Genıtal Wart Treatment

Genital warts are skin growths that may appear in the genital area, around the anus, or rarely in the mouth-throat region due to human papillomavirus, namely HPV infection. Medically, they are also called condylomata acuminata [1][2].

Genital warts may appear as small, skin-colored, pink, brown, or grayish bumps. While some people have small individual lesions, in others, larger structures that merge and take on a cauliflower-like appearance may develop [1][2][5].

Most genital warts are associated with low-risk HPV types. According to CDC and NCBI sources, especially HPV types 6 and 11 are responsible for most anogenital warts [1][5]. These types are generally considered low-risk in terms of cancer; however, since high-risk HPV types may also be present in the same person, regular screening and physician evaluation are important [3][4].

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Causes of Genital Warts and Transmission Routes

The cause of genital warts is HPV infection. HPV is a very common group of viruses that affects the skin and mucous membranes. The CDC states that HPV is most commonly transmitted through sexual contact and may also be transmitted when the person has no symptoms [1][6].

The HPV types that cause genital warts are mostly low-risk types. In particular, HPV 6 and 11 are responsible for a significant portion of genital warts [1][5]. However, HPV infection should not be evaluated only in terms of warts. High-risk HPV types are associated with cancers of the cervix, vulva, vagina, anus, penis, and oropharynx, especially cervical cancer [3][4].

How Is the Virus Transmitted?

• Sexual contact: It can be transmitted through vaginal, anal, or oral sexual contact [1][6].
• Skin contact: Even without full intercourse, close skin contact with an infected genital or anal area may be sufficient for transmission [1][6].
• Transmission without symptoms: HPV can be transmitted even when there are no warts or obvious lesions [6].
• Limits of condoms: Condoms reduce the risk; however, since HPV can also be transmitted from areas not covered by a condom, they do not provide complete protection [6].
• Transmission during birth: In rare cases, transmission from mother to baby may occur during birth [5].

When genital warts are present, sexual contact may cause the partner to be exposed to the virus as well. The CDC recommends that people with genital warts avoid sexual intercourse until the warts disappear [6]. However, how long contagiousness may continue after the warts disappear can vary from person to person [6].

Symptoms of Genital Warts: Where and How Do They Appear?

Genital warts may appear weeks or months after exposure to HPV. In some people, the virus may remain without symptoms for a long time. Therefore, it is often not possible to determine exactly when and from whom genital warts were transmitted [5][6].

In women, warts may be seen on the vulva, vaginal entrance, inside the vagina, cervix, and around the anus. In men, the penis, scrotum, groin, and area around the anus may be affected. Lesions may also develop in the mouth and throat region after oral contact [1][2][5].

The main symptoms are:

• Small, skin-colored, pink, gray, or brown bumps
• Single or multiple wart-like lesions
• Lesions that merge and take on a cauliflower-like appearance
• Itching or a feeling of discomfort in the genital area
• Tenderness during sexual intercourse
• Rarely, bleeding or discharge

Genital warts do not always cause pain. In fact, in some people, warts may be so small that they are not noticed [2][5]. Therefore, when a suspicious bump, color change, or newly developed genital lesion is seen, it is important to consult a gynecology, dermatology, or urology specialist.

Diagnostic Methods for Genital Warts

The diagnosis of genital warts is usually made by physical examination performed by a specialist physician [1][2]. The appearance, location, number, and extent of the lesions are important in determining the treatment plan.

In some cases, if the diagnosis is not clear or if the appearance of the lesion is different from typical genital warts, a biopsy may be required. The CDC states that biopsy may be performed for lesions that appear atypical, bleed, become hardened, are ulcerated, do not respond to treatment, or when the diagnosis is uncertain [1].

1. Pap Smear: Used to monitor cell changes in the cervix. It is important not for diagnosing genital warts, but for cervical cancer screening [3][4].
2. HPV DNA Test: Used especially within cervical cancer screening to investigate high-risk HPV types. The CDC states that HPV testing for low-risk types should not be used routinely in the management of genital warts [7].
3. Colposcopy and Biopsy: If there is an abnormal smear/HPV result in the cervix or a suspicious lesion is seen, this is an examination with magnification and, when necessary, taking a tissue sample [3][4].

In people with genital warts, not only treatment of the wart itself but also compliance with the cervical cancer screening program should be evaluated. Especially in female patients, smear and HPV screening recommendations are planned according to age, previous test results, and risk status [3][4].

Genital Wart Treatment and Applied Methods

Do genital warts go away on their own? Some warts may shrink or disappear spontaneously over time. However, some may grow, multiply, cause discomfort, or increase the risk of transmission [1][5]. Therefore, the treatment decision should be individualized.

The CDC states that no single method is superior for everyone in the treatment of anogenital warts; treatment selection should be made according to the size, number, and location of the warts, patient preference, treatment cost, side effects, and the physician’s experience [1]. The aim of treatment is to eliminate visible warts, reduce complaints, and help lower the risk of transmission [1][5].

1. Medical Treatment with Creams

For small warts in suitable locations, topical treatments prescribed by a physician may be used. In some cases, these medications support the immune response, while in others, they chemically affect the wart tissue [1][5].

Since the genital area is sensitive, wart medications should always be used with a physician’s recommendation. Wart medications used on the hands or feet should not be applied to the genital area; irritation, burns, or wounds may develop [2].

2. Cryotherapy — Freezing Treatment

Cryotherapy is the freezing of wart tissue using very cold applications such as liquid nitrogen. The frozen tissue may crust and fall off over time. This method is performed in the clinic by a physician, and more than one session may be required in some patients [1][2].

3. Electrocauterization — Burning Treatment

Electrocauterization is the process of burning wart tissue with the help of an electric current. It can usually be performed under local anesthesia. It may be preferred for more widespread or prominent warts [1][5].

4. Surgical Treatment

Surgical treatment may be considered for large, widespread, pedunculated, treatment-resistant warts or warts that need to be removed quickly. Warts may be cut out or cleared using different surgical methods [1][5].

In special situations such as pregnancy, suppressed immune system, widespread lesions, or warts located in the anal, vaginal, or cervical area, the treatment plan should be made more carefully. The treatment method must be determined by physician evaluation [1][5].

Can Genital Warts Recur After Treatment?

Genital warts can recur after treatment. This is because treatment removes visible warts; however, the presence of HPV in the skin and mucous membranes may continue for some time [1][5]. NCBI/StatPearls states that recurrence can be common in genital warts and that topical, ablative, and surgical options may be used in management [5].

The risk of recurrence may be more pronounced especially in the first months. Factors such as the condition of the immune system, smoking, stress, simultaneous infections, the extent of the treated wart, and re-exposure through a partner may affect the likelihood of recurrence [1][5].

Therefore, follow-up after treatment is important. Even if the warts disappear, the person should monitor for new lesions, inform their partner, use protection methods, and in female patients, should not neglect age-appropriate cervical cancer screenings [3][4][6].

What Are the Ways to Prevent Genital Warts?

One of the most important steps in preventing genital warts is the HPV vaccine. ACOG states that the HPV vaccine provides the highest protection when given before sexual activity begins and can significantly reduce the risk of HPV-related genital warts and cancer [3]. The CDC also explains that 4vHPV and 9vHPV vaccines provide protection against HPV types responsible for most genital warts [6].

The HPV vaccine does not treat an existing infection in people who have previously had HPV or genital warts; however, it may provide protection against HPV types the person has not yet encountered [3][6]. Vaccine eligibility should be evaluated together with a physician according to age, vaccination history, and individual risk status.

The main methods recommended to prevent genital warts are:

• Consulting a physician about the HPV vaccine [3][4][6]
• Using condoms correctly and consistently during sexual intercourse [6]
• Avoiding sexual contact while genital warts are present [6]
• Informing the partner and, if necessary, referring them for evaluation
• Preferring monogamy or a mutually monogamous relationship
• Consulting a doctor early when suspicious lesions are present
• Not neglecting cervical cancer screenings [3][4]
• Getting support to quit smoking if you smoke

Condom use reduces the risk of HPV transmission; however, because HPV can also be present on skin areas not covered by a condom, it does not provide complete protection [6]. Therefore, prevention should be considered together with vaccination, regular screening, and a conscious sexual health approach.

What Happens If It Is Not Treated?

If genital warts are not treated, they may remain the same in some people, disappear spontaneously in others, or grow and multiply in some people [1][5]. An increase in warts may cause itching, irritation, bleeding, discomfort during sexual intercourse, and psychological stress.

Delaying treatment may also cause the risk of transmission to continue in case of contact with a partner [6]. Therefore, when visible warts are present, evaluation and treatment planning should not be delayed.

Most genital warts are associated with low-risk HPV types and do not directly mean cancer [1][5]. However, high-risk HPV types are associated with cervical, vulvar, vaginal, anal, penile, and oropharyngeal cancers [3][4]. Therefore, it is important for women with a history of genital warts to follow smear and HPV screening recommendations.

Genital wart treatment is a manageable process but may require regular follow-up. Continuing doctor check-ups after treatment, noticing new lesions early, informing the partner, and not neglecting regular screenings are important for healthy monitoring.

Frequently Asked Questions About Genital Warts

References

1. Centers for Disease Control and Prevention (CDC). Anogenital Warts - STI Treatment Guidelines. (https://www.cdc.gov)
2. NHS. Genital warts. (https://www.nhs.uk)
3. American College of Obstetricians and Gynecologists (ACOG). Human Papillomavirus (HPV): Infection and Vaccination. (https://www.acog.org)
4. World Health Organization (WHO). Human papillomavirus and cancer. (https://www.who.int)
5. NCBI Bookshelf / StatPearls. Condylomata Acuminata. (https://www.ncbi.nlm.nih.gov)
6. Centers for Disease Control and Prevention (CDC). About Genital HPV Infection. (https://www.cdc.gov)
7. Centers for Disease Control and Prevention (CDC). Human Papillomavirus (HPV) Infection - STI Treatment Guidelines. (https://www.cdc.gov)