Genital infection with human papillomavirus (HPV) is the most common of all sexually transmitted disease (STD), with genital warts occupying about a third of consultations in specialized centres like ours.
Most of these infections are asymptomatic and subclinical, and can only be diagnosed by physical examination, cytology or a test to detect viral DNA. Genital warts are the most visible manifestation of HPV infection. They can be located in different areas, so it is essential to fully explore the entire genital area.
The types of HPV that infect the anogenital region are divided into non-oncogenic or low risk (6, 11, 42, 43, 44), associated with genital warts, mild dysplasia lesions not progressing to high grade lesions and recurrent respiratory papillomatosis, and high-risk or oncogenic types (16, 18, 31, 33, 35, 39, 45, 51, 52, …), associated with the appearance of dysplasias that can progress to high grade lesions or cancer.
The main transmission route of genital HPV infection is penetrative sexual contact. However transmission by genital skin to skin contact has also been described. Although the primary route is sexual, there are also other ways of transmission, which are not strictly sexual, such as digital or through objects. 55% of patients with genital warts have been shown to have the same HPV on their fingers.
Among others, these warts must be differentiated from Molluscum contagiosum warts, common warts, flat condylomata, seborrheic keratosis, lichen planus, etc.
Biopsy is the definitive diagnostic method, although it may be suspected by inspection with acetic peniscopia and magnifying lenses or specific cytology. The screening test for HPV DNA by PCR is the most sensitive method for the diagnosis of genital HPV infection.
With treatment, the infection is not eradicated, but it is reduced, and probably the transmission of HPV too. We recommend treating warts, by laser or conventional surgery if they are primary, multiple or large, and medical treatment in the case of small or single warts. These treatments are usually painless and easy to perform. It is also important to provide psychological and emotional support to the patient, who is usually overwhelmed by a state of confusión and a feeling of guilt.
Relapses are frequent, especially in the first three months. Approximately 20-50% of patients will have a relapse. It is important to inform the patient that this does not mean treatment has failed, and that sometimes more than one treatment session will be needed in order to eradicate the warts. Reviews should be conducted every 3 months.
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