DEAR DR. DONOHUE: I had no symptoms, but a routine pelvic exam disclosed that I have genital warts. My doctor says they can cause cancer. I am very upset by all this. What should be my next step? – K.S.

ANSWER: All warts, whether on the hands, the feet or the genitalia, are caused by papillomaviruses, a large family with more than 100 different strains. Some strains gravitate to the fingers and hands, some to the feet and some to the genitalia.

Of the strains that infect the genitals, a few can, in time, effect cancer changes. That sounds ghastly, and it is, but it needs to be put in perspective. More than 5.5 million genital-wart infections occur yearly in North America, but the incidence of cervical cancer is actually falling. Surveillance programs are responsible for the decline, and those programs will likely keep you in good health. Pap smears are the chief means of following genital warts and the changes they effect.

The warts can be treated in a number of ways. Which way is best depends on the number of warts, their locations and if there are any changes seen in the cells infected by the warts.

If a Pap smear shows changes that have the potential to evolve into cancer, the doctor can freeze the affected site or can remove it with an electric current – a technique called LEEP, loop electrocautery excision procedure. There are other ways of dealing with this too.

Your next step is to follow the schedule your doctor will give you for future Pap smears.

The booklet on herpes and genital warts presents the details on these infections and their treatments. To order a copy, write to: Dr. Donohue – No 1202, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What are blepharitis, its cause and its treatment? – A.B.

DEAR DR. DONOHUE: I am told I have blepharitis, but no one tells me the proper care for it. Can you give me any advice? Does smoking have any connection to it? – R.F.

ANSWER: Blepharitis (blef-uh-RITE-us) is a common eyelid condition. The lids redden and become scaly and crusty. Often they’re stuck together upon wakening in the morning. They might itch.

Combating blepharitis requires dedication because it’s a long, arduous task. Soak a washcloth in warm water and apply it to the closed eyelids for 15 minutes three times a day. That softens the crusts. Then gently scrub the lids with a cotton swab dipped in a solution of equal parts baby shampoo and plain water. It can take months before you see results.

Sometimes, prescription antibiotic eye ointments are needed to turn the corner on blepharitis.

Cigarette smoking does not cause it.

DEAR DR. DONOHUE: Please write about bladder cancer. I am a woman, 72 years old, and have it.

I had a vague pain in my back and stomach and happened to mention it to my family doctor. She had me get an ultrasound, which showed something suspicious in the bladder. A urologist ordered a CT scan, which showed a 1-inch tumor, which was removed. It had not spread to other organs.

How did this grow in me without any symptoms except for the vague pains in my back and stomach, so vague that I almost didn’t mention them to my doctor? – G.H.

ANSWER: Bladder cancer is fourth on the list of the most common male cancers and 10th on the list of female cancers. Your story is quite typical. It’s a cancer that produces few signs and symptoms in its early stages. The most common sign of it is painless passage of blood in the urine. The blood can be visible to the eye or detectable only with microscopic examination. As the tumor enlarges, it can cause a burning sensation upon urinating, and it often makes a person urinate more frequently. Pain isn’t common. I don’t know if your stomach and back pains were caused by the tumor, but those symptoms fortunately led to the investigation that discovered it.

Cigarette smoking is closely associated with bladder cancer.

DEAR DR. DONOHUE: I have never seen a letter to you about agoraphobia. I have it so bad that I am housebound.

I am so discouraged and feel so hopeless because of it. Is there any way out of it? – F.B.

ANSWER: The literal translation of “agoraphobia” from Greek is “fear of the marketplace.” It’s panic attacks that occur when a person is outside the home and in a crowd, a mall, a supermarket, a busy street or other public arenas where many people congregate.

When an attack happens – and it can do so without warning – people’s hearts race. They might become dizzy and tremble. Often they have chest pain or believe they are choking. They are convinced that they’re on death’s door.

There’s a glitch in the way these people’s brains produce chemical messengers. The brain alerts the body to imminent danger when there is no real threat.

Agoraphobia can turn a person into a social hermit, but it is not a hopeless condition. A therapist can help you and others who suffer from this not-uncommon condition learn how to deal with these erroneous signals and how to subdue the irrational fear they initiate. Sometimes that’s accomplished by exposing people to the situations that provoke an attack. It’s a way of desensitizing the brain to the triggering input.

Medicines can also restore the normal production of brain messengers, and they play an adjunct role in treating this.

There is no reason to feel hopeless. Phobias are common, and people can achieve mastery over them with the help of a professional. The family doctor can put you in touch with such a person.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.