Most people are familiar with the term “genital warts”, as it is the best-known and most widespread sexually transmitted infection (STI). People who have come into contact with the disease typically go through periods of distress, since it is entirely understandable that they worry about the course of their health. The good news, however, is that visiting a specialised dermatologist–venereologist will provide answers, solutions, and a specific management plan that will improve the patient’s life.

Genital warts develop after the body is infected with the human papillomavirus (HPV), an RNA virus. It is the most common sexually transmitted disease, and it is estimated that approximately 80% of the sexually active population will at some point in their lives come into contact with this virus.

What are genital warts?

Over 150 subtypes of the human papillomavirus have been identified. Some of these have no carcinogenic potential (low-risk HPV), while others can integrate into the human genome, leading initially to dysplasia in the epithelium of the cervix, vulva, penis, and anus, with the potential to evolve into cancer (high-risk HPV). The low-risk types include HPV 6, 11, 42, 43, and 44, while the high-risk types include HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, and 58. Genital warts are the most common cause of cervical cancer.

Clinically, genital warts are characterised by raised, firm, exophytic lesions with a characteristic cauliflower-like appearance. They have a diameter of 2–5 mm and take on the colour of the skin. They are asymptomatic lesions without pain or itching and multiply easily. The incubation period ranges from 1 to 12 months — and sometimes even longer — making it often impossible to identify the suspected contact.

Where do genital warts appear?

Genital warts appear in the broader genital area. In men, they are located on the penis, the pubis, the scrotum, and the glans, while in women they appear on the labia minora and majora and on the cervix. Genital warts also appear in the perianal area in both sexes. Because of the above, it is possible that a condom does not offer absolute protection, but it certainly significantly reduces the chances of infection.

What are the causes of genital warts?

Understanding the causes and recognising the symptoms of genital warts is essential for early diagnosis and treatment. Genital warts are mainly caused by specific strains of HPV, primarily HPV-6 and HPV-11.

These viruses are highly contagious and are transmitted mainly through sexual contact. It is important to note that not everyone exposed to HPV will develop genital warts, as individual immune responses vary.

What are the symptoms of genital warts?

The symptoms of genital warts can vary, but typically include:

  • Small, grey or skin-coloured bumps in the genital or anal areas.
  • Itching, burning, or discomfort in affected areas.
  • Bleeding during sexual intercourse or with bowel movements.
  • Warts may appear individually or in clusters, which many describe as resembling cauliflower.

Why is examination by a dermatologist–venereologist necessary?

Genital warts are highly contagious and can be transmitted through sexual contact. Seeking treatment from a dermatologist–venereologist is essential for several reasons:

  • Specialised diagnosis: Dermatologists are trained to accurately diagnose genital warts, distinguishing them from other skin conditions. A wrong diagnosis can lead to inappropriate treatment.
  • Personalised treatment: Dermatologists–venereologists can suggest tailored treatment plans based on the area, size, and number of warts, ensuring the best possible outcome.
  • Follow-up: Dermatologists–venereologists can monitor treatment progress and provide necessary adjustments, ensuring complete elimination of warts.
  • Emotional support: Coping with genital warts can pose a challenge for patients. Dermatologists offer emotional support and guidance throughout the treatment process.

How are genital warts diagnosed?

Diagnosis of genital warts is made through clinical examination by an experienced dermatologist–venereologist. It is considered relatively easy, mainly due to the typical appearance of the lesions in the affected areas. Early diagnosis is crucial for effective treatment and prevention of further complications.

In the past, an acetic acid solution was applied to the affected area, which made warts more visible, helping with diagnosis. However, this method is not particularly preferred anymore due to the intense irritation that develops in the area. In rare cases, a skin biopsy is performed. A small tissue sample is taken, and laboratory analysis follows to confirm the presence of HPV. Finally, for the diagnosis of specific virus types, a DNA test is performed — a method that accurately determines the subtype of the virus.

Why is early diagnosis important?

Early diagnosis of genital warts is vital for several reasons:

  • Prompt treatment can prevent warts from growing and spreading.
  • It reduces the risk of complications, such as the development of cancer in some cases.
  • Early identification and treatment of genital warts can limit their impact on a person’s emotional and sexual well-being.

What does treatment for genital warts include?

Dermatologists offer various treatment options for genital warts, each with its advantages and disadvantages. The choice of appropriate treatment depends on the location, size, and number of warts, as well as the patient’s overall health condition.

Therapeutically, no completely effective drug substance has been found, which is why recurrences are common. Furthermore, treatment has not been shown to reduce the risk of viral transmission, since transmission is possible from a carrier without visible lesions. Nevertheless, if warts appear, there are ways to manage them.

The different treatment options for genital warts include:

  • Pharmaceutical preparations: A dermatologist–venereologist may prescribe creams or ointments containing substances such as imiquimod, podophyllin, and podofilox, which can be applied directly onto the warts.
  • Laser cauterisation: High-intensity laser beams, such as the CO2 laser, can be used to destroy warts.
  • Surgical removal: In cases of large or persistent warts, dermatologists may recommend surgical excision.

Topical medications, while non-invasive, may require a prolonged treatment period. Surgical removal is effective, but may leave marks. Now, the main treatment method chosen is laser treatment, because it is safe, precise, leaves no marks, and is considered particularly effective.

The specialised dermatologist–venereologist evaluates each case and suggests a course of treatment that is appropriate for the needs of each case.

Is there a way to prevent genital warts?

Preventing the spread of genital warts is vital for controlling HPV transmission. Measures that can be taken to prevent the spread of genital warts include:

  • Safe sex practices: Consistent and proper use of condoms can greatly reduce the risk of HPV transmission, although they do not provide complete protection.
  • HPV vaccination: Vaccines such as Gardasil 9 can protect against certain HPV strains responsible for genital warts and cancer. It offers coverage of up to 93% and protects against the high-risk types 6, 11, 16, 18, 31, 33, 45, 52, and 58. It should ideally be given to boys and girls before sexual activity begins.
  • Limiting sexual partners: Reducing the number of sexual partners can lower the risk of HPV exposure.
  • Regular screening: Regular screening for both HPV and genital warts can lead to early detection and intervention.
  • Communication: Open and honest communication with sexual partners about STIs is essential for prevention.

Genital warts in women

It is estimated that approximately 75% of the female population of reproductive age will be infected with HPV. Whether they develop genital warts is independent, as cases may be asymptomatic. The strains of the virus are transmitted through sexual contact (vaginal, anal, or oral), which is why a condom is not guaranteed to protect us.

The strains most often responsible for genital warts in women are HPV strains 6 and 11. Whether the virus manifests is also closely linked to the state of the immune system. For this reason, patients are advised to follow a healthy lifestyle, avoiding excesses, with good nutrition and regular exercise.

It should be noted that although genital warts mainly appear in areas such as the vulva, vagina, cervix, pubis, urethra, perineum, groin, perianal area, as well as the mouth, lips, tongue, palate, and pharynx (through oral sex), they can also affect other areas. This happens mainly through, for example, shaving the sensitive area. This is also one of the reasons why women who depilate this area are advised to schedule sessions for hair removal with the Alexandrite Laser.

Early diagnosis of genital warts in women is of paramount importance because the consequences may become dangerous. Genital warts in women are indeed caused by low-risk HPV strains. These strains are not associated with the development of malignancy. However, in the same areas, high-risk strains may coexist, which are linked to causing dysplasia or malignancy in the cervix, vulva, vagina, anus, and pharynx.

Conclusions

Genital warts are a common and treatable STI caused by HPV. Seeking treatment from a specialised dermatologist–venereologist is essential for accurate diagnosis, tailored treatment, emotional support, and long-term care. Early diagnosis and prompt treatment are vital for preventing complications and reducing the emotional and physical burden the disease can place on a patient’s life.

Preventive measures, such as safe sex practices and HPV vaccination, play an important role in reducing the spread of warts and protecting our overall sexual health. The experience and guidance of a specialist physician can help patients face the challenges associated with genital warts, improve their daily lives, and prevent future infections.