Genital Warts

In every sexual contact with an infected person, without the use of a condom, there is a 68% chance of infection by the virus. However, a small percentage of those exposed to the HPV virus will develop genital warts. That depends on the patient’s immune system. In the vast majority, the immune system satisfactorily suppresses the virus and keeps it in a latent state. Even so, it is possible for them to transmit the virus if they do not have any clinical signs. In addition, patients who have been treated in the past and have no longer lesions may also transmit the viral infection (by a smaller percentage).

Unfortunately, the genital wart virus cannot be removed from the body once it infects the cells.

Therefore, it remains forever inside it indicating a latent state.

There are about 200 types of HPV, but few of them cause genital warts and even fewer are oncogenic, that is, they can cause cancer if they are not treated by the immune system of the person they attack.

HPV 6 and HPV 11 are responsible for the 90% of genital warts.

The low-risk viruses that cause genital warts are HPV6, HPV11, 42, 43, 44.

The high-risk viruses for malformations, cervical cancer, and anal cancer are HPV16, HPV18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. In men, penile cancer is also associated with HPV infection.

HPV is transmitted by the direct friction of the affected skin with skin or mucous membrane that has lesions. The friction results in micro-injuries and thus the virus penetrates the epithelium. That is why sexual contact is the easiest way to transmit the genital warts virus. However, the penetration is not required for transmission, skin-to-skin contact is sufficient. The transmission can also occur through oral-genital contact that is why we also check the oral mucosa during the clinical examination. We can also have genital warts around the anus either after anal sex or by inoculation, i.e. the transfer of the virus from an infected area with fingers or infected objects.

The incubation period is 1.5-9 months with an average of 2 months after infection.

The clinical manifestation is different depending on the type of virus, but in most cases they appear as small flesh-colored bumps. Then, these grow and multiply. In women, the manifestation of the viral infection is on the external genitalia, perineum, perianus and oral mucosa while the cervix must be checked by a gynecologist with a Pap test. In men, the mouth and anus should also be checked for genital warts.

It should be noted here that the use of a condom protects only the area that is covered by it.

Factors that favor the transmission but also the persistence and proliferation of the virus are the low immune system, smoking, alcohol, frequent change of partners and the coexistence of other STDs.

Shaving the hair of the infected areas should also be avoided so as not to spread the virus to the adjacent areas.

Vaccination for cervical cancer protects women (as well as their partners) from the most common oncogenic strains and also from the most common strains of genital warts. They are given free of charge to women up to 26 years of age, but they can also be given to boys (however, it is not provided free of charge).

The vaccines against HPV that have been approved in Europe and the USA and are available in Greece protect against up to nine types of HPV. The 9-valent vaccine against HPV was released in 2017 in Greece and was integrated into the National Immunization Program (NIP). The 9 types for which the newest HPV vaccine is indicated (HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58): are responsible for approximately 90% of cervical cancer, for 82% of HPV-related high-grade precancerous lesions of the anogenital region and for 90% of genital warts.

The treatment methods are all destructive of the damage that has occurred either with special topical solutions, or laser, or cryotherapy, or diathermocoagulation. It becomes painless with the use of anesthetic cream, comfortably and quickly while we check the entire area for microscopic lesions. No method, however, can guarantee that there will be no recurrence (relapse), which is more common in the first 2 years of infection. The type of the virus cannot be determined by a simple clinical examination. If you want to do so, we take a biopsy and determine the type with the PCR method. In men with frequent periurethral recurrences (relapses), the urethra is also checked internally by an urologist, while rectoscopy is also recommended for perianal genital warts resulting from penetration.

There are imiquimod creams as well as herbal preparations that help strengthen the body’s defenses locally, as well as special vitamins to strengthen the body’s defenses in general.

From the moment of diagnosis, the responsible behavior includes the correct information of the sexual partners as well as the protection of the new sexual partners and definitely the use of condom. It is considered that there is a cure, when for at least 8-9 months after the last appearance of genital warts and their treatment we do not have a recurrence (relapse).