MEN'S HEALTH MATTERS:Genital warts are one of the most common sexually transmitted diseases, writes THOMAS LYNCH.
Q I am 32 years old and have warts on my foreskin. I also have a little wart-like lesion just at the opening of my water passage. I had unprotected intercourse about four months ago and am too embarrassed to do anything about this problem. What is the treatment?
A It sounds as if you have developed genital warts. Genital warts are one of the most common sexually transmitted infections seen in Sexually Transmitted Infection (STI) clinics.
They are caused by the human papilloma virus (HPV), which is common in young sexually active people.
Not everybody who comes in contact with HPV will develop warts. It may take up to nine months after initial sexual contact with a person with HPV for warts to develop. Genital warts are not harmful and do not increase the risk of cancer or reduce fertility.
If you have, as you say, developed genital warts after unprotected intercourse it is very important to have a sexual health screen as occasionally other infections can be present without any symptoms. Up to 50 per cent of men with Chlamydia trachomatis infection do not have any symptoms.
Treatment for genital warts is topical in that the treatment is applied directly to the warts. There are lots of different treatments available for genital warts and the choice of treatment is determined by many factors including the number, the appearance, the size and their position.
Many of the treatments are aimed at destroying the wart and others are aimed at boosting the immune system to get rid of the HPV that has caused the wart.
Where possible, wart treatment is home based after an initial medical consultation and sexual health screen. Warts may recur after initial clearance and the chances of this happening are greater if you are a smoker, have certain medical conditions or take medications that weaken the immune system. Occasionally warts will need to be removed surgically.
Q I have had a big problem with a scaly rash on my scalp. It is very irritating and it also affects my eyebrows, nose and chest. My doctor says that it is probably a yeast infection. Can you explain what this means?
A This sounds like seborrheic dermatitis. This is a common harmless rash, which affects the face, scalp and chest, although it can also affect the armpits and groin. It is common within the eyebrows, on the edges of the eyelid, inside or behind the ear and in the creases at the side of the nose. It may or may not be itchy and the severity of it can vary from day to day.
It is thought to be due to sensitivity to a normal skin bug, a type of yeast called malassezia. In most people this bug just causes dandruff, but people who get seborrheic dermatitis seem to be more sensitive to the toxic substances that the bug produces and they develop red irritable scaly skin.
It is not contagious or related to diet but it can be made worse by illness, stress and tiredness and there are certain medical conditions which it is associated with.
It can be very persistent, though it can be kept under control, rather than cured, with regular use of anti-fungal agents and the occasional use of topical steroids.
Try using a medicated shampoo containing ketoconazole, selenium sulphide or salicylic acid. Use this two to three times a week for at least a month, and make sure that you massage it well into the scalp and leave it to work for a few minutes before washing it off.
Most of these shampoos are available over the counter. If it is affecting your face or chest you may need to use an antifungal cream with or without a steroid if it is very itchy and red.
This column is edited by Thomas Lynch, consultant urological Surgeon, St James’s Hospital, Dublin with contributions from Dr Fiona Lyons, consultant genito urinary physician, and Dr Patrick Ormond, consultant dermatologist and dermatological surgeon, St James’s Hospital, Dublin