Genital Warts

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Dr. Christopher Tzermias

Dermatologist – Venereologist

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Condylomata acuminata (genital warts): General information

Etymologically the word “condylomata” comes from the Greek word “condylos”, which means a rounded knob, protrusion, tip.

Learn more about the treatment of genital warts here

The ending of the Greek word “-oma” is also used for neuter nouns denoting a disease or a pathological condition, such as hemangioma, hematoma, lipoma, a benign lump that develops and grows.

Furthermore, the etymology of the Greek word for “acuminata” is a combination of the words acute and tend to, meaning, sharp peak, having an acute, sharp or spear-like tip. It should be mentioned that genital warts usually, but not always, develop into condylomata acuminata at the final phase, but not necessarily during the initial phase.

These lesions of the genital and perigenital area were known since ancient times and the time of Hippocrates, and they were termed warts. The term wart means a “round colliculus near the anus” since from the ancient times it was a finding in homosexual men.

It is the most common sexually transmitted disease.

The sexual transmission of genital warts was firstly described in 1954, when Barret announced that genital warts were found in 24 women, 6 weeks after their husbands’ returned from the military campaign in the Far East (Korean War). All men had come in contact with women from the Far East and they all had genital warts on the penis.

Genital Warts – HPV

Definition

HPV-caused genital warts are due to the low risk strains of HPV, i.e. non-carcinogenic strains. Such strains may be together with high risk HPV strains on the lesions caused by genital warts. Both low- and high-risk strains are revealed when HPV strains are identified as genital warts.

Symptoms

Genital warts are not causing discomfort usually. However, in certain cases they may cause itching, burning sensation and pain to the patient, and they may bleed.

Types

There are six morphological types of genital warts:

  1. Like a small cauliflower of light or dark colour
  2. Like a small and smooth hill in the colour of the skin
  3. Type with hyperkeratotic, rough surface
  4. Flat type, like a dark coloured spot
  5. Filamentous type, like a tassel, of light colour usually
  6. With a stem, like papillomas, of dark colour usually

Localisation

In women most most genital warts appear on the area of the vaginal, perineal and perianal areas.

In men, most genital warts appear on the penis, scrotum, urethra and perianal  region.

Genital warts a are usually located on the labia and the entrance of the vagina, the anus, the head and body of the penis, but also in areas not covered by the condom, such as the base of the penis, the scrotum, while for both women, they may be located in the perianal region, the perineum, the pubic area, the the groin and upper thighs.

Nowadays, findings of genital warts in areas not covered by the condom are very common, because of the use of condoms while ignoring the risk of transmission by the area it doesn’t cover.

Less frequent sites are the lips, tongue, oral cavity, palate (velum) and pharynx. In such cases, there is a history of oral sex.

Transimission

Genital warts are among the most common sexually transmitted diseases. Most people are exposed to one of the types of HPV at some point during their lives. However, not everybody gets infected and genital warts are not developing on everyone, since the organism’s immune system may be stronger.

The modes of transmission of genital warts in order of probability are::

  • Sexual contact, vaginal or anal, without a condom
  • Sexual contact, vaginal or anal, with condom
  • Oral sexual contact
  • Overly-rigorous rubbing of the genital area with the genitals, ontaminated objects (sex toys), contaminated towels or fingers

The factors may increase the risk of HPV and genital warts transmission are the following:

  1. The frequent change of sexual partners ncreases the risk of HPV transmission. It is estimated that one in two sexually active adults will be infected at some point in their lives.
    In every sexual contact with an infected person the possibility of getting the infection is 70%. Studies in women and men show positive correlations between the number of sexual partners and genital warts. Knowing your sexual partner for less than 8 months before sexual contact has been proven to be correlated to an increased risk of getting genital warts.
    According to the data, the longer and better someone knows his/her sexual partner, the more the chances of getting genital warts are decreasing.HPV DNA has never been found in a woman, who has never had sexual contact.
  2. he development of the virus and lesions is favoured by a weakened immune system. Genital warts are more common among patients with diseases affecting the immune system, such as AIDS.
    The period of time it may delay or regress the course of the disease, the normal immune system of a human organism, is not clear.
  3. Various minor injuries such as those caused by the shaving of the perigenital area, and by certain hair removal methods, such as waxing, which are also aggravating and predisposing factors, facilitating the penetration and the infection from the virulent strains of genital warts.
  4. Apart from genital warts, due to all the above mentioned reasons, the frequency of other sexually transmitted diseases is also increased, including genital herpes and molluscum contagiosum. Pre- or co-existing genital herpes is also creating entry foci for the virus.
  5. Alcohol has been considered as an aggravating factor, although it is not evident in all research studies whether it influences the risk of virus transmission.
    Smoking has also been implied by certain studies as related to HPV, while no relation has been found by other studies. It is not clear whether smoking is an aggravating factor for the predominance of HPV or whether smoking is a co-indicator, together with other behaviours not examined in these studies.
  6. Increased presence of genital warts has been observed in women using contraceptive pills. It is not clear whether this is due to the hormonal changes or just due to the more liberated sexual behaviours.

No correlation between circumcision and warts.

When referring to the permanent presence of genital warts in an organism, the term “permanent” refers to the permanent presence of inflammation rather than to the actually permanent presence of the virus.

About the author

Dr. Christopher Tzermias

Dermatologist – Venereologist

tzermias.gr

Specialised in England (Oxford, London) and in North America (New York, San Diego) in LASER Dermatology and pioneer in the application of advanced LASER in Greece. He established the first and very well equipped inpatient departments of LASER Dermatology in Greece, in the Athens Medical Centre at Marousi, Athens, St. Luke's Clinic at Panorama, Thessaloniki and in the Interbalkan Medical Centre of Thessaloniki. He was the Director of Invasive and LASER Dermatology of the Athens Medical Centre for 18 years, from 1996 to 2014.

Accessible by appointment in his clinics in Kolonaki - 49, Vas. Sofias str. (210 72 42 600) and Marousi - 71, Kifisias Ave. (210 61 00 900).

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Is scarring possible due to the lesions from genital warts?

No scarring appears when the method of sublimation is used for treatment, which is achieved painlessly, noninvasively, without incision and stitches, using an ultrapulse CO2 laser.