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It has been estimated that at least 75% of the population of childbearing age is infected by the guilty virus HPV.

genital warts

General Information & Methods of Transmission

It is the most common sexually transmitted disease, but the triptych information-prevention-treatment can be proven winning, if followed properly.

Genital warts (condylomata acuminata) exist since the ancient times, more specifically from the time of Hippocrates. At that time they were mostly observed in homosexual men, while nowadays they constitute a problem of both homosexual and heterosexual men and women. Even sexual contact between two women can be a threat, since rubbing between the female genital organs is enough for the transmission of the virus. This is also true when it comes to rubbing with contaminated fingers, contaminated sex toys or other contaminated objects (such as towels, bed sheets, etc.).

It has been estimated that at least 75% of the population of reproductive age is infected by the guilty virus HPV (Human Papilloma Virus) at some point of life, of which 50% is people between 15 and 25 years old. These percentages explain why genital warts are the most common sexually transmitted infection.


Don’t ignore them

Their presence is due to an infection by strains of the virus called “human papilloma virus”. Common warts are caused by different strains of the same virus that also causes dysplastic lesions in the cervix and may progress into the development of malignancies. Until today, more than 80 strains of the virus have been identified, 40 of which infect the genital, perinatal and oral area of sexually active people. Cutaneous warts are caused by low-risk HPV strains, i.e. non carcinogenic strains. Nevertheless, within these strains there may also be high risk HPV strains present (such as 16, 18, 31, 33 and 45), which may cause cancer (e.g., cervical, anal). Therefore, the diagnosis should be made as soon as possible.


Symptoms, types and detection

In many cases warts are symptomless. Rarely the patient may complain because of a feeling of pain, itching or burning sensation. Even in less cases a wart may bleed, which consequently leads to increased rate of transmission in the surrounding areas.

The appearance of the lesions varies and six morphological types have been identified:

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

In men, most genital warts appear on the urethra, the penis, the scrotum, the mons and the perianal region, the groin and upper thighs. In women, warts are detected in the labia, the vaginal walls, the mons pubis, and the perineal, perianal and groin areas. Many times, they are not easily detectable, as they may be covered by hair or they may be located between skin folds. On the other hand, in neglected cases they form extensive plates that can block the urethra or vagina, making both urination and sexual penetration painful. Since warts can be also transmitted through oral sex, they can also appear in rare cases on the lips of the mouth, the tongue, the oral cavity, the palate and the pharynx.

The lesions that cause cutaneous warts, may be clinical (visible to the naked eye), subclinical (visible only with a magnifying glass) or latent (not visible, they can be detected only with PRC identification through a sample of tissue).


Modes of transmission

Condyloma acuminata, which are named after their acute, sharp end formed when they are finally configured, are transmitted through sexual contact, either through the vaginal or through the rectal route. In addition to this, there is also a risk in cases of rubbing with contaminated fingers or contaminated sex toys or other objects (towels, bed sheets).

The virus enters the skin and mucous through microscopic scratches that are caused in the genital and perinatal areas during sexual contact. This is the reason why the use of a condom is not enough, as it does not cover entirely all areas on which the virus may exist and be incubated.

Nevertheless, it is worth noting that genital warts do not infect everyone who is exposed to the virus, and the lesions are not present in all infected people, as the immune system may be stronger. However, even when the lesions are actually visible, the long incubation period of the virus (it may last up to eight months), and the possible preservation in latent condition even for several years before its “awakening”, make the identification of the sexual partner who transmitted the virus difficult, especially in case of transient relationships.

Therefore, frequent change of sexual partners is the biggest risk factor for the transmission of the virus. It’s estimated that in any sexual contact with an infected person, the risk of contamination reaches 70% if no proper protection is used. Obviously, the people who are mostly protected are those who are in a long term relationship or know their partner more than eight months before starting sexual contact with him/her.

Another particularly important point is the body’s own defence system. In case of excessive weakness because of an autoimmune disease or because of some immunosuppressive or immunomodulatory treatment, the probabilities of infection multiply, together with the probabilities of genital warts development and further exacerbation of the infection.

Apart from the above, another aggravating factor is the small injuries that can be caused by shaving or waxing of the genital area, as well as concurrent sexually transmitted diseases, like for example genital herpes. Other factors that have also been implicated include smoking, alcohol consumption and the use of contraceptive pills, which seem to be associated with other habits too that have not been taken into consideration in the relevant clinical studies, such as the choice of not using a condom while taking contraceptive pills.

See the infographic to find out more about genital warts.

About the author:

Christofer Tzermias

Specialised in the UK (Oxford & London) and in North America (New York & San Diego) in the field of LASER Dermatology, Dr Tzermias, has been providing dermatological state-of-the-art treatments using cutting-edge LASER and Energy based Devices for over 20 years. He has been Director of Interventional and LASER Dermatology Department at the Athens Medical Center for over 18 years and for the last 9 years is the Scientific Director of IQ - Intensive Quality Dermatology & Cosmetic Surgery Clinics, which at the 2017 Healthcare Awards won the ‘Innovation Award for Innovative Services’ for their pioneering contributions. Since 2018, IQ Dermatology & Cosmetic Surgery Clinics has also been operating in London, UK and in Muscat, Oman. Dr Tzermias is a Fellow of the world-renowned American Society for LASER Medicine and Surgery (ASLMS), a Founder Member of the European Society LASER Dermatology (ESLD), the Vice President of the ‘Open Health Alliance’ and he is also on the Board of Directors of Elitour - Greek Medical Tourism Council.

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