The first vaccine against HPV, Gardasil, won FDA approval June 8, 2006. The vaccine protects against infection from four strains of the virus. Two of these strains, HPV-16 and HPV-18, account for about 70% of cervical cancers. The other two strains covered by the vaccine, HPV- 6 and HPV-11, account for about 90% of genital warts. The vaccine is approved for 9- to 26-year-old females. Other vaccines against HPV are currently being studied and are showing great promise in reducing infections.
 

More Frequently Asked Questions

- FAQ: What do genital warts look like?
- FAQ: What is genital HPV infection?
- FAQ: How do people get HPV?
- FAQ: How Do I Know If I Have Genital Warts?
- FAQ: What Happens If I Don't Get Genital Warts Treated?

A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.

Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. In these cases, the child can develop RRP.
 

More Frequently Asked Questions

- FAQ: What do genital warts look like?
- FAQ: What is genital HPV infection?
- FAQ: How Do I Know If I Have Genital Warts?
- FAQ: What Happens If I Don't Get Genital Warts Treated?
- FAQ: How Can I Prevent Getting Infected With Genital Warts?

More Frequently Asked Questions

- FAQ: What is genital HPV infection?
- FAQ: How do people get HPV?
- FAQ: How Do I Know If I Have Genital Warts?
- FAQ: What Happens If I Don't Get Genital Warts Treated?
- FAQ: How Can I Prevent Getting Infected With Genital Warts?

The virus commonly spreads through skin-to-skin contact. This includes sexual contact or touching or scratching the bumps and then touching the skin. Handling objects that have the virus on them (fomites), such as a towel, can also result in infection. The virus can spread from one part of the body to another or to other people. The virus can be spread among children at day care or at school. Molluscum contagiosum is contagious until the bumps are gone-which, if untreated, may be up to 6 months or longer.

The time from infection to the appearance of lesions can range up to 6 months, with an average incubation period between 2 and 7 weeks.

Diagnosis

Diagnosis is made on the clinical appearance; the virus cannot routinely be cultured. The diagnosis can be confirmed by excisional biopsy.

Histologically, molluscum contagiosum is characterized by molluscum bodies in the epidermis above the stratum basale, which consist of large cells with:

• abundant granular eosinophilic cytoplasm (accumulated virons), and
• a small peripheral nucleus.

Symptoms

Molluscum contagiosum lesions are flesh-colored, dome-shaped, and pearly in appearance. They are often 1–5 millimeters in diameter, with a dimpled center. They are generally not painful, but they may itch or become irritated. Picking or scratching the bumps may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions. They may occasionally be complicated by secondary bacterial infections. In some cases the dimpled section may bleed once or twice. The viral infection is limited to a localized area on the topmost layer of the epidermis. Once the virus containing head of the lesion has been destroyed, the infection is gone. The central waxy core contains the virus. In a process called autoinoculation, the virus may spread to neighboring skin areas. Children are particularly susceptible to auto-inoculation, and may have widespread clusters of lesions.

Treatments

Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks, to 2 or 3 months. However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months, to about 18 months, and with a range of durations from 6 months to 5 years.

Treatment is often unnecessary depending on the location and number of lesions, and no single approach has been convincingly shown to be effective. It should also be noted that treatments causing the skin on or near the lesions to rupture may spread the infection further, much the same as scratching does. Nonetheless, treatment may be sought after for the following reasons:

Medical issues including:

• Bleeding
• Secondary infections
• Itching and discomfort
• Potential scarring
• Chronic keratoconjunctivitis
• Social reasons
• Cosmetic
• Embarrassment
• Fear of transmission to others
• Social exclusion

Many health professionals recommend treating bumps located in the genital area to prevent them from spreading. The virus lives only in the skin and once the growths are gone, the virus is gone and cannot be spread to others. Molluscum contagiosum is not like herpes viruses, which can remain dormant in the body for long periods and then reappear. Thus, when treatment has resulted in elimination of all bumps, the infection has been effectively cured and will not reappear unless the patient is reinfected. In practice, it may not be easy to see all of the molluscum contagiosum bumps. Even though they appear to be gone, there may be some that were overlooked. If this is the case, one may develop new bumps by autoinoculation, despite their apparent absence.

Cryotherapy

Cryotherapy involves killing infected cells by "freezing" them with a pressurized liquid spray, usually liquid nitrogen or nitrous oxide. The procedure can be mildly uncomfortable to painful depending on quantity and location of infected cells. The procedure can be performed by any health professional, including nurse practitioner or physician assistant. The infected cells will heal within 2–3 weeks.

Povidone-iodine

There are a few treatment options that can be done at home. Povidone-iodine surgical scrub can be gently scrubbed on the infected area for 5 minutes daily until the lesions resolve (this is not recommended for those allergic to iodine or betadine). However, the ability of iodine to penetrate intact skin is poor, and without a pin prick or needle stick into each molluscum lesion this method does not work well. Do not use on broken skin.

Astringents

Astringent chemicals applied to the surface of molluscum lesions to destroy successive layers of the skin include trichloroacetic acid, podophyllin resin, potassium hydroxide, and cantharidin.

Australian lemon myrtle

A 2004 study demonstrated over 90% reduction in the number of lesions in 9 out of 16 children treated once daily for 21 days with 10% strength of essential oil of Australian lemon myrtle (Backhousia citriodora) dissolved in olive oil. However the oil may irritate normal skin at concentrations of 1%.

Benzoyl peroxide

In a small randomized controlled trial twice daily application of 10% benzoyl peroxide cream for 4 weeks was found to be more effective than tretinoin 0.05% cream; after 6 weeks 92% of the benzoyl peroxide group were lesion-free, compared with 45% of the tretinoin group (p = 0.02)

Cantharidin

Cantharidin is a chemical found naturally in many members of the beetle family Meloidae which causes dermal blistering. Not FDA approved but available through Canada or select US compounding pharmacy. It is not painful on application, and so it might be preferred by some when treating small children. It should probably not be used near the eyes or in uncooperative children, as the chemical is caustic if scratched and rubbed on the eyes. It is usually applied with a wooden applicator like the sharp end of a wooden cotton bud. Some advocate leaving it on unoccluded. Some advocate covering it with tape for 1 to 8 hours. Extreme caution should be used when administering Cantharidin. Despite the fact that it is used as an aphrodisiac in some countries, it is highly toxic to humans if ingested, as little as 65 mg has been estimated.

Tea tree oil

Another essential oil, tea tree oil is reported to at least reduce growth and spread of lesions when used in dilute form. Tea tree oil may cause contact dermatitis to those with sensitive skin, although less often in dilute form.

Over-the-counter substances

For mild cases, over-the-counter wart medicines, such as salicylic acid may or may not shorten infection duration. Daily topical application of tretinoin cream ("Retin-A 0.025%") may also trigger resolution. These treatments require several months for the infection to clear, and are often associated with intense inflammation and possibly discomfort.

Imiquimod

Doctors occasionally prescribe imiquimod, the optimum schedule for its use has yet to be established. Imiquimod is a form of immunotherapy. Immunotherapy triggers your immune system to fight the virus causing the skin growth. Imiquimod is applied 3 times per week, left on the skin for 6 to 10 hours, and washed off. A cure may last from 4 to 16 weeks. Small studies have indicated that it is successful about 80% of the time. Another dose regimen: apply imiquimod three times daily for 5 consecutive days each week. This is not FDA-approved treatment for molluscum contagiosum.

Systemic treatments

Cimetidine (however, double blind placebo studies seem to refute this), Griseofulvin (single case, anecdotal evidence) and Methisazone have seen some use.

Surgical treatment

Surgical treatments include cryosurgery, in which liquid nitrogen is used to freeze and destroy lesions, as well as scraping them off with a curette. Application of liquid nitrogen may cause burning or stinging at the treated site, which may persist for a few minutes after the treatment. Scarring or loss of color can complicate both these treatments. With liquid nitrogen, a blister may form at the treatment site, but it will slough off in two to four weeks. Although its use is banned by the FDA in the United States in its pure, undiluted form, the topical blistering agent cantharidin can be effective. It should be noted that cryosurgery and curette scraping are not painless procedures. They may also leave scars and/or permanent white (depigmented) marks.

Laser

Pulsed dye laser therapy for molluscum contagiosum may be the treatment of choice for multiple lesions in a cooperative patient (Dermatologic Surgery, 1998). The use of pulsed dye laser for the treatment of MC has been documented with excellent results. The therapy was well tolerated, without scars or pigment anomalies. The lesions resolved without scarring at 2 weeks. Studies show 96%–99% of the lesions resolved with one treatment. The pulsed dye laser is quick and efficient, but its expense makes it less cost effective than other options. Also, not all dermatology offices have this 585 nm laser. It is important to remember that removal of the visible bumps does not cure the disease. The virus is in the skin and new bumps often appear over the course of a year until the body mounts an effective immune response to the virus. Thus any surgical treatment may require it to be repeated each time new crops of lesions appear.

Prognosis

Most cases of molluscum will clear up naturally within two years (usually within nine months). So long as the skin growths are present, there is a possibility of transmitting the infection to another person. When the growths are gone, the possibility for spreading the infection is ended.

Unlike herpes viruses, which can remain inactive in the body for months or years before reappearing, molluscum contagiosum does not remain in the body when the growths are gone from the skin and will not reappear on their own. However, there is no permanent immunity to the virus, and it is possible to become infected again upon exposure to an infected person.
 

Signs and symptoms

Genital warts often occur in clusters and can be very tiny or can spread into large masses in the genital or penis area. In other cases they look like small stalks. In women they occur on the outside and inside of the vagina, on the opening (cervix) to the womb (uterus), or around the anus. They are approximately as prevalent in men but the symptoms may be less obvious. When present, they usually are seen on the tip of the penis. They also may be found on the shaft of the penis, on the scrotum, or around the anus. Rarely, genital warts also can develop in the mouth or throat of a person who has had oral sex with an infected person. The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years (decades) may occur. HPV can last for several years without a symptom. Having sex with a partner whose HPV infection is latent and demonstrates no outward symptoms still leaves one vulnerable to becoming infected. If an individual has unprotected sex with an infected partner, there is a 70% chance that he or she will also become infected. The immune system eventually clears the virus through interleukins, which recruit interferons, which slow viral replication.

Vaccines

Gardasil (sold by Merck & Co.) is a vaccine that protects against human papillomavirus types 16, 18, 6, and 11. Types 6 and 11 cause genital warts, while 16 and 18 cause cervical cancer. The vaccine is preventive, not therapeutic, and must be given before exposure to the virus type to be effective, ideally before the beginning of sexual activity. The vaccine is widely approved for use by young women, it is being tested for young men, and has been approved for males in some areas, such as the UK.

Management

There is no cure for HPV , but there are methods to treat visible warts, which could reduce infectivity, although there are no trials studying the effectiveness of removing visible warts in reducing transmission. Genital warts may disappear without treatment, but sometimes eventually develop a fleshy, small raised growth. There is no way to predict whether they will grow or disappear. Warts can sometimes be identified because they show up as white when acetic acid is applied, but this method is not recommended on the vulva because microtrauma and inflammation can also show up as acetowhite. Magnifying glasses or colposcope may also be used to aid in identifying small warts. Depending on the sizes and locations of warts (as well as other factors), a doctor will offer one of several ways to treat them. Podofilox is the first-line treatment due to its low cost. Almost all treatments can potentially cause depigmentation or scarring.

Video Frequently Asked Questions

- FAQ: What do genital warts look like?
- FAQ: What is genital HPV infection?
- FAQ: How do people get HPV?
- FAQ: How Do I Know If I Have Genital Warts?
- FAQ: What Happens If I Don't Get Genital Warts Treated?
- FAQ: How Can I Prevent Getting Infected With Genital Warts?

Recommended Treatment

Herbal Freak recommends AntiWarts for the treatment of genital warts.  To read our review of the AntiWarts solution, please click here.