Excision, Electrosurgery & Laser Surgery for Anogenital Warts

The treatment of anogenital warts primarily tackles the issue of the warts that are shown on the skin and does not completely destroy the virus causing the problem. There are a number of treatments available for this infection and they are split into two categories. The first is physical ablation, which involves destroying the warts by physically removing them with a laser or scalpel. The second group is topical and there are a range of creams and lotions that can be applied to the infected area in order to get rid of the warts. Both categories have a number of techniques which all have pros and cons so discuss your treatment thoroughly with your doctor.

Physical Ablation

There are a number of different techniques that are available to physically remove the warts from the infected area. They will need to be performed by a doctor and so it is not a treatment that you can carry out yourself. They involve surgery and you will usually be given a local anaesthetic to numb the area that the warts are on.

The first method is excision, which is where you physically cut the warts from the skin using a scalpel. It is usually used on warts that have developed into small clusters and are quite hard. The warts are removed with a scalpel and then the wound is stitched. You should not experience any pain during the operation because you will be given a local anaesthetic. This will numb the area and stop you from feeling any sensation. After the warts have been removed, the skin will be tender and quite sore. You will need to keep the area clean and avoid wearing tight clothing so that it does not become irritated. There is also the possibility of scarring because the surgery causes a wound but these usually fade over time. Due to scarring, if you have large warts, they will not usually be removed in this fashion as it causes large scars.

Another method carried out is Electrosurgery and it is usually used alongside excision. The surgeon will cut the warts from the skin and then a metal loop is applied to the remaining wart and an electrical current passes through. This will kill any remaining infected tissue. The treatment can be quite intense and a regional anaesthetic is usually administered whereby they inject into your spine to numb the lower half of your body.  There will be pain after the procedure and there area will be sore for a number of days. This treatment is usually carried out on the larger, harder warts.

Laser surgery is also used to treat anogenital warts. It is less invasive than excision because it does not cut the wart off the skin. It is usually carried out on the infected areas that are hard to reach such as the urethra. The laser is applied to the warts and they are burned from the skin. Again, there will be some pain involved and this will depend on the amount of treatment you need and the area will be sore for a period afterwards. However, the recovery period is faster than excision.

The final treatment used is Cryotherapy. This uses a different approach whereby the warts are frozen off. Liquid nitrogen is applied and this kills the cells of the warts. After a short period of time, the warts should fall off the skin. This procedure is usually carried out on small warts and you may feel a slight burning when the treatment is given. There will also be discomfort for a couple of weeks following the treatment and you may need more than one procedure.

Topical treatments

There are a number of topical treatments that can be given to treat anogenital warts and these all need to be prescribed by a doctor. It will depend on the hardness of the warts and the amount of warts that you have as to which will be the best treatment for you.

Imiquimod is a cream that you apply to the warts three times a week. Once you have applied it to the infected area, you need to leave it for approximately six to ten hours to allow it to have some effect. It is usually prescribed to individuals suffering from large individual warts and it is effective but it can take up to several weeks before the warts disappear. There are also a number of side effects such as flaking skin, burning in the area the cream is applied, headaches and hardening of the skin. These are rare side effects but if they do occur, contact your doctor for advice. Once you stop the treatment, the side effects should disappear within two weeks.

Podophyllotoxin is not a cream like Imiquimod but a liquid that is applied to the warts. It destroys the cells within the warts so that they disappear and you need to apply it directly to the warts themselves. The treatment must be carried out in a certain way so as to protect the skin from too much harm as it has a harmful effect on the skin. The first treatment usually involves applying the liquid twice a day each day for three days. You will then have a four-day break so that your skin does not become too irritated. You then continue in the same manner until the area is free of warts. This usually means you will need four or five cycles but you may need more. There are some side effects because you may have a reaction to the treatment or the skin may become irritated. Contact your doctor if you are worried about any side effects you are experiencing.

The final topical treatment is Trichloroacetic acid, which is also a liquid form of treatment. It is a lot stronger than podophyllotoxin and if it is not applied correctly, it can damage the skin around the warts and cause more damage than necessary. Therefore, this is a treatment that is carried out by a doctor or nurse once a week for several weeks until the warts disappear. There is some discomfort because the area can be irritated for a few minutes after application.

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