Freezing and Cauterization of Genital Warts

Genital warts may appear in/around the anus, in the pubic area and or in the vagina. They appear like pink or red growth in or around the sex organs. They often appear in clusters of 3-4.They may grow and spread rapidly. They are usually painless but sometimes might cause mild pain, itching and bleeding.

Freezing and Cauterization of Genital Warts

Genital warts might take a few weeks to show up after a person has been infected. The treatment for genital warts depends on the type, area, and size of the warts. If your warts are too small to be visible and they are the same color as your skin color, there is no need for treatment, as they will vanish with time. However, if your warts have grown in size or causing itchy lumps, which can be seen and felt either as a cluster or single wart, you can get them removed with topical applications and physical ablation or surgery. Cryotherapy (freezing of warts) and cauterization are the two physical ablation techniques that are used by the doctors to remove genital warts. Let’s learn about them in detail.

Freezing or Cryotherapy

In the past a number of cooling agents have been used in cryotheraphy. Cooling agents such as a salt-ice mixture (-4° F [-20° C]) and carbon dioxide snow (-112° F [-80° C]). However liquid nitrogen (-320.8° F [-196° C]) is commonly used to treat genital warts in males.

In cryotherapy, the genital warts are removed by freezing them with a cold substance, which is most commonly liquid nitrogen. If the warts are large, they are usually trimmed with a small knife, and liquid nitrogen is applied with a cotton swab or sprayed to and around the wart area to freeze the tissue. Although this process can be slightly painful, the tissue often softens after the application.

Depending on the size and thickness of the wart, the treatment may take 1 to 4 sittings with a gap of 1 to 3 weeks between each sitting, depending on the doctor’s suggestion. Almost 85% of the area might clear off within the first 3 sittings. During each sitting, the wart is frozen and thawed for better results. This kind of treatment is usually followed to treat small warts that specifically develop on or near the vulva or shaft of the penis. It can be used safely during pregnancy.

The warts in cryotheraphy are destroyed by cryocytolysis. However this procedure should be avoided in patients who have poorly controlled diabetes or those who have cryoglobulinemia . For vaginal warts use of a cryoprobe is not recommended. In the application of cryotheraphy, the skill and experience of the clinician will greatly affect the efficacy and toxicity of the treatment. For warts on dry and moist skin cryotheraphy is effective.

Working

In cryotherapy cold temperature is used to kill a growth such as genital warts. There are many more factors involved than just simply being cold, though.

• Heat transfer—cryotheraphy involves removal of the wart by freezing it but actually it is the heat transfer that causes the wart to get damaged. The liquid nitrogen used by the physician has an extremely low boiling point of -196 degree Celsius. It means that that if it touches anything above that temperature it will boil. First the liquid nitrogen touches the wart; the body heat of the person gets transferred to the liquid. This causes the nitrogen to boil off immediately. By sending a continuous freezing temperature to the wart tissue, a steady stream is directed at the wart tissue.

• Cell death- in this procedure the wart cells freeze when they are exposed to the extremely low temperature of liquid nitrogen. The liquid nitrogen goes deep throughout the wart until the entire wart growth is frozen quickly. The real damage happens during the thawing process. In each cell, when frozen, the liquid present inside forms ice crystals. A great deal of damage is caused to the wart cells. This damage gets worse when more cells thaw out. Cell death happens due to freezing and thawing.

• Inflammation- one of the natural response to cell death is inflammation. This helps to complete the process till the wart is destroyed entirely. Due to this inflammations a blister is formed which holds in the dead cells and viral particles until the body resorbs it all.

What to expect after the treatment

Depending on the number of warts removed and their location, the recovery period may vary between 1 to 3 weeks. The warts are usually completely healed within 2 weeks without noticeable or very little scarring. The following may occur after the treatment:

    • Fever

    • Bleeding at the site of removal

    • Strained nerves, which appear as red streaks that eventually heal. This might be seen after frequent freezing and thawing

    • Formation of a blister, which might break and release fluid, which should be cleaned immediately to avoid spreading of the wart virus.

    • Yellowish discharge of pus that smells bad. This may indicate an infection and must be discussed with the doctor

    • Pain at the site of removal

It’s advised to avoid sexual intercourse until the area heals and you no longer feel any soreness.

Some other things women need to know about cryotherapy are:

    • A watery vaginal discharge may occur after the treatment for about 1 to 3 weeks.

    • Continuous bleeding and pain might be experienced.

    • Instead of tampons, women should use sanitary napkins for 2 to 3 weeks.

    • Sexual intercourse must be avoided until the area heals.

    • Recurrence of warts might be possible, as this technique does not completely eliminate skin infections which might be around the wart area.

This therapy is a good idea for warts in the following area:

• Vagina
• Labia
• Penis
• Scrotum
• Anus

Prognosis

Usually after 2 to 4 treatments it eliminates small penile warts and in almost 70 % of the cases it removes genital warts with a recurrence rate of 21%. Ulceration might occur rarely with cryotheraphy. However it does not eliminate HPV infection. Even though the genital warts have disappeared the individual remains a carrier of the virus. Compared to other treatments used for genital warts cryotheraphy leads to minimal tissue scarring. Usually recurrence of genital warts following cryotheraphy might occur within months to years, it depends upon the other medical treatment that is received during this period.

Risks associated with the Cryotherapy

Just like any other treatment, there are certain risks associated with cryotherapy. Scarring is usual after the treatment. Other complications, like damaged nerves, infection, ulceration blistering, darkening, pitting of the treated area, swelling, pain, pus discharge, heat, or tenderness might be felt, depending on the area that was treated and the number of freeze-thaw cycles used.

Cauterization or Electrocautery

In electrocautery, doctors remove the genital warts through the use of the heat generated due to electricity. Electrocautery is used to burn, desiccate and destroy warty lesions. It uses high-frequency electrical currents. By curettage the damaged or dead tissue is removed. A needle-like instrument or probe is usually heated with a low-voltage electric current, and the hot tip is used to burn the tissue or the unwanted cells in the skin.

It is a very effective method that can be used to remove warts on the penis, vulva, or around the anus, which is in small number. Since the treatment is painful, an injection or local anesthesia is given to the patient for pain control. General anesthesia may also be used, depending on the number of warts to be removed and their size.

Electrocautery is usually preferred for removing small areas of warts with little blood loss. It can be used safely during pregnancy. Even people who have pacemakers can undergo this treatment after consulting the physician. This is a quick process that usually takes around 20 minutes. It is also not as expensive as other wart removal treatments.

The use of this method is limited since it can cause irreversible damage to the surrounding tissue. Treatment of larger lesions using this therapy has been associated with scar formation that is permanent. Prior and post procedure pain is common with this procedure. Since local anesthesia is used when carrying out this procedure, this makes electrocautery a very involved and impractical treatment option. Due to current interference and potentially fatal disruption of pacemaker rhythms electrocauteruy is strictly contraindicated in patients with implantable cardiac devices.

Working

For many years in different forms cauterization has been practiced in medicine and surgery. Cauterization has a history of removing unwanted growths and sealing blood vessels.  In the earlier days a searing hot iron was used but nowadays electrical currents and chemicals are used. This method is carried out under the effect of an anesthesia to keep the process comfortable for the patient.

A lot of heat energy can be delivered by an electric current. This heat is used to remove warts in electrocautery treatment.  Heat has a powerful effect on living tissue. It can kill unwanted cells by drying them out and denaturing important proteins and other structure. Hence this method is very effective in dealing with warts as well as other growths on the skin. A metal probe with a current is applied to the wart. This effectively burns the wart. Sometimes multiple sessions are required to remove the wart completely.

What to expect after the treatment

A wound is formed in the area where the wart was removed, and it eventually dries and falls off. Depending on the number of warts removed and their locations, the recovery period may vary between 1 to 6 weeks. If a large area of tissue was burned, the healing time may extend further. It becomes important to keep the wound area clean and dry so that healing is quicker and there are no further infections. A bandage can be used to protect the wart until it completely scabs over. The following may occur after the treatment:

    • Pain, redness, and swelling on the area

    • Bleeding at the site of removal

    • Scarring

It’s advised to avoid sexual intercourse until the area heals.

Prognosis

In one study it was found that electrocautery was effective for about 8 out of 10 people. It not only removed the wart but also stopped them from coming back six months after the treatment. After electrocautery it is less likely that the warts will return back. However even by this method the HPV infection cannot be cured. The HPV may still remain in an inactive state in the body even after the warts are removed.

Risks associated with the Electrocautery

The following are some of the risks associated with electrocautery:

• Continued bleeding or oozing of blood from the wounded area- however electrocautery seals the blood vessels as it removes the warts, blood loss is minimal.

• Infection of wound may lead to swelling, pain, or redness- to reduce the infection antibiotics may be given.

• Pain at the site- after the elctrocautery procedure medicine may be needed for several days to reduce the pain

Summing up, both cryotherapy and electrocautery are used to treat small warts. There are certain risks associated with them, but they can be managed. For example, to avoid infection, your doctor may give you antibiotics during the treatment. To reduce pain after the treatment, he will also prescribe you some medicines. Treatment costs and their side effects vary, according to the size of the warts. Therefore, understanding the procedure prior to the treatment and discussing your doubts with your doctor beforehand can greatly help.

Also, it is not necessarily true that the burning of warts, especially genital warts, removes the virus from the body. Therefore, always use precautions and keep your genitals clean in order to avoid spreading the infection to others.

Self care

• Touching or scratching the warts causes it to spread to other body parts
• While being treated for genital warts do not have sex. Medicine that is used weakens condom and diaphragms. The genital wart may spread to the other partner.
• In order to diagnose and prevent the spread of HPV virus women should get regular Pap smear done

Prevention

• Inform your partner that you are being treated for genital warts and that they may also be infected and need treatment

• HPV vaccine is given from 9 years to 26 years of age. It helps prevents genital warts. Ask your healthcare provider more about this vaccine.