viral shedding and worsening of your condition. Do not shave the area with blade. Try hair clipper with protective shield instead. Do not use over the counter anti itching medicine such as hydrocortisone. Keep a close eye on the effected areas. If your previous removal techniques have failed over and over then you might need to give it a second thought and a different approach, but do not lose hope. Ask your doctor all the question that you may have. Ask about the pathophysiology of HPV wart, treatment outcome, success rates, cosmetics, before and after pictures, healing time, possible adverse effect of treatment, doctor's experience of treating genital warts and what do you need to do to protect yourself etc.
Anal Warts Treatment
I always tell my patients; untreated genital warts have a big chance of infecting anal area. I have seen so many heterosexual patients in my practice over years with anal warts and almost every single time, patients point out the following concern.
"I am straight and I have never had anal sex"
You don't have to have anal intercourse, although, anal intercourse increases your chance of infection. Regarding the female anatomy; the vaginal opening is in close proximity to the anus, so the male genital area could be in contact with the perianal area during intercourse.
Unfortunately, the treatment of anal warts is much more difficult than genital warts , They are more stubborn due to anal anatomy and physiology. Many routine treatment routes can not be use in anus which could lead to significant discomfort and complication such as as topical acid application, etc. In many cases anal warts need to be treated in hospital setting, so It is imperative for patient to seek care as soon as getting infected with one before too late.
Before & After Pictures »
Cosmetic Outcome of Treatment
It is the most important part of the treatment of genital warts. Clinician must find the best successful pathway for treatment to create desirable cosmetic outcome. Patient will share the most private part of his/her body with his/ her love one or future partners. No one like to get questioned about unusual appearance on most private part of his/her body during the most intimate time. A claimed of "100 % satisfaction guaranteed" will not give you new genital skin! and you have to live with that for rest of your life regardless of wart removal success, so be very careful of choosing a right clinician with skilful and experienced hand. Although there is no 100% guaranteed for any type of surgery done on human by anybodies but we are extremely careful to create the most desirable outcome with no collateral damages to your genital, please refer to our before and after pictures.
As majority of our patients come to our center from far distances, it is our goal to try to limit your treatment session to one visit. If you have numerous warts or extensive anal warts then we might need to divide your treatment visits.
How To Choose A Doctor For Your Persistent Anal Warts Treatment
You might not be close to our center. Although we have special accommodation for our out of state patients and we have treated many of them in past. Not everyone could come to our institution for their treatment. You may live in other country or very far from us. There is a very simple rule to pick a right doctor in your area / your country.
Look for well known specific doctor and not just a clinic name. You make sure to ask to see before and after pictures and ask to see lots of them. A physician with great experience of HPV treatment should have treated many warts with great success and should have many cases to support that. The key is not just treating but treating with success. Having years and decades of experience in practicing medicine does not mean he/she can successfully remove and eliminate your warts. Ask how confidence your physician is to remove your warts. That is all. These 2 simple easy patients understanding element could assist you to find the right expert.
What Can Happen If You Do Not Treat Your Genital Warts
There are many possible complications and we only mention few of them below:
- Possible extension to urethra causing urinary obstruction
- Possible extension to anus causing anal bleeding, fecal incontinence
- Disfiguring genital
- Loosing elasticity of genital skin, this is very important as the penis needs elasticity of skin for erection and vaginal entry needs to be stretched for penetration
- Decrease sexual sensation of genital skin
- Itching, bleeding, sloughing
- Pregnancy complication (always treat them before planning for pregnancy)
Laser Treatment With High Relapse Rate
Laser is a device that has recently been used by different health providers for treatment of genital warts. Laser intensity and depth has of penetration is pre set. This is the reason that many patients with laser therapy have high relapse rate of recurrence of genital warts. The depth of the genital wart is not even and equal, so laser will not completely destroy the wart. Once again destruction of genital wart is very challenging and each individual wart needs different attention. There is no unique routine procedure for all.
Undesirable Radio Wave (Radio Frequency) Treatment
Lesser expensive devices than laser such as Radio waved is also recently used for treatment of skin problem and because it is cheaper than laser then many spa and clinics seem using them. Radio frequency is electromagnetic energy of frequency range between ~ 3khz-3GHZ to cause vibration. It produces heat similar to microwave. As it increases the tissue temperature it basically cook the area. The cosmetic effect and outcome is not close or as well as laser or other more precise target oriented treatment. The amount of heat production and vibration might be different in different tissue ( similar to placing a dish of food in microwave which you could get both hot and cold area on same dish). It is very important to remember that genital warts is not skin tag, mole or fibroepithelial that you burn and cook the sticking out tissue and it goes away easily and never grow back. Human Papilloma virus will re-produce the genital warts after it falls off again and again. Dr. Arani does not recommend this technique for treatment of genital warts.
Urethral wart is the most difficult HPV lesions to treat and accessibility is the most challenging obstacle for attempt to remove the growth.
Urethra is a small diameter tube in millimeter and not centimeter and it dilate when urine pass so it is even narrower at rest. Having growth in that narrow tube would create significant mechanical and physiological issue as follow:
- urinary passage obstruction
- urethral damage
- Pain upon sex and urination
Considering difficulty of HPV wart treatment secondary to relapse rate then urethral wart make this ordeal more difficult because the accessibility issue.
Urethral wart would bleed significantly if incised, liquid nitrogen is unable to target the urethral, Acid and topical application would damage the urethra and cause excruciating pain, laser plume may spread HPV further, cautery probe has difficulty to reach the urethral wart. In conclusion, clinician should be very cautious of targeting urethral wart growth. Please click here to see our before and after urethral wart photo
What CDC Recommends:
According to Center of Disease Control, the treatment of genital warts should be "guided by the preference of these patient, the available resources, and the experience of the health-care provider".
- Preference of patients : We always discuss the treatment plan with the patient before a procedure
- Available resource: Our clinic is not only equipped with freezing device, but we also have wide range of modalities and equipment for genital treatment to choose from:
- Surgical removal tangential scissor excision or tangential shave excision
- Electro surgery cautrey
- Infra red
- Thermal cautery
- Cryotherapy device (freezing)
- Health care provider experience: Dr. Arani has treated many patients with genital warts - patient happiness is our ultimate goal.
Partial Treatment Of Anal Warts
Treatment of anal warts should be complete and you should not leave any wart behind. After you have completed your treatment, you should go back to your doctor in about 6 months (depends on your doctor's decision) for re-evaluation to see if there are new warts (which should be immediately eradicated).
Reconstructive Genital Warts Treatment
The majority of our patients come to our center after having had a variety of different treatments in the past with relapses and scar development. We primarily approach these cases with micro-scissor excision and in some cases partial scar revision. Our minor micro-surgical procedure approach is completely painless.
High Risk HPV Causing Cancer
"Of greatest importance, persistent infection with certain types of HPV is a leading cause of cervical cancer. Progression from cervical cancer precursor lesions to invasive cancer is a slow process, estimated to take 10ñ15 years. Cervical cancer is an uncommon consequence of HPV infection in women, especially if they are screened for cancer regularly with Pap tests and have appropriate follow-up of abnormalities. The purpose of screening with the Pap test is to detect cervical abnormalities that can be treated, thereby preventing progression to invasive cervical cancer, and also to detect invasive cervical cancer at a very early stage. If detected early and managed promptly, survival rates for cervical cancer are over 90%. In the past 40 years, widespread cervical cancer screening using the Pap test and treatment of pre cancerous cervical abnormalities have resulted in a dramatic decrease in the incidents and mortality rates due to cervical cancer in the United States. However, each year in the United States, an estimated 12,200 women develop cervical cancer and 4,100 women die from it. Of women in the United States who develop cervical cancer, about half have never had a Pap test. Because genital HPV infection is most common in men and women who have had multiple sexual partners, abstaining from sexual activity (i.e. refraining from any genital contact with another individual) is the surest way to prevent infection. For those who choose to be sexually active, a monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections. For those who choose to be sexually active but who are not in a monogamous relationship, reducing the number of sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV infection."
Overseas and Out of State Patient Accommodation
We have many patients that come to us from long distances. Please find the following nearby hotel for your accommodation. Please call us in advance in order to expedite treatment and diagnostic services before you arrive.
Out of state patient may accommodate in the nearby Radisson Hotel
3540 South Figueroa Street, Los Angeles California 90007
Reservations: (888) 201-1718 US Toll Free
There are 2 FDA approved vaccines in USA, one made by Merck and other by Glaxo Smith. I will briefly explain both of them.
Gardisil made by Merck introduced in 2006 covers 4 different HPV Types 6, 11, 16, and 18. First 2 types are responsible for majority of genital warts and last 2 are responsible for cervical cancer. In other words, type 6 and 11 are low risk and 16 and 18 are high risk HPV. The main components of the vaccine are purified inactive proteins from aforementioned HPV. The vaccine will not infect you, but will boost your immunity to fight against the virus. Vaccine are given in series of 3 shots on day 0, 2 months and 6 months. We have this vaccine available in our medical center for administration.
Cervarix is made by Glaxo Smith received FDA approval in 2009. It will cover Type 16 and 18. We usually prefer Gardisil for our patients as our practice focus on Genital warts and Gardisil will cover that, However, Cervarix remain as approved Vaccine for prevention of cervical cancer please consult with your physician to choose which one is right for you.
Dr. Arani's lecture on HPV Vaccine
Will HPV Vaccine Help Me If I Already Have HPV?
According to the vaccine insert: Yes, you may get a benefit from the vaccine if you already have HPV. This is because many people are not infected with all 4 types of HPV, which are contained in the vaccine. In clinical trials, individuals with current or past infections with one or more vaccine-related HPV types prior to vaccination were protected from disease caused by the remaining vaccine HPV types. HPV Vaccine is not intended to be used for treatment for above mentioned diseases. Talk to your health care professional for more information.
How About Partners and Sex
Patients always concern regarding sex with their partner. This is a very sensitive subject needs to be addressed. If you carry the diagnosis of genital warts then you are contagious. Some people don't develop genital warts after getting expose to HPV and some people develop severe case of genital warts. To this date we don't know why certain people are naturally more immune than others. You could be more contagious if you have untreated genital warts and significant advance visible disease. We will address your concern in detail in your visit and will give you basic advice and answer all your questions.
Before & After Pictures
How About Internet Remedies / Creams / Solutions / Ointments?
There are many of these available online.We mostly know of these products through our patients and their unpleasant experiences. These products cause adverse and undesirable effects. They irritate and stimulate viral shedding which would increase the number of warts. Scars, loss of skin, and increasing size of warts are very common as well. If this happens then returning the product ("100% guaranteed") will not fix the damage and your real loss is your health - not your money. Read the following FDA guideline and be careful especially when it comes to your sensitive genital organ.
Examples of Adverse Reactions From Failed Treatment
Your first shot is your best shot when treating genital/anal warts. It is imperative that you choose the right institution, physician, and method to minimize recurrence and scar development. Disfiguring scarring and warts mixed with scarring are much more difficult to treat. Permanent, unsightly scars cannot be reversed by “money-back guarantee” promises.
Choosing a clinic offering discounted services may save you money but also result in detrimental skin damage and low success rate, negatively impacting your health and life. Physician reputation and skill should be your top priority when choosing the right treatment in your country or your area. Dr. Arani’s skills and artistry work are the hallmark of our center’s reputation and name.
For Anogenital warts treatment. We primarily specialize in and focus on treating HPV genital warts and other STD-related conditions. We don't treat other skin conditions such as moles or skin tags. Most of our patients can be treated in only one session with our innovative technique.
According to Food and Drug Administration (FDA)
Promoters of fraudulent health-care products often use similar claims and practices to lure consumers into buying their goods. The FTC and FDA advise consumers to be suspicious of:
Claims that the product is "natural" or "non-toxic," suggesting it does not have side effects. "Natural" or "non-toxic" does not necessarily mean safe. Some "natural" supplements contain potent stimulants; others can result in negative interactions with medicines. Testimonials from people who claim amazing results. Testimonials often are undocumented and are not a substitute for scientific proof. Claims that a product is a "scientific breakthrough," "miraculous cure," "secret ingredient" or"ancient remedy."Claims that the product is an effective cure for a wide range of ailments. Claims that use impressive-sounding medical terms. Claims that the product is available from only one source, and payment is required in advance. Claims of a "money-back" guarantee. Web sites that fail to list the company's name, physical address, phone number or other contact information.î
How to spot health fraud: READ HERE
Example of warning letter for Silver product: READ HERE
Summary of Strategies To Prevent Genital HPV Infection
According to the Center of Disease Control
Based on currently available science, the following recommendations summarize the strategies most likely to be effective in preventing future infections with genital HPV infection and cervical cancer.
- The surest way to eliminate the risk for future genital HPV infections is to refrain from any genital contact with another individual.
- For those who choose to be sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections. However, it is difficult to determine whether a partner who has been sexually active in the past is currently infected.
- For those choosing to be sexually active and who are not in long-term mutually monogamous relationships, reducing the number of sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV infection. Partners less likely to be infected include those who have had no or few prior sex partners.
- While available scientific evidence suggests that the effect of condoms in preventing HPV infection is unknown, condom use has been associated with lower rates of the HPV-associated diseases of genital warts and cervical cancer. The available scientific evidence is not sufficient to recommend condoms as a primary prevention strategy for the prevention of genital HPV infection, but it does indicate that the use of condoms may reduce the risk of cervical cancer.
- Regular cervical cancer screening for all sexually active women and treatment of pre cancerous lesions remains the key strategy to prevent cervical cancer.
- In the future, receiving a safe and effective HPV vaccine to help prevent genital HPV infection as well as the HPV-associated diseases of genital warts and cervical cancer would be an important prevention measure. However, an effective HPV vaccine would not replace other prevention strategies.