What's Your Problem?

Doctor Louise answers readers' questions.

Warts and all

Adam from Cairns writes: I have some annoying little lumps around my bum that my partner says are warts. They only appeared in the last few months and I haven’t done anything about them because I hoped they would just go away. But they haven’t. What should I do?

Dr Louise replies: It does sound like you have genital warts but it is important you have a doctor check them out to confirm that they are warts and also to make sure there aren’t any other STIs [1][Sexually Transmissible (or Transmitted) Infection] Infections spread by the transfer of organisms from person to person during sexual contact. Also called venereal disease (VD) (an older public health term) or sexually transmitted diseases (STDs). present. (They often hunt in packs!)

Genital warts are caused by a number of strains of the Human Papilloma Virus [2]A small infective organism which is incapable of reproducing outside a host cell. (HPV).There are lots of different types of HPV. Some strains cause genital warts, others cause the more regular warts you get on your hands and feet, some strains have no symptoms at all and a few are associated with anal and cervical cancer.

Genital warts are spread by close skin-to-skin contact and it can take weeks, months or even years between the time you are infected and the warts appear. They are often painless and can appear as raised or flat bumps, alone or in clusters. Contact with warts from other parts of the body does not seem to cause genital warts.

HPV is good at ‘hiding’ from the body’s immune system and so warts can be tricky to get rid of. Treatment is often difficult and time consuming, usually requiring multiple applications and often this does not eliminate them totally.

Two common treatment options are ‘cryotherapy’ and topical solutions.

Cryotherapy is a technique administered by a doctor or nurse. It involves freezing the warts and the treatment is usually repeated about ten days later. Sometimes the warts blister up immediately and sometimes you don’t notice any change until after a few treatments.

Topical solutions such as podophyllotoxin can be applied to external genital warts but you must be sure the product is specifically designed for sensitive genital skin. I have seen some nasty skin reactions from home-applied wart treatments. Aldara cream can also be self-applied depending on the site of the warts and can be effective in some cases. It is available only by prescription or from a sexual health service.

The bottom line is that you get a full sexual health check-up to confirm the diagnosis and also to get the best treatment option for your situation.

Tired of being tired

Dennis from Perth writes: Lately, I have been having a lot of trouble sleeping. I feel tired at night but when I go to bed I end up just lying there. Sometimes I lie awake until 3 or 4 in the morning. It’s driving me crazy. I don’t want to start taking sleeping pills but if this continues I may have to.

Dr Louise replies: Sleep problems are common and happen to most people at some time.

Stress in our daily life can stop us from relaxing and falling into a deep sleep. Worrying thoughts can also affect our quality of sleep – we may dream more, the dreams may be disturbing and we may wake more frequently.

It is important to consider if there are any serious conditions causing sleep disturbance. Depression can cause earlymorning wakening, trouble falling asleep or even too much sleep.

When the quality and quantity of our sleep is poor, it can affect our memory, concentration and energy. We feel grumpy and find it difficult to make big decisions.

Is there anything inhibiting your ability to sleep such as caffeine, cigarettes, chocolate or other stimulants? Limit these things, especially at night. Alcohol can also cause sleep disturbance. Try and do some activity during the day but vigorous exercise prior to bed can inhibit sleep. Avoid heavy meals before bedtime and go to bed only when you are tired. Try to avoid daytime naps if possible as they can affect your evening sleep.

Try getting up and going to bed at the same time each day. Routines are helpful. They provide signals to your mind and body to get ready for sleep. Listening to quiet music or reading helps some people.

There are relaxation techniques you can do to help you ‘wind down’. Many people find meditation helpful. Books, DVDs and CDs are available to guide you and there are even products you can download onto your phone.

While tossing and turning we may start thinking: ‘Oh, I have a big day tomorrow and I am going to be tired and irritable’ and this can frustrate things further. Try and relax and rest, even if you aren’t sleeping. Sometimes we just need to accept that we haven’t slept as well as other times.

If none of these techniques are useful, see your GP or counsellor. Talking about your stressors and worries can be useful and they may suggest strategies to help. Medication can be prescribed in some situations, but should only be used for a few nights on a very short-term basis.

DOCTOR LOUISE

Keep your questions under 100 words and email them to: pl@napwa.org.au [3]
Dr Louise Owen is Clinical [4]Pertaining to or founded on observation and treatment of participants, as distinguished from theoretical or basic science. Director of the Centre Clinic in St Kilda. Her advice is not meant to replace or refute any advice given by your own doctor as your individual medical circumstances are best dealt with by your own practitioner.