More than 24,000,000 Americans are infected with the human papillomavirus (HPV), which can cause one of the most common, yet least recognized, sexually transmitted diseases (STDs)--external genital warts (EGWs). In fact, nearly three out of four Americans will be infected with HPV in their lifetime. According to a nationwide survey of adults ages 18-40, external genital warts remain unrecognized by 97% of respondents as one of the most common STDs.

"These results are a wake-up call for sexually active adults of any age. HPV and external genital warts are a significant public health problem ... because many are unaware of what genital warts are, how to prevent them, or even what treatments are available," reports professor Anita L. Nelson, Department of Obstetrics and Gynecology at the David Geffen School of Medicine at the University of California, Los Angeles. "Sadly, there is no cure for HPV, the virus that causes genital warts, so prevention and prompt treatment ... are essential."

They can appear as small growths or bumps that may be raised or flat or manifest in a cluster with a cauliflower-like appearance. Genital warts, medically referred to as condyloma, are spread by direct, skin-to-skin contact with an infected partner, usually during sexual activity. Research also has indicated that HPV may be transmitted by hand-to-genital touching. Warts may appear within several weeks after sex with an infected person or they may take several months to present, or never appear at all. HPV can remain dormant for months or years.

In women, genital warts can occur on the vulva, perianal area, vagina, and cervix. In men, genital warts can appear on the tip or shaft of the penis, urethra, scrotum, and perianal area. Left untreated, they may become quite large, cause discomfort and pain, and interfere with sexual activity. Although not all HPV infections will result in genital warts, as many as 1,000,000 new oases are diagnosed in the U.S. each year.

While there is no cure for the virus that cause EGWs, warts can be eradicated through laser surgery, cryotherapy (freezing), or chemical treatments. However, these painful procedures can involve tissue destruction and scarring. Even after the warts have been removed, it is likely that individuals still harbor HPV in surrounding normal tissue. The period of communicability, however, is unknown.

"Surgical, destructive, and chemical [applications] are effective for treating external genital warts, but they require time for healing, are often painful, and may require multiple visits to the clinician's office. Newer therapies, such as [imiquimod-containing] cream, boost the immune system and allow patients to apply the treatment in the privacy of their homes," Nelson relates.

Immune response modifiers, such as imiquimod, are a new class of drugs that stimulate the body to produce specific cytokines, (interferon-alpha, for instance), which are naturally occurring proteins used by cells of the immune system to communicate with each other.

Most local skin side effects to imiquimod are mild to moderate and include erythema (redness), erosion, flaking, edema (swelling), scabbing, and induration (hardening) at the wart site. Most common application-site reactions are itching (26%), burning (16%), and pain (four percent). Application-site pigmentation changes also have been noted.

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