WARTS - Full extract

Bruno arrived at the surgery with his 11-year-old son, Nick. "This bloke's got a lump on his foot," said Bruno. "He's been hobbling around all week."

On examination, Nick had a large plantar wart on his heel and a couple of smaller warts on his big toe. After explaining what warts are all about, I talked about various treatment options. Nick was intrigued to see liquid nitrogen bubbling away in the cannister, but despite my reassurances, he was apprehensive about it being applied to his foot.

I showed him some wart paint and demonstrated how it could be applied each night after bathing the foot. "Does it hurt?" he asked. "Not at all," I replied. "But it can be a bit of a bother having to put it on each night." Nick thought about this and grabbed his father's arm. "Sounds good to me Dad. Let's go."

Warts are caused by an overgrowth of superficial layers of skin in response to a viral infection. About 10 per cent of people get warts at times and they are more likely to occur in children. They occur on all parts of the body, but the hands, knees and feet are more commonly affected. The virus responsible is called the Human Papilloma Virus (HPV). At last count, about 60 different types of the virus had been described.

Some types of HPV cause the standard crusty old wart on the hands and knees. Other types cause flat warts. But of most interest at the moment are the subgroups that cause genital warts.

The latest DNA-probe techniques have demonstrated that several HPV subgroups play a role in the development of cancer of the cervix. Although warts may not be visible, evidence of HPV infection can be noted on a Pap smear well before even the earliest sign of cervical cancer. This finding is a useful prompt for more frequent smears or, in some cases, referral to a gynaecologist for a more detailed examination.

Common warts are certainly quite contagious through skin-to-skin contact or from using an infected person's towel. Even the floors of shower recesses can harbour the virus. However, the person's own immune system also seems to be a major factor. Some people will never get warts, while others are particularly prone. The incidence of genital wart infection seems to be increasing worldwide. Intimate sexual contact is the main mode of infection; perhaps this trend might reverse as more people use condoms regularly.

The treatment of warts has altered considerably over the years. With common warts, we have to be sure that the treatment isn't worse than the condition. We also know that warts seem top have a definite lifespan and will probably go away eventually. We usually recommend a wart paint, making sure the healthy skin around the wart is protected with petroleum jelly. Sometimes we go straight to cyrotherapy, a freeze-off treatment using liquid nitrogen. No injections are required and it works well, but several applications are often necessary.

Warts on the soles of the fleet are called plantar warts and deserve a special mention. They tend to grow inwards and are often quite resistant to treatment. However, they usually respond to liquid nitrogen or the application of a paint or paste.

Genital warts are in a different category altogether. Because they are so contagious and because of the association between HPV and cancer of the cervix, they are treated more aggressively. If local paints and creams or liquid nitrogen do not clear the warts, referral to a specialist may be required; sometimes removal by electrical diathermy under general anaesthetic is necessary. A very careful assessment is always done because other sexually transmitted conditions may also be present, and it is essential for the affected person's partner or partners to see a doctor for a check-up.

Health Tips:
* With common warts always use your own towel. And if you have warts on your feet wear thongs in the shower.

* Genital warts always require a thorough check with your doctor.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001