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August 20,1982 / Montrose Voice 17
Health
Warts in
Your Shorts?
By Harvey Thompson, M.D.
C 1982 Stonewall Features Syndicate
There is "gay" cancer, "gay" pneumonia,
"gay" gonorrhea, and the "gay bowel syn
drome," so why not "gay" warts, too?
Maybe. The viruses of warts from various
body parts may look alike, but analysis
shows at least five different human papilloma viruses (HPV's), which cause warts.
Genital warts have been found with
nucleic sequences different from the
garden-variety "common" wart. And, for
what it's worth, genital warts may be of
multi-cellular origin, whereas common
skin warts come from a clone (pardon the
expression) of cells that originate in a single infected cell.
How warts spread isn't clear. The medical books usually say they are extremely
contagious. So, why in some couples who
are versatile in sex roles does one of the
guys have them while the other doesn't?
A famous example of this was Tom Sawyer and Huck Finn. Remember, Tom had
warts, Huck didn't, and they did spend a
lot of time in the woods together!
Dr. Oriel of the University Hospital in
London writes articles on warts every few
years. He must be one of the authorities,
judging by the frequency with which his
name appears in the wart bibliography. In
a recent month, in the Sexually Transmitted Disease Journal, he wrote that "contact tracing studies have shown little
evidence of the sexual infectivity of the
anal warts."
He has written about warts since 1970,
so he ought to know. His conclusion was
that "no satisfactory explanation of the
natural history of the anal warts has yet
been given." Just what I thought.
Warts are frustrataing. I would rather
have syphilis or gonorrhea anytime;
either is easier to treat, and the cure rate is
higher. The treatment for warts seems to
depend upon their location and the physician's enthusiasm. The usual treatment
for anal warts is podophyllin. There is also
salicylic acid, cantharides, liquid nitrogen, cautery, radiation (in the old days), or
surgery.
Experimental treatments include topical anti-viral agents, topical chemotherapy, or vaccine injections (using old wart
parts mixed together in a blender). Folk
remedies include rubbing a copper penny
over the wart, or burying a potato under a
stump. Hypnosis or suggestion has been
known to work in ridding children of
warts on their fingers. Back in med school,
we used to give them a quarter for each one
in dermatology clinic; between inflation
and location, anal warts must cost much
more.
Warts frustrate both doctor and patient.
Treatment with podophyllin is disappointing; only 50% are cured in the first or
second treatment. The applications have
to be done weekly, which can get expensive at $15 per crack.
Warts often recur, even with those who
have given up anal sex. The incubation
period ranges from one to 20 months, with
four about average, so new warts might
pop up after others have disappeared. The
range of incubation makes epidemiology
difficult; your lover of the past year may
have nothing to do with their popping up
around your rectum recently.
Condylomata lata of secondary syphilis
can look a lot like a wart and is also found
perianally. Experience has taught me to
Veep this in mind.
Patients often call in to be seen for their
"hemorrhoids," which turn out in examination to be warts. Why shouldn't rectal
self-examination with a soapy forefinger
be a monthly event in the shower? Warts
will usually feel rough on the surface and
nontender, while hemorrhoids will be
softer and tender.
Rectal cancer is the most common GI
cancer in the American male. So, why
hasn't the American Cancer Society gotten into pushing rectal self-exmination?
The ACS calls colorectal cancers "the
cancers nobody talks about." One of their
longstanding recommendations is an
annual rectal exam for people over 40.
Why not start doing these exams on yourself much earlier?
One of the great advances in breast
cancer detection is due to women being
taught to look for lumps in their breasts by
themselves. An additional benefit would
be your ability to check your prostate for
early nodules or cancer there. It's doubtful
that the situation will be "rectified" and
the omission is part of the "rectal taboo"
or even homophobia. After all, can you
imagine the ACS doing TV spots that
advise men to stick their fingers up their
rears?
Why do anything about anal warts at
all? Well, often patients want them treated
for aesthetic reasons. Like those men with
non-pathogenic amoebas, they just don't
want them around. I think, though, that if
the wart is small and doesn't bleed or hurt,
you could just sit on it and apply "tincture
of time." One ofthe "wart articles" claims
that they involute spontaneously within
two years any way, and may need little
attention.
Hepatitis-B
Vaccination Has
Added Costs
By Johannes Stahl
The manufacturer of Heptavax-B, a vaccination to prevent hepatitis-B, announced
that the cost at which they sell the drug is
around $100. This price reflects what the
direct buyer pays to Merck Sharp &
Dohme, the manufacturer of the drug.
However, by the time the recipient is
injected with the vaccine, this price can
increase significantly.
Bob G. Howell, Houston registered pharmacist, said the drug is usually sent first
to a "wholesaler and then to the pharmacy, clinic, or hospital." The price ofthe
vaccine is increased at every stage of handling between manufacturer and patient.
Howell said he couldn't commit anyone
to an exact price but estimates that the
pharmacy will charge about $140. This
figure does not include the cost for the
three trips necessary to receive the injection series from a doctor. A conservative
estimate of $20 per office visit brings the
total so far to nearly $200.
Medical authorities state that gay males
are in a "high risk" category of contracting the disease and should be tested before
the vaccination to see if they have already
had hepatitis-B infection. Those who have
had the disease don't always show symptoms and the vaccine would be ineffective
for those who have a history ofthe disease,
whether they knew they had the disease or
not. The vaccine is effective only for
hepatitis-B and not for hepatitis-A or non-
A, non-B, say the manufacturers.
The Houston City Health Department
says they conduct free screening for hepatitis infections in their mobile units, but
not in the actual clinic. The units go to
different locations in the gay community
for four hours about once a week. If the
patient goes to a private doctor, add the
cost for the office visit and the cost for the
required lab work. This could add another
$60 to the total bill.
If a private physician is used exclusively, the cost could run as high as $260.
Those people using public health facilities
for the screening could pay $200.
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