Genital Warts

Nowadays, the viral infection of warts is considered one of the most common and widespread sexually transmitted diseases. An estimated, 50-70% of sexually active individuals will contract HPV in their lifetime, and there is a 70% chance that any unprotected sexual intercourse with a person infected with the virus will also infect his/her partner.
Dr. Amalia Tsiatoura
DERMATOLOGIST - VENEREOLOGIST

Warts" usually appear in only 10% of people carrying HPV, as in many cases the virus is fought by the immune system and does not manifest itself, remaining in a latent state." says Dermatologist - Venereologist Dr. Amalia Tsiatoura.

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Genital Warts

Transmission

The human papilloma virus (HPV) is the most common cause of sexually transmitted diseases. There are about 70 different genotypes of HPV and they are divided into high-risk and low-risk. The former are responsible for the development of various malformations, as well as for the development of cancer, especially cervical cancer. The latter are mainly associated with warts, with HPV genotypes 6&11 being responsible for 90% of cases.

The transmission of warts is mainly through sexual intercourse (vaginal, anal, or orogenital), as well as through any contact with the skin or mouth. Transmission of warts is easiest when clinically visible warts are present, whereas in subclinical cases transmission of warts is significantly less, but not non-existent. The appearance of warts occurs either in internal or external areas of the genital organs (internal warts and external warts). In many cases, there is also extensive spread to the surrounding areas. The virus enters the skin and mucous membranes through small lesions in the genital area, which are formed during sexual intercourse.

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Genital Warts

Diagnosis

Today, thanks to the HPV DNA Test, it is possible to make an accurate diagnosis of warts and HPV infections and identify the type of virus responsible for the lesion. We can also determine whether the virus is low or high risk. It is applied to all HPV lesions in both men and women by taking a cervical smear in women or a tissue sample from the lesion in men.

At Cosmetic Derma Medicine, DNA Test is performed in all cases of recurrent genital warts and HPV infections. Our Dermatology & Plastic Surgery Department provides a full range of genital warts treatment, even in a single visit.

This is achieved with CO2 Laser treatment, combined with Surgical treatment where required. Genital warts treatment aims to treat warts radically, where possible, in order to prevent infection or the development of symptoms in the future.

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Genital Warts

Treatment

Although in some cases genital warts can disappear on their own, it is recommended to treat them immediately. Depending on the number and size of the lesions, warts can be treated with the following methods:

Genital Warts treatment with CO2 Laser

Treatment of genital warts with CO2 Laser is the most effective method of fighting warts and is much faster than the use of creams that take several weeks to act. In addition, using the CO2 Laser achieves not only the treatment of superficial symptoms, but the problem is treated from the root. Laser treatment selectively targets only the existing warts leaving the surrounding healthy skin intact. CO2 Laser treatment is characterized by the absence of post-operative pain and scarring, while the aesthetic result is excellent. Genital Warts treatment with CO2 Laser is bloodless, painless, and scar-free and the treatment of the problem is often definitive in a single session. It has also been shown by clinical studies that applying lasers to warts is also associated with a lower risk of recurrence, as their reappearance afterwards is significantly reduced.

Genital Warts treatment with Cryotherapy

This is an easy method that is being used for more than 50 years for the treatment of genital warts. The lesions are cooled either directly, with liquid nitrogen injected in the form of a spray or through a cryoderm. Usually, no local anesthesia is used and pain is well-tolerated. It is considered a safe method for genital warts treatment, which can also be applied during pregnancy. It should be repeated every 1-2 weeks until the complete disappearance of the lesions. As a treatment for genital warts, it is inferior to laser as it causes greater damage and scarring and is associated with higher recurrence rates.

Treatment of genital warts with Cauterizing

When the lesions are few in number, they can be destroyed by electrothermal therapy under local anesthesia. The treatment of warts with cauterizing is inferior to laser treatment as it causes a great deal of thermal damage to healthy tissue and scarring. There is postoperative pain and bleeding and the recurrence rate is quite high.

Surgical removal of warts

Genital Warts surgical removal is applied in exceptional cases and mainly when we have their development on phimosis where circumcision is performed, as well as in neglected cases, when the lesions congregate in single hyperplastic plaques and do not respond to local wart treatment or develop on hemorrhoids areas. In exceptional cases, full-thickness skin grafts may be required.
Genital Warts

FAQ

What are the advantages of CO2 Laser treatment?

The method of treating genital warts with CO2 Laser has significant advantages:
  • It is bloodless, painless and minimally invasive
  • It does not require stitches and leaves no permanent scars or marks.
  • It does not require a long recovery time.
  • It has the lowest recurrence rate in HPV lesions and is thus the most effective genital warts treatment.

What are the problems caused by genital warts?

HPV viruses are divided into high-risk and low-risk viruses. HPV 16 and HPV 18 are oncogenic viruses. The complications of warts are classified into:
  • Mild complications: formation of erosions and wounds on the skin and mucous membranes (sores), bleeding, inflammation, and problems with urination and defecation. They are usually accompanied by intense psychological stress.
  • Major complications: Huge increases in the size of the warts (giant warts), precancerous lesions, and malignant neoplasms of the genital area, penis, vulva, anus and even the bowel.
HPV 16 and HPV 18 in women are associated with the development of cervical cancer. Therefore, when there is HPV infection and genital warts occurrence, there may be an increased chance of developing cancer. In men, genital cancer may be associated with HPV infection, from HPV 33, HPV 35, HPV 56 and HPV 58.

How can we prevent genital warts infection?

Low-risk HPV genotypes, the ones responsible for the development of warts, can occur in any sexually active person. The only way, therefore, to reduce the risk of infection is to abstain from sexual intercourse or to have intercourse only with a partner who only has intercourse with you. Even the use of condoms does not offer 100% protection against transmission of the virus. If a person develops genital warts, then abstinence from all sexual activity is recommended until the lesions are completely removed.

Because "strict monogamy" is practically impractical, the best way of prevention is to use a condom at every sexual intercourse, not to change sexual partners too often, to regularly visit and get examined by a dermatologist and to apply the HPV vaccine before starting sexual intercourse.

In addition to people who regularly change sexual partners, people with weakened immune systems are more susceptible to infection. The percentage of sexually active men who are about to become infected with HPV is as high as 50%, and research has shown that a woman's chance of becoming infected with HPV is higher in women who consume several alcoholic drinks, as well as in those who have regular sexual intercourse. The riskiest age for a woman is in her 20s and gradually decreases until 35.

The diagnosis of genital warts is clinical, as their form is characteristic and should be carried out by an experienced dermatologist in order to suggest the appropriate method of treatment for the affected area, Whereas biopsy is used only in cases where a differential diagnosis of warts from other lesions occurring in the area and presenting the same clinical picture is required, such as syphilis, nevi, papillomas, warts, infectious tremor, genital malformations and cancers.

What are the symptoms of genital warts?

The symptoms of genital warts vary and are never the same in every patient. In many cases the virus does not cause warts to appear and is only detected by clinical and laboratory tests. Furthermore, there are cases where warts are not immediately visible as they are covered by the hair in the area. When they do occur, genital warts appear as skin protrusions and may look like small pimples or moles. They may be white or the same colour as the skin and are often extremely difficult to detect with naked eye due to their small size. In this case, they can only be detected with an HPV DNA test and are called "subclinical".

Many times, the symptoms of genital warts can mimic the clinical picture of other lesions, such as syphilis, moles, infectious termites, which can take a brownish form, papillomas and warts. The clinical distinction of the above lesions from warts can only be made by a Dermatologist – Venereologist.

Warts may be numerous, small and isolated, clustered or solitary and quite large with a smooth or blossom-shaped surface. Usually, the symptoms of warts do not include pain or bleeding, but these are not excluded in very large warts that can be injured. The most common areas are:
  • Vulva
  • Penis
  • Anal
  • Urethra
  • Clitoris
  • Scrotum
  • Mouth
  • Tongue
  • Lips

Is it possible that I could be infected and not know it?

In many cases our immune system fights the virus on its own, or renders it inactive, through its endogenous defense mechanisms. Thus, there are quite a few times when a person, even if infected with the virus, does not develop genital warts. Furthermore, due to the general asymptomatology of the virus, warts may not be noticed by the patient. In any case, any person with an active sexual life should be examined regularly by a dermatologist for the presence of warts.

In which areas are genital warts developed?

In women, genital warts are usually found on the vaginal area, cervix, labia, urethra and sometimes, more rarely, they may develop on the bladder. The causes that help acute warts to develop are infection with trichomoniasis, some other infections that cause the area to be wetted by vaginal secretions and pregnancy. In pregnancy warts can become hyperplastic strongly exophytic and can spread very easily.

In men, the location of warts is usually in the area of the glans, the penis, the scrotum, the epididymis, the inner petal of the foreskin, the urethra and, less frequently, the bladder. Causes that help acute warts to develop are topical corticosteroid use, urethritis, mucositis, immunosuppression and oxyuria. High incidence rates in the development of warts are seen in HIV carriers, chronic use of immunosuppressive drugs and in cases of diabetes mellitus.

Is recovery required after laser treatment for genital warts?

One of the advantages of genital warts treatment with CO2 Laser is that the recovery period is minimized and patients are able to return to their daily activities immediately. There is no pain, discomfort, bleeding and scarring. The patient can return to work and daily activities on the same day.

Is there any chance of recurrence?

There are people who will only be affected once. However, due to the ability of the virus to remain active in the cells for a long time, many patients may relapse and experience symptoms several times during their lifetime.

I am pregnant and have been infected with HPV, what should I do?

Pregnant women are also potential targets of the human papillomavirus (HPV). In general, infection should not be a cause for concern as it does not cause any problems. However, in some cases, multiple warts may develop or increase in size.

Less commonly, the presence of warts may lead to cellular changes. For this reason, it is very important that all pregnant women have a cervical screening, especially those who have not had a test at least a year before pregnancy.

If there are active warts at the time of delivery, a Caesarean section should be performed.

Why should I choose Cosmetic Derma Medicine for the treatment of genital warts?

Cosmetic Derma Medicine Medical Group is the largest and most specialized medical group with 14 clinics in Greece & Cyprus, and more than 15 years of experience in the field of Dermatology & Plastic Surgery.

Thanks to the latest generation equipment, it is possible to treat genital warts with CO2 Laser, Cryotherapy, Cauterizing or Surgically. The high rates of successful treatment of genital warts in just a single visit prove the effectiveness of the use of CO2 Laser, in combination with the specialized medical staff of Cosmetic Derma Medicine.

The Dermatology & Plastic Surgery Department of the clinic, headed by the Dermatologist – Venereologist Dr. Amalia Tsiatoura and the Plastic Surgeon Dr. Anastasios Vekris, provide a full range of treatment for even the most challenging cases of genital warts. Our medical team is at the patient's side 24/7 for whatever is needed.
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