Genital Warts (Condyloma And Human Papillomavirus)

Condylomata acuminata, commonly referred to as genital warts, is a highly infectious sexually transmitted disease caused by the infectious agent human papillomavirus. More than 20 types of human papillomavirus have been identified as infective. Of these, types 6 and 11 typically produce visible genital warts. Warts typically occur at multiple sites in the urogenital, perineal, and perianal regions. They appear as soft, moist, small pink or gray polyps, although they can also appear flat and smooth or granulated. Polyps may enlarge to form pedunculated clusters the size of which can become so large as to affect urination, defecation, and normal vaginal delivery. Genital warts may be painful, friable, and pruritic; however, the majority are asymptomatic.

Human papillomavirus types 16, 18, 31, 33, and 35 are strongly associated with cervical neoplasia, cervical intraepithelial dysplasia, and squamous cell carcinoma. Up to 80% of sexually active adults in the United States carry human papillomavirus; however, only 5% develop human papillomavirus lesions or cervical dysplasia. The outcome of human papillomavirus exposure depends on a number of factors, for example, human papillomavirus type, host immunity, and smoking status. The risk of infection increases with the number of sexual partners and is associated with unprotected sexual intercourse. Condoms are not adequate protection against transmission. Conditions of immunodeficiency, epithelial injury of the genital area, and pregnancy all increase the risk of human papillomavirus infection.

It is suspected that human papillomavirus remains dormant in the body once contracted; therefore, the goal of treatment is to minimize visible lesions and prevent progression to neoplasia, rather than eradicate the virus.

Diagnosis of genital warts

Diagnosis of genital warts typically occurs during a woman’s routine screening health examination. The health care provider may visibly assess human papillomavirus infection if characteristic lesions are present. Genital warts must be differentially diagnosed from the flat-topped condyloma lata of secondary syphilis. A diagnosis made by inspection can be confirmed by biopsy. Biopsy is indicated only if the diagnosis is uncertain, if the lesions do not respond to standard therapy, if the disease worsens during treatment, if the patient is immunocompromised, or if the warts appear to be pigmented, indurated, fixed, or ulcerated (signs of neoplasia or squamous cell carcinoma). Endocervical warts can be detected via colposcopy.

Although there are human papillomavirus nucleic acid tests available to identify the viral type, these tests are not routinely ordered. There are, in fact, no data that support the use of type-specific human papillomavirus nucleic acid tests in the routine diagnosis or management of genital warts. The human papillomavirus nucleic acid tests are available primarily for research purposes and to determine possible risk for carcinoma in high-risk individuals.

Human papillomavirus is classified as clinical, subclinical, or latent, depending upon the extent or absence of lesions.

Genital Warts: Conventional Treatment Approaches

The Botanical Practitioner’s Perspective

The herbalist’s approach to genital warts may be in conjunction with or in place of conventional treatment. A comprehensive botanical approach supports the body’s inherent abilities to resist infection and uncontrolled cellular proliferation caused by the virus. Herbs with antiviral actions are key components of the botanical protocol. Herbs with immunostimulatory actions, particularly activation of cell-mediated immunity, are of specific importance. Adaptogens are also ideally included in a comprehensive botanical protocol to further support the immune system.

Botanical Treatment Strategies for Human Papilloma Virus

THERAPEUTIC GOAL THERAPEUTIC ACTIVITY BOTANICAL NAME COMMON NAME
Reduce viral infection Antiviral Allium sativum Garlic
Prevent neoplasia Antimicrobial Astragalus membranaceus Astragalus
Reduce cervical inflammation and heal tissue Antitumorigenic Calendula officinalis Calendula
Commiphora mol-mol Myrrh
Echinacea spp. Echinacea
Canoderma lucidum Reishi
Hypericum perforatum St. John’s wort
Hydrastis canadensis Goldenseal
Lavandula officinalis Lavender
Lomatium dissectum Lomatium
Melissa officinalis Lemon balm
Origanum vulgare Oregano
Melaleuca altemifolia Tea tree
Thuja occidentalis Thuja
Thymus vulgaris Thyme
Usnea barbata Usnea
Improve overall immune response via HPA axis support Adaptogens

Protocol for the Treatment of human papillomavirus

Topical Treatment

Option 1. Combine the following tinctures and apply to lesions two to three times daily with a cotton swab for 6 to 12 weeks:

Thyme (Thymus vulgaris) 30 mL
Goldenseal (Hydrastis canadensis) 30 mL
Myrrh (Commiphora mol mol) 20 mL
St. John’s wort (Hypericum perforatum) 20 mL
Thuja (Thuja occidentalis) 10 mL

Total: 100 mL

Option 2. Combine the following tinctures and apply to lesions two to three times daily with a cotton swab for 6 to 12 weeks:

Tea tree (Melaleuca alternifolia) 30 mL
Goldenseal (Hydrastis canadensis) 30 mL
Oregano (Origanum vulgare) 20 mL
Lemon balm (Melissa officinalis) 20 mL
Licorice (Glycyrrhiza glabra) 10 mL

Total: 100 mL

Note that applying undiluted tincture to sensitive mucosa can cause a burning sensation. If this is too irritating to the patient, first apply a small amount of calendula oil to the surrounding area, and then apply tincture carefully on the lesion.

Option 3. For suppositories, use either combination of the above tincture combinations in a suppository recipe.

Combine external treatment with:

Antiviral Tincture: Internal Treatment

Combine the following tinctures:

Astragalus (Astragalus membranceus) 25 mL
Reishi (Ganoderma lucidum) 25 mL
Ashwagandha (Withania somnifera) 25 mL
Echinacea (Echinacea spp.) 15 mL
Usnea (Usnea barbata) 10 mL

Total: 100 mL

Dose: 5 mL twice daily for up to 6 months for acute cases; 3 mL daily for maintenance and prophylaxis for up to 6 months posttreatment for an acute case.

Treatment Of Human Papillomavirus: Discussion Of Botanical Protocol

Nutritional Considerations

The nutritional supplements recommended in site are appropriate for use when treating human papillomavirus infection.

Treatment Summary For Condylomata

  • • Apply antiviral botanical agents directly to affected sites using a cotton swab. Use suppositories for cervical, vaginal, or rectal lesions.
  • • Support the body’s inherent resistance using herbs with antiviral and immunostimulatory actions.

Case History

Mary, a 27-year-old female patient presented for her annual gynecologic examination and Pap smear. She had no menstrual or vaginal symptoms. She was currently not sexually active but had recently ended a 2-year, monogamous, heterosexual relationship. Her Pap smear revealed cervical atypia (ASCUS). The patient was counseled about her management options, ranging from colposcopy to wait-and-retest in 3 months. The patient was very anxious but chose to wait and have her Pap redone in 3 months. The second Pap demonstrated cervical ASCUS once again. The patient was extremely anxious about this result and wanted to be tested for human papillomavirus. She refused a biopsy. An human papillomavirus nucleic acid test was done that revealed the presence noncancerous human papillomavirus. At this point, the patient continued to refuse colposcopy; however, she wanted to be on active treatment. She willingly agreed to engage in active naturopathic treatment for 3 months and then to undergo a repeat Pap smear. The following treatments were recommended to the patient:

  • • Increased consumption of dark leafy greens and broccoli to at least three servings weekly.
  • • Engage in relaxation activities regularly (the patient chose to attend a yoga class).
  • • Folic acid: 10 mg po daily

Tincture Formula:

Echinacea (Echinacea spp.) 40 mL
Licorice (Glycyrrhiza glabra) 20 mL
Lemon balm (Melissa officinalis) 15 mL
St. John’s wort (Hypericum perforatum) 20 mL
Thuja* (Thuja occidentalis) 5 mL

Total: 100 mL

Dose: 5 mL three times daily

The patient was diligent with her protocol and tolerated treatment well. A repeat Pap smear done after 3 months of treatment was normal. The patient discontinued the folic acid and herbal tincture after this normal Pap smear result. A subsequent Pap smear 6 months later was also normal. All subsequent Pap smears up to the most recent one, done 24 months after her initial atypical Pap smear have been normal (no atypia present).