How are they transmitted?

Genital warts are transmitted by vaginal, anal, and oral contact. The virus is transmitted even when an infected person has no symptoms. Someone can develop genital warts even after years of contact with someone who is infected with HPV. This makes it extremely difficult to define when the transmission happened. Babies may also get warts which are transmitted by the infected mother during labour.

What are the symptoms?

Genital warts appear as growths in the genital, perianal, pubic area, thighs, which are asymptomatic. They can be small or big, flat or raised or with cauliflower shape. Rarely, they can cause itching, burning sensation or bleeding. Less often, they can appear on the mouth or throat.

Can HPV infection cause cancer?

There are over 100 different types of HPV. About forty of them are responsible for the appearance of genital warts while some others are responsible for the appearance of cancer, mainly at the cervix, the vagina, the penis and the anus. It also seems that HPV is involved in mouth cancer. It should be noted that the HPV types that cause genital warts (mainly 6, 11) are not the same with the ones that cause cancer (mainly 16, 18). Cancer usually appears years or even decades after the HPV infection. Often the types of virus that cause genital can coexist with those that cause cancer.

Is there a lab test that traces genital warts?

The diagnosis of genital warts is clinical and confirmed by a dermatologist. PAP test is an important diagnostic test to define HPV infection in the cervix. Nowadays, there is a DNA test with which we can identify the virus strain responsible for the infection. It is very important when we want to detect whether an infection with oncogenic virus strains coexist with genital warts.

Is there prevention?

• The use of condom reduces, although it doesn’t completely eliminate the possibility of genital warts infection, because a condom cannot cover all the areas in which an HPV can be transmitted.
• PAP test for all women aged 21-65 to prevent cervix cancer.
• Vaccination: Today, there are vaccines against genital warts available, mainly types 6, 11 which are responsible for 90% of genital warts and oncogenic virus strains 16, 18 responsible for70% of cervix cancer. The vaccine is given in three doses, 6 months apart. It is recommended to girls aged 9-14 or young women who have not been affected up to their 26 years of age. The American Paediatric Society recommends vaccination for boys aged 11-12 as well, for virus types 6, 11 to avoid the transmission of genital warts.

What is the treatment?

There are several treatments to treat genital warts but we cannot guarantee complete cure. This is why constant treatments are needed as well as a combination of them.

The treatments that deal with genital warts can be classified as follows:

• Pharmaceutical treatments:

1. Podofilox (podophyllin): an antimitotic medicine which destroys genital warts. Possible side effects are skin irritation, ulcers and pain. Its use is contraindicated during pregnancy.
2. Imiquimod (Aldara): a cream which boosts the immune system topically. Possible side effects are, skin irritation, a burning sensation and sometimes blisters on the affected area. Less often there are muscle aches, cough and weakness.
3. TCA at 80%-90% concentration, which seems to “burn” the genital warts. Possible side effects are kin irritation, ulcers and pain.

• Invasive treatments:

They are used for big or multiple genital warts, genital warts that don’t respond to topical agents, people psychologically affected and want to have them instantly removed and finally, pregnant women on which pharmaceuticals are contraindicated.

These treatments include:

1. Cryosurgery: With this method, a cold burn that gradually leads to the reduction and finally the shedding of the genital warts is created. Possible side effects are swelling and pain on the treated area.
2. CO2 laser Removal: After a topical anesthesia, the genital warts are removed while at the same time hemostasis is done. Possible side effects are pain after the treatment and scars.
3. Surgical removal: it is used rarely to remove very large lesions.

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