In this article, it is aimed to compile the most frequently asked questions about genital warts, which have become increasingly common especially among the younger population and have turned into an important health problem, in a question-and-answer format in light of current information.
What are genital warts?
Genital warts are lesions caused by the HPV virus, typically found in moist genital areas. In women, they are most commonly located at the vaginal entrance, in the vagina, and around the anus, and less frequently on the cervix. In men, they are seen on the tip of the penis, on the scrotum (testicles), and around the anus. They are painless, skin-colored, raised lesions that may appear as single pinhead-like structures or, when clustered together, resemble a cauliflower. In many individuals, they may also exist as lesions that are very difficult to notice. Sometimes bleeding may occur.
Why are genital warts an important public health problem?
HPV, the cause of genital warts, is most commonly transmitted through sexual intercourse and is expected to become so widespread that approximately half of sexually active individuals may develop it. Lesions, that is, warts, are more frequently observed in women compared to men.
What are the characteristics of HPV (Human Papilloma Virus)?
HPV is a virus with more than 100 types. Although most HPV types are harmless, approximately 40 types can cause infections in the genital area. International sources indicate that up to 80% of women and men become infected with HPV at some point in their lives. Among HPV types, types 6 and 11 are particularly responsible for genital warts. Some HPV types are considered high-risk for cancer; types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 fall into this category. The most high-risk types are 16 and 18; it has been reported that cervical cancer develops within 10 years in about 20% of cases with these HPV types. Studies have shown that HPV is responsible for approximately 70% of cervical cancers.
How are genital warts transmitted?
HPV, which causes genital warts, is most commonly transmitted through skin-to-skin contact, especially via vaginal, oral, or anal sexual contact with an infected partner, and more rarely through other routes. In other words, although the primary mode of transmission is sexual contact, it can also be transmitted without sexual intercourse.
Do condoms fully protect against genital warts?
Although condoms largely reduce the transmission of genital warts, they do not provide complete protection. Transmission may occur through genital skin areas not covered by the condom.
How are genital warts diagnosed?
Lesions that appear as small pinhead-like structures, either separate or clustered together, raise suspicion. However, diagnosis is made through a physician’s examination by observing the lesions. In suspicious cases, diagnosis can also be confirmed by pathological examination of a biopsy sample.
How are genital warts treated?
Genital warts can be treated mechanically (burning, freezing, or surgical removal) or chemically (creams, liquid medications, etc.). The appropriate treatment method should be determined by the physician based on the size of the lesions. The disappearance of lesions does not necessarily mean complete cure, and genital warts may recur after some time.
What problems can genital warts cause?
If left untreated, genital warts can grow to very large sizes and may become infected. In such cases, symptoms such as foul-smelling discharge and bleeding may occur.
What is the vaccine against genital warts, when and to whom should it be administered?
Although it is not yet included in the routine vaccination program in our country, vaccination is recommended in the USA for girls aged 9–26. In some countries, vaccination is recommended for both boys and girls. The vaccine must be administered in 3 doses within 6 months (at months 0, 2, and 6).
Is the HPV vaccine administered during pregnancy?
The answer to this question is ‘no’. However, studies conducted in women who were vaccinated unknowingly during pregnancy show that there is no increase in the risk of abnormalities in the baby. This is also consistent with the fact that the vaccine is not a live vaccine.
How many years does the vaccine provide protection?
Current vaccines are considered to provide protection for about 5 years. After that, a booster dose is recommended until the age of 26.
If genital warts are present, should the vaccine still be administered?
The currently available vaccines in our country are bivalent (against HPV types 16 and 18) and quadrivalent (against HPV types 6, 11, 16, and 18). If exposure to all these types has already occurred, vaccination is not appropriate. It is expected that a vaccine covering 9 HPV types will soon become available in our country as well.
If the HPV vaccine has been received, is follow-up no longer necessary?
The HPV vaccine does not provide complete protection against cervical cancer. Regular smear (Pap test) screenings must still be continued.
Do genital warts cause harm during pregnancy?
During pregnancy, genital warts may grow and multiply due to changes in the immune system. In such cases, it is very important to check for accompanying infections. As a general rule, if genital warts are present, the preferred mode of delivery should be cesarean section. Otherwise, the baby may develop laryngeal papilloma (wart-like lesions in the larynx).
The most important point to remember is this: genital warts, or HPV in general, are never something to be ashamed of or feared; if present, medical evaluation and appropriate treatment planning along with regular follow-ups are essential.
Wishing you all health and happiness...
Prof. Dr. Ümit İNCEBOZ / Obstetrics and Gynecology Specialist / İRENBE