Genital warts (condyloma) are common sexually transmitted diseases in sexually active people. Their size and number may vary. It can be seen in multiple and different sizes as well as a single one. In this article, I will talk about the causes, symptoms, prevention methods, diagnosis and treatment of genital warts, which is one of the most common sexually transmitted diseases.

What is genital wart?

Genital warts are lesions that are formed by the human papilloma virus (HPV) and appear in the genital areas, which are raised from the skin, sometimes at the same level as the skin, and can be multiple and in different sizes. It is common in sexually active ages. It is the most common sexually transmitted disease.

What are the causes of genital warts?

The causative agent of warts in the genital area is a virus called human papilloma virus (HPV). There are many types of this virus. There are more than 40 types of HPV that cause warts in the genital areas. HPV 6 and HPV 11 types often cause genital warts.

How are genital warts transmitted?

HPV virus is transmitted through sexual intercourse. Therefore, this disease is among the sexually transmitted diseases.

How long after intercourse does HPV appear?

The incubation period of HPV varies from 2 weeks to 2 years on average. Mostly genital warts (codyloma, verru) occur 3-4 months after intercourse with sick people.

Are genital warts dangerous?

Warts in genital areas due to HPV virus are important because they cause some types of cancer. It is definitely beneficial to see a urologist or, if female, a gynecologist.

Is it possible to have intercourse when there are warts in the genital areas?

These warts are transmitted as a result of contact with sick people. In other words, genital warts are a sexually transmitted disease. In case of having unprotected intercourse while there is a wart, there is a possibility of transmission of the disease to the other party.

Can you have sexual intercourse with a person with HPV?

People with warts in the genital area must be treated and then have intercourse. If there will be intercourse, a condom must be used. Otherwise, the disease will be transmitted to the other side.

How do we know if we have genital warts?

If there was no lesion on the skin of the genital area and warts appeared on the skin after intercourse without protection, then genital warts should be suspected. These lesions may not always be raised as warts, sometimes they may appear as brown spots on the skin of the genital area.

How to detect the presence of HPV?

There is no blood test for the diagnosis of HPV. HPV is diagnosed in smears taken from the cervix in women. It is possible to make HPV typing with advanced tests.

Are genital warts transmitted from the toilet?

Genital warts are not transmitted from the toilet or sink. Likewise, there is no passage through forks, spoons, plates, glasses etc.

Are there any barriers to marriage for people with HPV?

Having HPV does not prevent marriage. With proper diagnosis and treatment, approximately 70% of HPV is cleared from the body after 1 year and 90% in 2 years.

Is there a definitive treatment for HPV?

After the warts on the body are removed, the disease is not completely cured. Only the lesions caused by the virus are eliminated. There is no treatment method that completely destroys the virus from the body.

How long after the wart treatment is intercourse?

You can have intercourse 7-14 days after genital warts are removed.

Do genital warts go away on their own?

Genital warts can go away on their own over time. Sometimes it can recur after treatment. However, it is not possible to completely remove the virus from the body.

What are the risk factors for genital warts?

Since the disease is a sexually transmitted disease, the risk factors are also similar.

• Those who have more than one sexual partner
• Having intercourse without protection
• Having another sexually transmitted disease
• People interacting with people they don’t know
• Having sexual intercourse at a young age
• Weakening of the body’s immune system: such as those with HIV disease, using drugs that take body resistance.
• Excessive smoking

How to avoid genital warts?

Protection from genital warts is similar to methods of protection from sexually transmitted diseases. The points to be considered in order to protect against HPV infection are as follows:

• Having a relationship with a small number of partners
• Getting vaccinated against HPV virus
• Using condom during intercourse
• Not interacting with people you don’t know

Is there a vaccine against genital warts?

There is a vaccine available against the pollen HPV virus that causes genital warts. It is recommended to be vaccinated against HPV virus in girls and boys at the age of 11-12 years. Sometimes this vaccine can be given at the age of 9 years. It is better to get the HPV vaccine before starting sexual intercourse in boys and girls. At the age of 11-12, 2 doses of vaccine should be given 6 months apart.

It is recommended that children aged 9-10 and 13-14 be given 2 doses of the vaccine in the same way.

In general, it has been reported that 2 doses of HPV vaccine administered to children under the age of 15 are very effective against infection. If vaccination has been done in adolescents and young adults aged 15-26, 3 more doses should be given afterwards.

The vaccine has no serious side effects.

What are the complications of genital warts?

Some common complications of HPV infection are:

• Cancer development: Cervical cancer in women is a type of cancer associated with HPV infection. In addition, cancers of the vulva, anus, penis, mouth and throat are also associated with HPV. HPV 16 and HPV18 are the types that most commonly cause cervical cancer.
• There may be problems during pregnancy: Sometimes warts on the genitals in women can grow and cause problems during childbirth.

Other types of cancer that can develop due to HPY:

• Penile cancer
• Anal cancers
• Throat cancer
• Esophageal cancer

What kind of complaints do patients with genital warts have?

There may be different large and numerous warts in the genital areas of men and women. Urologically, we are generally interested in warts in male patients. Warts appear weeks or months after intercourse with an infected person.

• Small, skin-colored, sometimes brown-colored skin blisters appear as raised lesions in the genital areas. Sometimes they may be too small to be seen with the naked eye, the skin color is different from normal skin.
• Sometimes these lesions may merge with each other and appear as cauliflower-shaped blisters.
• There may be complaints in the form of discomfort and itching in the genital areas, which bother the patients.
• These lesions may bleed during sexual intercourse. In particular, it is necessary to pay attention to the lesions in the penis in this respect.

Where are genital warts most common?

Warts caused by HPY infection can be seen in different regions in men and women.

The most common areas in men:

• In different parts of the penis
• On the skin of the scrotum
• In the groin
• On the hips
• Around the anus and inside

The most common areas in women:

• Vagina and anus inner and outer parts
• In the cervix (cervix)

Apart from genital areas, warts can also be seen in areas such as lips, mouth, throat, as a result of contact with sick people.

How to diagnose genital warts?

Diagnosing genital warts is not difficult. It is usually easily diagnosed on examination.

• Detailed medical historuy of the patient: A detailed history should be taken from these patients. Patients who have recently had unprotected intercourse are more likely to transmit a sexually transmitted disease.
• Examination: In the examination of the genital areas, warts are visible. Diagnosis is easily made by just seeing it with the eye.
• Pap smear: Pap smear is taken by the obstetrician in female patients. A sample taken from the cervix is ​​examined.
• HPV test: In the sample taken with Pap smear, the virus that causes cancer in women is investigated. This test is usually given to women age 30 and older. Young women do not need this test, as HPV will recover without treatment in younger women.

Treatment of genital warts

If warts are very small and cause no complaints, they do not necessarily need to be treated. If the lesion is large, if there is itching, pain, or if the patient is cosmetically uncomfortable, they should be removed.

Creams used for this purpose:

• Imiquimod
• Podophyllin
• Trichloroacetic acid, TCA
• Sinecatechins

Surgical treatment of genital warts

Genital warts can be removed surgically. We have been applying these treatments in our center for a long time. The surgical methods applied for the treatment of genital warts are as follows:

• Cryotherapy: Here the lesions are frozen with liquid nitrogen. With liquid nitrogen applied on the wart, the warts are frozen and shed. Care should be taken that the liquid does not come into contact with normal skin. The process may need to be repeated. It is an application without serious side effects. There may be mild pain and itching.
• Burning warts with electrocautery: With this process, warts are burned with special cautery. Local anesthesia is applied so that the patients do not feel pain. In our clinic, we treat warts with this method. During the procedure, the normal skin part is preserved. It has no serious side effects.
• Removal of wart surgically: If necessary, large lesions are removed starting from the intact skin edge with local anesthesia.
• Laser treatment: It is the process of removing warts with laser. Normal skin should be avoided during the procedure. In large lesions, there may be scarring and pain at the lesion site.

In summary; Genital warts are a sexually transmitted disease mostly caused by HPV 6 and HPV 11 types. Prevention is very important in the emergence of the disease. Prevention is possible with vaccinations made at an early age. When lesions appear, it is possible to remove warts with simple surgical procedures.

Prof. Dr. Emin ÖZBEK

Urology Specialist