Genital warts (condylomas) – causes, symptoms and treatment

Condylomas, also called genital warts, are small growths on the skin and mucous membranes of the genitals and around the anus. They are caused by the human papillomavirus (HPV) and are among the most common sexually transmitted infections, especially in young people.

Although they are not life-threatening, genital warts are contagious, tend to come back and cause worry and tension in a couple. The good news is that they are recognised with a simple examination and are removed successfully. Dr Penev sees and treats patients with genital warts in Plovdiv and Karlovo.

What are genital warts

More than a hundred types of HPV are known. About nine out of ten cases of genital warts are caused by types 6 and 11, which are considered low-risk – they cause growths but do not lead to cancer. High-risk types, such as 16 and 18, rarely form visible warts, but they are linked to pre-cancerous changes and to cancer of the cervix, penis, anus and throat.

The virus enters through microscopic breaks in the skin during vaginal, anal or oral sex, and through close skin-to-skin contact; condoms reduce the risk but do not remove it. The incubation period is long – from a few weeks to months, and sometimes longer – so the appearance of genital warts does not necessarily mean recent infidelity. Most people who are infected have no visible changes and do not suspect that they carry the virus.

Symptoms

• soft, skin-coloured, pink or greyish growths on the glans, foreskin, frenulum and shaft of the penis, the scrotum, the groin or around the anus;
• single or clustered growths, sometimes merging into a bumpy surface that looks like cauliflower;
• flat, barely noticeable spots, seen mainly on dermatoscopy;
• itching, burning or slight bleeding with friction – there is usually no pain;
• with warts at the opening of the urethra – a split stream or bleeding when passing urine.

When it should not be put off: a growth that grows quickly, bleeds on its own, is hard, ulcerated or darkly pigmented must be examined straight away, because it may be a pre-cancerous or cancerous change; the same applies to genital warts that spread unusually in someone with a weakened immune system.

Causes and risk factors

The only cause is HPV infection. The risk of catching it and developing warts is higher with:

• starting your sex life early and having more partners;
• sex without a condom with a new partner;
• a weakened immune system – chronic illness, immunosuppressive medicines, HIV infection;
• smoking, which makes it harder to clear the virus;
• inflammation of the glans, for example balanitis, and other sexually transmitted infections;
• a tight foreskin (phimosis) and the moist environment beneath it.

Diagnosis

In most cases the diagnosis is made by looking. Dr Penev asks when the changes started, about sexual contacts and previous treatment, and examines the penis, scrotum, groin and the area around the anus. If needed, dermatoscopy – examination under magnification – shows the typical blood-vessel pattern of a wart and distinguishes it from pearly papules along the rim of the glans, which are a normal variant (see the article on white spots on the penis), from small sebaceous glands and from molluscum contagiosum.

A biopsy is taken if the appearance is unusual, if there is pigmentation or bleeding, or if there is no response to treatment. With warts at the opening of the urethra, the canal is also examined, because the growths can spread inwards and mimic urethritis. Because HPV often goes together with other infections, Dr Penev offers testing for syphilis, HIV, chlamydia and gonorrhoea; a special HPV test is not done routinely in men, because it does not change the treatment.

Treatment

The aim of treatment is to remove the visible warts; there is no medicine against the virus itself, but the immune system usually suppresses it over time. The choice of method depends on the number, size and location of the warts and on your preferences.

Treatment at home: for small and few warts, Dr Penev may prescribe a preparation that you apply yourself to a schedule over several weeks – a podophyllotoxin solution, which destroys the wart tissue, or a cream that stimulates the local immune response.

Procedures at the practice: genital wart removal is done under local anaesthetic – depending on the case and the doctor’s judgement – with a laser, electrocoagulation, cryotherapy with liquid nitrogen, or excision for larger growths. The procedures take minutes, the skin heals in one to three weeks, and sometimes several sessions are needed. Extensive warts, or warts inside the urethra, are treated in hospital at Kaspela University Hospital (UMBAL Kaspela), Plovdiv.

Recurrences are common, mostly in the first three to six months, so follow-up visits are needed. During treatment, avoiding sex or using a condom is recommended, and your partner should be told and examined.

When to see a urologist

Book a consultation for any new growth on the genitals, even if it does not hurt – only a specialist can tell a wart from normal skin variants and from more serious changes. See a urologist too if you have had contact with a partner with confirmed genital warts, even if you have no visible changes yet.

Prevention

The most effective protection is the HPV vaccine, which protects both against the types that cause most genital warts and against the high-risk types. It works best before the start of sexual life, but after assessment it can also be useful for adult men. Condoms reduce the risk, and giving up smoking helps the immune system clear the virus.

Genital warts are unpleasant but treatable and should not make you put off seeing a doctor. Book an appointment with Dr Penev in Plovdiv or Karlovo – the consultation is discreet, and the treatment plan is drawn up to suit your situation.