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Continuing medical ignorance: modern myths in the management of genital warts

Genital warts are the most common sexually transmitted disease (STD) in industrialized countries. Since they also often respond poorly to current treatments, they account for substantial morbidity. Human papillomavirus (HPV) typing methods have shown that HPV 6 and 11, the most common types found in genital warts, are not found in cancer of the cervix. These types, however, do cause minor degrees of cervical dysplasia which also results in morbidity both through fear and through over-treatment. The sexual nature of transmission of genital warts has been known from ancient times; there is also good evidence of vertical transmission and transmission through non-genital contact. Barrier contractive methods do not completely prevent transmission of genital warts and may give little worthwhile protection. These facts, together with the established persistence of HPV contribute to the associated psychological morbidity. There are a number of treatments for genital (and other) warts. This attests to the fact that no one of these is clearly superior to the others. Until better treatments are developed much of the management of this condition must consist of using such treatments that are available to maximize efficacy while trying to reduce unnecessary costs, inconvenience and potential injury and sustaining morale through what may be a long and demoralizing course.