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by mommydoc
As a board-certified obstetrician-gynecologist, I must point out two factual errors in the imiquimod section of this Epinion. The author states erroneously: "*A more severe version of warts is genital herpes. Unlike common warts, genital herpes can be easily transmitted by sexual activity."
These are untrue and misleading statements. First, genital herpes is caused by the herpes simplex virus (HSV) and warts are caused by the human papilloma virus (HPV). While both can cause genital lesions, they are unrelated viruses, they present as totally different lesions and treatments are different. In addition to common warts, HPV can cause both genital warts and cervical dysplasia which can lead to cervical cancer. Typically, the subtypes which cause cervical cancer are different from the subtypes which cause anogenital warts. However, while the subtypes which cause common warts on fingers or feet are very unlikely to cause anogenital warts, such transmission has been documented in children and thus, common warts on the fingers of sexually active adults should probably be treated fairly aggressively to prevent transmission to the genitals of the partner. (See http://www.medscape.com/viewarticle/483621_4 for reference)
Additionally, the author states erroneously: "The way Aldara works is by causing the immune system in your body to fight off the HPV virus. Since the virus dies, you'll no longer get warts!" This is patently untrue. Aldara (imiquimod) acts to stimulate the body's immune system to fight the virus, but one is never actually "cured" of the virus, and, while very long-term remission is generally the case, it is possible to have future eruptions without new exposure to the virus. In other words, the virus is killed off locally at the site of the wart, but is still present systemically and there is always the possibility of recurrence, especially if one becomes immunocompromised.
A good reference for herpes is found at http://www.herpes.com/hsv1-2.html. A good reference for HPV is found at http://www.niaid.nih.gov/factsheets/stdhpv.htm.
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May 15 '05
12:24 pm PDT
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