Anogenital warts, also called condyloma acuminate, are one of the most common sexually transmitted diseases caused by human papillomavirus (HPV). At least 75% of sexually active adults have been infected with at least one type of anogenital HPV at some time in their life. Clinically, they present as small tumors, almost flat or slightly inflated, a few millimetres in diameter, which appear in the genital area. However, their size may vary, and can range from the size of pin’s head up to 12 cm, in cases of giant condylomas. Usually pain is not observed. They are highly contagious, and occur in equal numbers in unvaccinated males and females. Transmission from one partner to another can occur even when a condom has been used.
Lesions are divided into three main categories:
- Clinical lesions ( those seen with the naked eye)
- Subclinical lesions (distinguished only by magnifying glass and not by naked eye)
- Latent lesions (give no visible signs and are detected by PCR identification by tissue sampling)
Anogenital warts may occur in the following sites: Vulva, vagina, cervix, urethra, penis, scrotum and anus. However, they can also arise on the lips or within the oral mucosa. They should be diagnosed exclusively by a dermatologist who is expert in selecting the appropriate treatment.
The virus cannot be eradicated from the body. It infects cells and stays inside them forever. But malformations and clinical/subclinical lesions can be removed.
Available treatments include:
- Cryotherapy
- Electrosurgery
- Laser ablation
- Surgical removal
- Treatment with chemicals (podophyllotoxin)
None of the above methods is better than the other and none is ideal for all occasions. Many times a few months after a successful treatment, warts appear again in the same area. This is because when an area is infected, several of its cells may display the infection at different times. Thus although some sites that had warts were healed, adjacent sites that appeared healthy may develop warts later. For this reason, even after treatment, areas that have warts that are not visible (anus, vagina) need reexamination. We should always keep in mind that the HPV types that cause external visible warts rarely cause cancer. Other HPV types are less common in visible warts but are strongly associated with anogenital cancer. Therefore HPV vaccination should be performed before the onset of sexual activity as it is most effective when offered at a young age.
