Warts are benign tumors of the skin or mucous membrane due to some papillomavirus (HPV).
Clinical signs:
– Soft growths (“cockscomb”), painless, sometimes grouped together (cauliflower appearance) or macules (flat condylomata) are more difficult to visualize. Warts can be external (vulva, penis, scrotum, perineum, anus) and / or internal (vagina, cervix, urethra, rectum, oral cavity in patients infected with HIV).
– In women, the presence of external warts justifies speculum examination in search of vaginal or cervical warts. Examination may reveal a budding tumor ulcerative cervical cancer related to evoking papillomavirus 1.
Treatment:
The choice of treatment depends on the size and location of the genital warts. In patients infected with HIV, treatment may be less effective and more frequent relapses.
External warts <3 cm and vaginal warts:
The solution of podophyllotoxin 0.5% 2 can be applied by the patient himself but in case of vaginal warts, treatment is necessarily applied by the medical personnel.
Explain to the patient how: with an applicator or cotton swab, apply the solution to the warts, without overflowing on healthy skin, let it air dry. For vaginal warts, allow the solution to dry before removing the speculum.
The solution was applied 2 times / day for 3 consecutive days per week for 4 weeks.
The podophyllin preparations are cons-indicated during pregnancy or breastfeeding 3. They should not be applied to the cervical, urethral, rectal, oral or extensive warts on. Misused, they cause painful ulcerations.
External warts> 3 cm; cervical, intra-urethral, rectal, oral and genital warts in women pregnant or breastfeeding:
Surgical excision or cryotherapy or electrocautery.
1 * Some types of HPV can cause cancer. If the context permits, the presence of genital warts in women justifies screening of precancerous cervical lesions (visual inspection with acetic acid or cervical smear, or other available technology) and treatment (cryotherapy, cone biopsy, etc. depending on the diagnosis).
2 * The 10% podophyllum resin, 15% or 25% is a much more caustic preparation, applied by medical personnel.Protect the surrounding skin (vaseline ointment zinc oxide) before applying the resin. Allow to dry. Wait 1-4 hours before washing with soap and water. Apply once / week for 4 weeks.
3 * The treatment of warts is not an emergency. In the absence of therapeutic alternative, the treatment may be delayed. The presence of genital warts in a pregnant woman is not an indication for caesarean section: it is unusual warts obstruct the birth and the risk of mother-child transmission of the virus is very low.
1 * Doxycycline is against-indicated in pregnancy. It should not be administered to lactating women if the treatment exceeds 7 days (use erythromycin).
2 * Ciprofloxacin should be avoided in pregnant women.
