What are genital warts (condyloma)?
Genital warts, medically known as condylomata acuminata, are benign skin growths that appear in the genital area and around the anus. They are caused by infection with the human papillomavirus (HPV). More than a hundred types of HPV are known; the low-risk types HPV 6 and 11 are responsible for most genital warts.
HPV is the most common sexually transmitted infection in the world, and most sexually active people encounter the virus at some point in their lives. Most infections are cleared by the immune system without causing symptoms; in some people, warts appear. Genital warts are a common, treatable condition and should not be seen as something to be ashamed of. The examination and consultation are carried out confidentially.
How are they transmitted?
- HPV is transmitted through skin and mucous membrane contact during sexual activity. In addition to vaginal, anal and oral sex, close genital contact without penetration can also lead to transmission.
- The virus can be carried and transmitted even when no warts are visible.
- Transmission through objects such as towels or toilet seats is very rare.
- Although rare, transmission from mother to baby during birth is possible.
Incubation period
The time between exposure to the virus and the appearance of warts is usually a few weeks to a few months, and sometimes even longer. For this reason, it is often impossible to determine with certainty which contact the warts came from. The appearance of warts in a long-term relationship does not necessarily mean that there has been a new contact.
Symptoms and appearance
Genital warts can appear as:
- Small, skin-coloured, pink or darker raised bumps
- Cauliflower-like growths clustered together
- Flat, slightly raised patches
- Single or multiple lesions, sometimes in clusters
In men, they most commonly appear on the shaft of the penis, the head of the penis, the foreskin, the scrotum, the groin and around the anus. Rarely, they can also be found inside the urinary opening; in this case the urine stream may spray or there may be bleeding. Warts usually do not cause pain, but they can cause itching, burning, irritation and slight bleeding.
Conditions that can be mistaken for warts
Not every bump noticed in the genital area is a wart. The following conditions are often mistaken for warts and cause unnecessary worry:
- Pearly penile papules: Small, skin-coloured bumps arranged in rows around the rim of the head of the penis. They are a normal anatomical variation, are not contagious and do not need treatment.
- Fordyce spots: Small, yellowish-white dots on the skin of the penis and scrotum; they are sebaceous glands and are harmless.
- Molluscum contagiosum: A different viral skin infection with shiny bumps that have a small dip in the centre.
- Folliculitis and small skin cysts
For this reason, when a bump is noticed in the genital area, the right approach is to be examined rather than to compare it with pictures on the internet. Self-applied wart treatments or corrosive substances can lead to both a wrong diagnosis and damage to the skin.
How is it diagnosed?
Diagnosis is usually made by examination; the typical appearance of warts is generally sufficient for diagnosis. A biopsy (small tissue sample) may be needed in the following situations:
- The appearance is atypical or the diagnosis is uncertain
- The lesion is dark, hardened, ulcerated or bleeding
- There is no response to treatment, or the lesion worsens during treatment
- The patient’s immune system is suppressed
If warts are suspected inside the urinary opening, the urethra can be examined with a thin camera. Where considered necessary, testing for other sexually transmitted infections may also be recommended.
Partners
It is recommended that the partner of a person diagnosed with genital warts is also examined. It is important for female partners to see a gynaecologist and to continue cervical cancer screening in line with their national screening programme. Avoiding sexual intercourse until the warts have healed completely, or at least using condoms, is recommended.
Treatment options
The aim of treatment is to remove visible warts and relieve symptoms. The method is chosen individually after examination, according to the number, size and location of the warts, the patient’s preference and previous treatments. Sometimes more than one method is used together.
Creams (topical treatment)
Certain creams or solutions that the doctor considers suitable are prescribed for the patient to apply at home according to a set schedule. These medicines either damage the wart tissue directly or strengthen the skin’s immune response. Their effect becomes apparent within a few weeks; redness, burning and irritation at the application site are common. Some creams cannot be used during pregnancy. These medicines should not be used without medical advice, nor replaced with wart products intended for areas other than the genitals.
Cryotherapy (freezing)
The wart tissue is destroyed by freezing it with liquid nitrogen. It can be performed in the clinic, usually without anaesthesia. More than one session a few weeks apart may be needed. After the procedure, redness, blistering and mild pain may occur in the area.
Electrocautery and laser ablation (burning)
The warts are removed by burning them with electrocautery or laser energy. This is performed under local anaesthetic; anaesthesia may be needed for numerous warts or warts covering a large area. Many warts can be removed in a single session. Healing usually takes a few weeks.
Surgical removal (excision)
The warts are surgically cut out under local anaesthetic. This is preferred particularly for large or clustered lesions or those requiring a biopsy, and it allows the tissue to be examined by pathology.
After treatment and recurrence
After treatment, it is recommended to keep the area clean and dry, follow the care advised by the doctor and avoid sexual intercourse until the wounds have healed.
Genital warts tend to recur. Treatments remove visible warts, but the virus can remain for a while longer in the surrounding, healthy-looking skin. New warts most often appear in the first months after treatment. For this reason, a follow-up examination is carried out a few weeks to a few months after treatment, and new warts are treated at an early stage. Over time, the immune system brings the virus under control in most people.
Genital warts in pregnancy
Because of changes in the immune system during pregnancy, warts may grow or increase in number. Some creams cannot be used during pregnancy; methods such as freezing, burning or surgical removal are preferred during this period, and treatment is planned together with an obstetrician. It is recommended that the male partner is also examined.
Risks
Depending on the method used, temporary pain, burning, redness, blistering, infection, changes in skin colour and, rarely, scarring may occur in the treated area. These possible side effects are discussed with the patient before treatment.
Prevention: HPV vaccination and condoms
- HPV vaccination is effective in preventing new infections with the types the vaccine covers; there are vaccines that also cover the types that cause genital warts. It is most effective before the start of sexual activity. The vaccine does not treat existing warts. Which ages and groups it is recommended for should be assessed with your doctor according to the current vaccination recommendations in your country.
- Condoms reduce the risk of transmission, but because HPV can also be transmitted from areas not covered by the condom, they do not provide complete protection.
- Being examined early when a new wart or a suspicious lesion is noticed helps to break the chain of transmission.
Although there are various studies on the relationship between circumcision and HPV, circumcision on its own should not be seen as a method of protection.
Genital wart treatment in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. In Bursa (Nilüfer), he examines male patients with genital warts in line with the principle of confidentiality at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00), and plans the treatment options together with the patient.
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book the time of your examination in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). For questions before you travel, you can send a message via WhatsApp (+90 541 622 54 82). More information is available on the international patients page and the contact page.
