HPV warts

Shieva Ghofrany: [00:00:00] Good morning. It's Friday. I'd love to say T G I F, but I'm gonna be on call again on Sunday. So couple days off, I decided that I would take a moment as we're waiting to do some things on labor delivery to talk about genital warts. I know it's not fun, but actually I got, I think four or five dms asking to talk about that. 

And I realize I have been amiss because I have not remiss, remiss because I have not talked about it. So genital. Which can often look like skin tags are little piles of skin like tissue, often down around your vulva, which just to remind y'all, we all use the word vagina inappropriately. Vagina is the inside tube. 

Vulva is the skin on the outside. You can get warts on the skin, on the outside, you can get them up inside on your cervix. Occasionally it's not as common, most likely. Again, skin on the outside, around your rectum. People can get them in their throat. They're. By the HPV virus. Y'all have heard me [00:01:00] talk about hpv, hpv, hpv, hpv, because I wanna sprinkle that word around to decrease anxiety, just so that you keep hearing it and not become desensitized. 

It's an important thing to know about, but desensitized because it's something that is just so common. So in the world of hpv, there are two broad categories. There are unfortunately called the high risk sub. Which are the category that can cause abnormal pap smears. My hair looks wonky. And potentially cervical cancer, though, that's rare. 

And then there's the other general subtypes, which are called the low risk subtypes, which do not cause any harm, but may cause warts. Now, how do you know which ones you have? Well, if you have a war, you got the lower subject. If you have an abnormal pap smear, you have the high-risk subtype. If you. One or the other. 

Do you know if you have the other one? The answer is no, because we have not yet, yet gotten so sophisticated that we can swab and figure out exactly which subtypes everyone has, though we're getting better. [00:02:00] When you have a pap smear, they'll report whether or not you have the high-risk subtypes and they will report that you do not have a few of the most concerning subtypes. 

They sometimes will comment on the low risk subtypes, but that's not technically part of the pap smear reporting that we need to know about. So unfortunately, what I have to say to everyone, , we don't know if you have HPV or not. It's not something we can blood test for, like herpes. It's not something that we can swab for. 

So the only way we would know is if you show up with these little piles of skin that can look like skin tags. Sometime this week I had a patient where she had a couple of little spots. She didn't like them. They were cosmetically just annoying to her. She's gonna come back and I'm gonna remove them. 

It's hard to say if hers are skin tags or warts. They look more like skin tags. So I'm gonna do, I'm gonna actually remove them. Curious as to what they are, and we'll send them to the lab. As far as how likely is it that you can give them to other people? The answer is just like HPV that causes the pap smear changes. 

Just like herpes. When it's [00:03:00] existing on our skin, the virus, we can transmit it. So even if you don't know if you've ever had a war, you can give it to someone else. Is that scary? No. It's common. It's one of those things that I say to all of you. Once I'm here, back in the operating room, waiting for people before I go change. 

Once you have started having sex, you have to remind yourself that this is an adult endeavor. You're going to choose wisely and try to have sex with people that you think are worthy of you. You're going to ideally use condoms if you are not sure what's going on. So that couldn't be absolutely protective of things like hiv, hepatitis, syphilis, and gonorrhea, and chlamydia. 

But you have to accept that HPV and herpes are the viruses that you can still get even with condoms, because again, they live all over the skin, not just inside the vaginal opening and not just on the shaft of the penis, but in the skin around the penis, on the vulva. So in places that will not be covered with a condom is that. 

Again, no, no, no, no, no. It's common. It's annoying. This is how I [00:04:00] look at it. HPV is one of those things that is really annoying and frustrating because so many of us have to deal with it, but the need to be scared of it is, um, wrong. There's no other way to say it. It's just wrong. Now, let's say you do. Think you have something patients will often run in really freaked out like, I have a bomb. 

It must be something terrible. First of all, the likelihood of it being anything terrible is small because terrible things in our vva are rare and they don't pop up. Vva. Cancer is not very common and it tends to be kind of a slower evolution, so it's not something that you're gonna all of a sudden notice. 

So if you have a bump or a lump, don't freak out because it's likely nothing terrible. Could it be a wart? Yes. Sometimes you think it's a wart and it's really just a pimple or a hair follicle, but when you go see your doctor, she'll be able to look and tell you, yes, it's a wart. No, it's not a wart. Or sometimes. 

In between because skin tags, like I said, can mimic warts and vice versa. How do you treat it? Well, first of all, you could leave it alone cuz it's not dangerous, it's just annoying. And some of them do go away on their own because it's your body's [00:05:00] immune system that let the virus kind of crop up these warts. 

And so it's your body's immune system that can decrease the chance of the warts as well. Meaning it can fight the virus and sometimes the warts will go away. Pregnancy is a funny time where all of a sudden patients will go, God, I think I have one. I've never had it before, or I haven't had it in decades. 

And that's not unusual because your immune system is a little bit lower immune suppressed as we know in pregnancy. And then sometimes those patients' warts go away on their own. Other things you can do are either remove them, meaning excise them in the office with a little, not to be gross, a little scalpel or a little cautery, which is the little electrical tool that we use to remove things. 

Not all of us have that capacity in the office. I don't c. Things in the office. So if someone needs it removed, I will give a little injection of Novocaine. It's really lidocaine in our world. And then we remove it and we send it to the lab if they want. Um, the second way to remove it would be t c a tri chlorotic acid. 

So you dab just a little Q-tip with some acid on the war. It b blache. It [00:06:00] burns, lack all get out. But within anywhere from two 10 days, you'll notice it kind of disintegrates and goes away. That can be reapplied a couple times, but you have to be cautious because it gets irritated and sometimes patients tend to wanna pick at it, which I caution them not to do because they can. 

And get a superposed infection. Little trick about that in the office is we put the tri chlorotic acid on it, we make sure it's B blanched, and then we put a cold tux pad just to soothe it. Third way, which is easier because it's done at home, but it's harder because you have to pay really good attention to what's going on. 

Um, is you use a cream called Ode. The brand used to be called Aldera, but now there's generic. It comes in teeny little packets, and you put a dab on each ward. Every other night, you don't use it every night, and it's really important to listen to your doctor's instructions. You put a little dab on it at night, you wash it off in the morning because if you leave it on or you slather it all over, it's gonna burn your skin because the way it works is it locally encourages some inflammation [00:07:00] and all of the immune system. 

Them to attack the wart and the virus. So imagine if you slaughter that all over your vulva, you're gonna get a mess of really, um, angry tissue as the inflammation is working to get rid of the infection itself. Okay? So I've had patients unfortunately who did not listen and came in with a hot mess, and it became really uncomfortable and often super infected with bacteria. 

So be very cautious. It works great, but it's a dab at night. Wash it off in the morning every other night. You can use it up to 12. Usually they'll go away. If you think it's a wart and you've tried either the acid or the cream and it has not gone away, I personally say, go talk to your doctor, because rarely what we think is a benign wart can be something else. 

So my threshold is I'll try the acid once or twice for a patient, occasionally three times I'll let them use the cream if they'd rather take care of this at home because so, It takes longer to take care of it at home, but they don't wanna come in for the, for the acid. But if it doesn't go away, that's my threshold for [00:08:00] saying it's likely nothing, but let's remove it and send it to the lab to make sure. 

Okay, so take home messages. Super common, super annoying, super irritating. Just emotionally. And yeah, they're kind of gross when we have to look at them ourselves as women or men. But are they dangerous? No. Men get them. So the only time a man will really know he has hpv, because again, he cannot get a pap smear and know that he has the other strains of hpv. 

He will know he has HPV if he has warts. So if he calls and says, oh, I found a wart, that means you have been exposed. What you don't know and he doesn't know is who gave it to who. So again, do not feel like you have just given him. He might have given it to you, you might have given it to him. There should not be any blame because that virus can live decades in our system and it can all of a sudden crop up again decades after you've even ever had sex. 

So again, common, common, common not to be worried about. Does the vaccine help against it? Yes, cuz you get vaccinated, Gardasil at garage. [00:09:00] Nine different strains of the vac of the virus. And right now, from what we know, strains six and 11 are the ones that are most likely to cause the warts. So it is less likely that the younger generation will get warts because they will be vaccinated. 

Okay, I hope that all makes sense. Um, I'm gonna go off to my day. I hope you guys have a good day. I'm just gonna pray that everything is well in the world in the next. Several hours. We'll pray for tomorrow. Tomorrow and we'll pray for the next several hours today. Okay, bye.