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‘HPV – Warts, Cancer, Vaccine: Where Are We Now?’

On the 2nd March 2019, Dr Manoj Malu, a sexual health consultant, was invited to represent Clarewell Clinics at the West Midlands Association for Contraception and Sexual Health (WMCASH) biannual symposium.

The symposium was held at Millennium Point in Birmingham and represented an opportunity for Clarewell Clinics to engage with other health care professionals in the speciality of sexual health.

Dr Malu was invited to speak on one of his specialist areas – the human papilloma virus (HPV).

Relevant for

Healthcare professionals

Time & Date

2:00pm on 2nd March 2019


Millenium Point, Birmingham

Length of seminar (CPD)

1 hour

Dr Malu’s lecture, entitled ‘HPV – Warts, Cancer, Vaccine: Where are we now?’, began with a discussion on the various clinical presentations of HPV. Dr Malu took the audience on a journey from HPV latent infection through to HPV malignant disease. The audience learnt how HPV can lead to genital warts and cancers, including cervical, anal, and several throat cancers. The various tools of HPV diagnosis were discussed.

Often, HPV is identified initially through observations by the patient or their partner, which leads to a more definitive investigations of VIA (visual inspection with acetic acid), HPV genotyping, cytology and biopsy. Dr Malu explained the mechanism behind the new GeneXpert technology employed at Clarewell Clinics. Such investigations are important in establishing a correct diagnosis as well as patient trust and satisfaction.

Dr Malu further spoke about the negative impact genital warts caused by HPV has on the self-esteem and sexual relationships of patients with HPV.

Treatment Options For Genital Warts

The lecture then covered the various treatment options available for genital warts. Over 95% of genital warts are treated with either cryotherapy, topical Warticon (podophyllotoxin) or topical Aldara (imiquimod); these are often used in combination. Cryotherapy was discussed in significant detail with the efficacies and risks of the various cryotherapy modalities (histo-freeze, cryo-spray and cryo-flask) evaluated.

The variability in the effect of cryotherapy depends on factors including the device used, the technique used, nature, distribution and size of warts, immune response and pain tolerability. Health care professionals in the audience were alerted to the potential occupational hazards of cryotherapy, particularly to the cornea and respiratory system. To reduce this risk, there has been a recent transition towards using liquid carbon dioxide instead of liquid nitrogen.

Dr Malu gave his insights into the latest ‘Instant Wart Removal’ techniques employed at Clarewell Clinics. The three main techniques discussed were hyfrecation, curettage and CO2 laser, giving an insight into the future of wart removal. ‘Instant Wart Removal’ produces pain free immediate results, which is safe in pregnancy and can often be delivered in a single clinic visit.

Concluding Remarks

Dr Malu’s lecture taught us that there is safe and effective treatment for genital warts caused by HPV. However, he also stressed how much further progress is required in the field of HPV. More effort is needed to increase the uptake of HPV vaccines by increasing access and combating anti-vaccine movements. More research is needed to investigate the mechanisms regulating HPV infection and progression to cancer. Dr Malu explained how these steps could lead to better outcomes for patients with cancer linked to HPV infection.

The WMCASH symposium was a successful event attended by over 200 delegates. The learning from the lectures and discussions will indeed help healthcare professionals and Clarewell Clinics in their future practice.


WMCASH is a professional organisation for healthcare professionals working in the field of sexual health. The aims of this organisation include:

  • Developing and supporting the knowledge of sexual and reproductive health care professionals.
  • Evidenced based education on the topics of sexual and reproductive health.
  • Promotion of audits and research related to sexual and reproductive health care.

This symposium is one of the many ways WMCASH seeks to achieve these ongoing aims. The aims of Clarewell Clinics align well with those of WMCASH and consequently were delighted to be involved in such a symposium

The symposium was composed of an array of experienced and qualified speakers giving lectures on topics including:

  • Unscheduled bleeding with contraceptive methods
  • Topical HRT
  • Management of sexual assault
  • CBT and its role in menopause management
  • Contraceptive surgery


About the speaker

Dr. Manoj Malu is a Consultant in Sexual Health & Clinical Director at Clarewell Clinics.

He has been dealing with HIV since 2000 when the first effective medication for HIV management became available.

In this time he has looked after 1000s of HIV positive patients, taught doctors, nurses and medical students about HIV and helped to better understand the anxiety that affects patients with negative HIV results.

In addition to this, he is one of the early adopters of HIV-1 RNA PCR testing for the early detection and intervention in sexual health clinics.