American Medical Association Family Medical Guide - American Medical Association [250]
WARNING!
Do Not Drink Alcohol When Taking Metronidazole
When taking metronidazole, do not drink alcohol or take nonprescription medications that contain alcohol (for example, some over-the-counter cold medications). The combination of metronidazole and alcohol can cause serious side effects such as abdominal cramping, flushing, headache, nausea, or vomiting.
Genital Warts
Genital warts are a common and highly contagious sexually transmitted disease (STD) caused by infection with the human papillomavirus (HPV). More than 5 million people are infected with HPV each year in the United States. There are more than 100 types of HPV, 30 of which can infect the genital area. Some strains of HPV can produce genital warts and cause precancerous changes in cells. Some strains of HPV have been linked to cervical cancer in women and other genital cancers in both men and women.
Genital warts are spread during vaginal, anal, or oral sex and usually develop in warm, moist areas of the body, including the vagina, vulva, cervix, penis, scrotum, urethra, anus, or rectum. The warts usually develop within 6 weeks to 6 months after exposure to HPV. In rare cases, genital warts may develop on the lips, the tongue, the roof of the mouth, or in the throat.
There is no cure for genital warts, but most outbreaks clear up on their own after a few months. The warts frequently recur, even after they have been removed, requiring repeat treatment.
Symptoms
Genital warts usually begin as tiny, soft, flesh-colored swellings that eventually become hard and rough-surfaced and often develop stalks. Multiple warts often grow in a cluster that resembles a small cauliflower. Genital warts are usually painless, but they can cause itching. The warts tend to grow more rapidly during pregnancy or when the immune system has been weakened by diseases such as diabetes (see page 889), HIV infection or AIDS (see page 909), or Hodgkin’s disease (see page 626), or by having chemotherapy (see page 23) or taking antirejection drugs after transplant surgery.
Because many people who are infected with HPV never develop genital warts, they do not know they are infected. However, even without warts, they can transmit the virus to others. If left untreated, genital warts can cause sores and bleeding, which can increase the risk of becoming infected with HIV by providing a site for the virus to enter the bloodstream.
Diagnosis
A diagnosis of genital warts is based on the symptoms and a physical examination. In women, genital warts are often detected during a pelvic examination (see page 140). A doctor will remove and examine any wart that looks unusual or that persists for an unusually long time, to make sure it is not cancerous.
Treatment
An outbreak of genital warts can be treated by applying a prescription cream or gel, such as imiquimod or podofilox, directly to the affected area. Other topical treatments, such as podophyllum, trichloroacetic acid, or biochloroacetic acid, are applied to the affected area by a doctor or nurse. Because these treatments can harm a developing fetus, they are not prescribed for pregnant women. Genital warts can also be removed by cryosurgery (freezing), electrocauterization (burning), or laser surgery using a highly concentrated beam of light. Warts inside the urethra can be treated with medication or removed surgically. In some uncircumcised men, circumcision may be recommended to help prevent repeated outbreaks of genital warts.
Gonorrhea
Gonorrhea is a common sexually transmitted disease (STD) caused by the gonococcal bacteria Neisseria gonorrhoeae. In men, the bacteria usually infect the urethra (the tube that carries urine from the bladder out of the body); in women, the bacteria usually infect the cervix (the opening to the uterus). Gonorrhea can also infect the rectum or the throat through