February, 2017, United States— Dr. Siavash, Pioneer on successful treatment method of persistent genital and anal warts makes recommendation of classification and staging of genital warts. HPV is known as the most common sexually transmitted infection in the world. According to Dr. Arani, infected patients with HPV related growth that has not responded to conservative treatment such as topical application, acid, cryotherapy should not delay in getting the right treatment, as further delay would contribute to the spread of the infection in the carrier and to the partner.

The final destination of genital warts seems to be anal area. Failure to remove genital warts successfully would lead to anal warts, which is potentially a dangerous condition which could lead to anal squamous cell carcinoma HPV vaccine Gardisil™ has helped decreasing number of HPV related growth, but still persistent genital anal warts continue to be obstacle for clinicians and patients. According to Dr. Arani infected patients with HPV related growth that has not responded to conservative treatment such as topical application, acid, cryotherapy should not repetitively continue the same pathway which might further mask the disease and with further delay would contribute to spreading of the infection to self and partner.

Dr. Arani recommended a new classification of Non-malignant HPV related growth, genital warts as following: Stage I: Single wart or group of warts (primary or mother wart) in close proximity of 2 cm from each other at pubic, inguinal area, genital, scrotum or perineum. Usually found at original site of infection when the entry of virus occurs during sexual contact. Primary growth or mother wart is typically larger than secondary growths.

Stage II: Secondary growths which are mainly offspring of primary wart appears at symmetrical area of same anatomical area, i.e., bilateral side of penile or labia majora. HPV infection usually spreads with autoinoculation from primary site or as two or more primary sites of infection simultaneously appear. This may progress to viral infection in multiple areas at the same time which has occurred during original or subsequent sexual encounters.

Stage III: Genital warts spread to different anatomical location than Stage I and II, i.e., from pubic to penile or to perineum area or from labia majora to vaginal fourchette.

Stage IV: Virus spread to perinanal area

According to Dr. Arani, infected HPV patients that have not responded to conservative treatment such as topical application, acid, and cryotherapy, should not repetitively follow the same treatment pathway which might further mask the disease and contribute to spreading of the infection to self and partner. Failure to successfully remove genital warts could cause the formation of anal warts which could lead to anal squamous cell carcinoma and further morbidity as well as long term health care management. This classification and recommendation is made to further observe and control the spreading of HPV infection in the patient.

In general, the higher stage of genital HPV infection, the more aggressive the treatment method and follow up required. While Stage I might benefit from conservative treatment, patients with Stage IV necessitate more invasive treatment and follow up. Patients with higher HPV stages have a greater chance to develop anal warts so that annual anal pap smears to screen for possible malignant or precancerous transformation is recommended.

About Dr. Siavash Arani, M.D.

Dr. Arani is author of HPV, The Silent Intruder. Dr. Arani Basal Cell Removal (BCR) method to treat HPV related growth was introduced in 2007 as 3 step micro surgical destruction and has helped thousands of patients with persistent and complicated warts from all over the world to live without HPV related growth today.