Genital warts are warts that appear on the genitals, groin, and ovary skin in men, and have increased in number and size recently.
It is a viral disease caused by the wart-forming virus (Human papilloma virus-HPV) in humans. Infection by this virus is the most common sexually transmitted disease in the world.
The disease is called genital wart, genital condyloma, condyloma acuminata or direct HPV among the people.
HPV affects both sexes. Men often go to the doctor, noticing the warts that have come off. On the other hand, it gives symptoms in the form of warts, which are seen on the external genital organs of women or mostly in the vaginal area during gynecological examination. Warts in the anal (breech) region or in the groin can be seen in both sexes.
It is reported that 630,000 people are infected annually all over the world, and two-thirds of these people are women.
HPV is a DNA virus and nearly 200 types have been identified. Only about 40 of them involve the genital area. These types are defined by numbers and types 6 and 11 are responsible for 90% of genital warts. Among the carcinogenic types, the most common types 16 and 18 cause anal region (breech) and penile cancer in men.
HPV is mostly (90%) transmitted by sexual contact. It can also be transmitted by oral or anal intercourse. Also, full sexual intercourse is not necessary for transmission. Viruses taken from warts containing viruses, especially during sexual contact, are taken from damaged skin-mucosa.
In general, the risk of infecting the partner of an individual with genital warts is 64%. The risk of female-to-male transmission is higher than the risk of male-to-female transmission. In this respect, the number of sexual partners can be considered as a risk factor for the transmission of the disease. It is known that the disease is more common in polygamous and those who start sexual intercourse at an early age.
The disease is also transmitted by anal or oral intercourse.
HPV warts are found in the anal or oral region. Especially during oral sex, transmission from woman to man is more risky than transmission from man to woman.
Although the evidence for contamination with the virus on objects is weak, it has been shown that the virus can survive for a long time on external surfaces (body hair, nails, used items, toilets, tools used in gyms, pool water and even items used during examination, etc.).
Transmission by contact with these objects has not yet been proven, but in individuals with low immunity, infection may be possible with the entry of a heavy viral load through skin abrasions.
HPV can be transmitted from mother to baby during normal vaginal delivery. It has also been shown that HPV (+) can carry the virus in the semen of a man.
There is HPV DNA in the smoke that comes out during the electrotherization process used for wart treatment, and breathing this smoke carries the risk of HPV contamination.
Therefore, it is recommended to wear an N95 mask during this treatment.
It is quite difficult to determine the time and source of contact with the virus. The duration varies according to the immune system of the person and the amount of virus taken. The incubation period of the disease varies between 2 weeks and 8 months.
In people with active immune system, HPV is usually cleared from the body at a rate of 70% within a year. However, cauliflower can cause genital warts (condyloma acuminata), cancerous structures and cancers in people with insufficient immune response.
Warts can be very numerous and large in people with a low immune system (organ transplant recipients, pregnant women, HIV (+) people or those who use immunosuppressive drugs, smokers). Usually, warts bleed during cleaning of the genitals or with itching. With bleeding, warts spread over a larger area.
Cervical, anal and oropharyngeal cancers may develop in people who have been exposed to carcinogenic HPV for a long time. HPV is responsible for 5% of all cancers in both sexes, 9.4% of female cancers (cervix, anus, vagina, vulva, oropharynx), and 6% of male cancers (anus, penis and oropharynx).
The virus can also be detected in the semen of HPV (+) men (7-26%). This can affect sperm count and motility and cause infertility.
In addition to physical symptoms, HPV can also cause psychosocial problems. It can lead to anxiety, depression and social isolation.
Examination by an experienced physician and seeing the lesion are actually sufficient to make a diagnosis. Pathological examination may be required by taking biopsy from bleeding, frequently recurring and very dark colored lesions.
The PCR test, which we use in the diagnosis of viral diseases, is also used in the diagnosis of HPV. The virus and type are determined by PCR method in the swab samples or the sample sent directly from the lesion. Knowing which type of virus you are infected with will be beneficial for the person and their partner.
Clearing the virus from the body completely can only be achieved by the immune system. Our aim in treatment is to remove warts. For this purpose, different treatment methods can be used. The treatment method is decided according to the number and size of the wart, the region where it is located, the experience and possibilities of the physician. Despite all these treatments, the risk of recurrence is 25-65%. That's why I follow my patients with 2-week and monthly check-ups in wart treatments.
Basically, the most common treatment method is removal of the wart with laser or electrocautery under local anesthesia. Surgical excision can be applied in larger warts. Ice cream, namely cryotherapy, is a method mostly applied by dermatologists. The tissue that dies as a result of freezing is cleaned over time.
One of the cream treatments, imiquimod is applied 3 nights a week and applied for 6-8 weeks. It acts by activating the immune system. May cause skin reactions (such as itching, redness). The other treatment is the removal of silica with an acidic solution (trichloroacetic acid) and is administered by the physician.
In addition to the treatment of the person, it is important to control and, if necessary, treat the partner by a gynecologist or urologist.
Condom used during sexual intercourse is not protective because it does not cover all genitals. It is possible to transmit by contact of the penis root-upper region, ovarian skin and anal region.
Circumcision also protects from HPV infections and HPV-related cancer. Therefore, the risk of penile cancer in our country is very low.
HPV vaccine is administered within the routine childhood vaccination program in some countries in Europe and America. With the vaccine, the immune system against HPV can be strengthened and the formation of genital warts and cancer development can be prevented.
These vaccines contain virus-like particles and do not contain virus DNA. Therefore, it does not have disease or cancer-causing effects. There are 3 types of HPV vaccines: Bivalent (Types 16, 18), quadrivalent (Types 6, 11, 16, 18) and nano-valent (Types 6, 11, 16, 18, 31, 33, 45, 52, 58). It is applied at 0 and 6 months between the ages of 9-14, and at 0, 1 (or 2) and 6 months for people over 15 years old.
Razors that irritate the skin and cause abrasions should not be used for cleaning the hairs on the genitals. Methods that destroy the protective layer on the surface of the skin make the skin open to infections. If possible, cleaning should be done with depilatory creams and machine without irritating the skin.
HPV does not only affect the outer part of the genitals, it can affect the outer opening of the urethra (meatus), the inside of the urethra (urethra), and even the bladder. These patients can see the wart at the end of the urethra. There may be wart obstruction in the urethra and thinning of the urine. The entire urethra should be examined with an instrument with a camera.
