0538 983 18 78What Is HPV (Human Papillomavirus)? How Is It Transmitted and How Does It Progress in the Body?

HPV is a group of viruses that infect the skin and mucous membranes (such as the mouth, throat, genital area, and anus).

• Transmission Routes: The most common route of transmission is sexual contact (vaginal, anal, or oral sex). It can also be transmitted through close skin-to-skin contact, such as the rubbing of genital organs against each other. For this reason, although condom use reduces the risk of transmission, it does not provide complete protection since it does not cover other areas of contact. The virus can be transmitted even without symptoms or visible warts.
• Clearance from the Body: The vast majority of HPV infections (80-90%) are transient. The body’s immune system usually clears or controls the virus within 1 to 2 years, often without the infection ever being noticed.
• Persistent Infection: In some cases, infections caused especially by high-risk HPV types can become persistent in the body. If the immune system cannot clear the virus, this persistent infection can lead to cellular changes and the development of cancer over the years (usually over 10-15 years or longer). Factors such as smoking can increase the risk of the infection becoming persistent.

HPV Types: Why Is the Distinction Between Low-Risk and High-Risk HPV Important?

HPV has more than 100 types, but not all of them cause the same health problems. There are two clinically important main groups:

• Low-Risk HPV Types: These types generally do not cause cancer. They most commonly lead to genital warts (condylomas). The most common low-risk types responsible for genital warts are HPV Type 6 and Type 11 (responsible for approximately 90% of all genital warts). They can rarely cause warts in the respiratory tract (respiratory papillomatosis).
• High-Risk (Oncogenic) HPV Types: These types have the potential to lead to cancer in cases of long-term infection. They are responsible for nearly all (99%) cervical cancers. The high-risk types most commonly causing cancer are HPV Type 16 and Type 18 (responsible for approximately 70% of cervical cancers). Other high-risk types (e.g., 31, 33, 45, 52, 58, etc.) can also cause cancer. High-risk HPV types are also associated with cancers of the vagina, vulva, anus, penis, and oropharynx (base of the tongue, tongue root, tonsils). These types generally do not cause genital warts, and the infection is usually asymptomatic; their presence can only be identified through screening tests (HPV test, Pap smear) or by detecting the cellular changes they cause.

What Is a Genital Wart (Condyloma)? What Are the Symptoms and How Is It Diagnosed?

Genital warts (condylomas) are benign skin or mucosal growths that occur in the genital area or around the anus, caused by low-risk HPV types (mostly Type 6 and 11).

• Appearance: They are usually skin-colored, pinkish, or brownish, and can occur singly or in multiples. Their surface may be flat, rough, or, most typically, cauliflower-like in appearance. They can be as small as a pinhead or can merge to form larger masses.
• Location: In women, they most commonly occur on the vulva (labia majora, labia minora, clitoral area), vaginal walls, cervix, perineum (the area between the vagina and anus), and around the anus. In men, they can occur on the penis, scrotum, and around the anus. They can rarely be seen in the groin or on the inner thighs as well.
• Symptoms: Genital warts are usually painless. However, depending on their location and size, they can sometimes cause itching, burning, mild bleeding (especially after intercourse or friction), or discharge. Due to their appearance, they can cause aesthetic concern, embarrassment, and psychological stress.
• Diagnosis: Genital warts are usually diagnosed through a careful visual examination by a physician. The typical appearance of the lesions is sufficient for diagnosis. In doubtful cases (for example, if the color or structure of the lesion is atypical, if it does not respond to treatment, or if the patient’s immune system is weak), a biopsy may be taken to confirm the diagnosis or to distinguish it from other lesions (molluscum, skin tags, precancerous lesions, etc.). Routine HPV DNA typing is not necessary for warts. When a wart is detected in a woman, it is important to perform a gynecological examination and a Pap smear test to check whether there is also a lesion on the cervix.

Genital Wart Treatment: Current Methods Applied in Ankara

The main goal in treating genital warts is to eliminate visible lesions, relieve the patient’s complaints (if any), improve the aesthetic appearance, and potentially reduce contagiousness (however, treatment does not completely eliminate the virus and the risk of transmission may persist). The choice of treatment is determined individually based on the number, size, and location of the warts, the patient’s preference, the cost of treatment, possible side effects, and the physician’s experience. The treatment options applied or recommended by Prof. Dr. Nuray Bozkurt in Ankara are as follows:

1. Patient-Applied Topical Treatments (Prescription Creams/Solutions): These treatments are generally suitable for small, few external genital warts. The patient applies the medication directly onto the warts as instructed by the doctor.

• Podofilox (0.5% solution or gel): Destroys the wart by preventing cell division. Applied twice a day for 3 days, followed by a 4-day break; this cycle can be repeated 4 times. Not used during pregnancy.
• Imiquimod (3.75% or 5% cream): Stimulates the body’s own immune system to fight the virus. It is usually applied 3 nights a week before bedtime and washed off in the morning. Treatment can take several weeks or months. It may cause local reactions such as redness and irritation on the skin.
• Sinecatechins (15% ointment): An extract derived from green tea. Although its mechanism of action is not fully understood, it may affect the immune response. Applied 3 times a day, and treatment can take a long time.

2. Physician-Applied Treatments (In a Clinic/Office Setting):

• Cryotherapy (Freezing Treatment): Freezing of the warts using liquid nitrogen (-196°C) or carbon dioxide spray. It is a very commonly used, effective method. The wart tissue freezes, dies, and crusts over and falls off within a few days. Several sessions may be needed, usually at 1-3 week intervals. A mild burning or stinging sensation may occur during the procedure. Blistering or mild pain may follow.
• Trichloroacetic Acid (TCA) or Bichloroacetic Acid (BCA): Chemical agents used at concentrations of 80-90%. Applied directly onto the wart, they create a chemical burn and destroy the wart tissue. Must be applied carefully by the physician, as it can damage surrounding healthy tissue. Usually applied in weekly sessions. Can be safely used during pregnancy.
• Podophyllin Resin (10-25% solution): A plant-derived medication that stops cell division. Carefully applied onto the warts by the physician, and the patient is instructed to wash the area 1-4 hours later. Since it can cause serious irritation, it is not applied to large areas and is strictly not used during pregnancy. It is less preferred today.
• Surgical Excision: Removal of warts, particularly large, pedunculated, or few in number, by cutting them out with a scalpel or scissors under local anesthesia. Usually provides treatment in a single session but may require stitches and can leave a scar. It is also a suitable method for obtaining a biopsy.
• Electrocauterization (Burning Treatment): Burning of the warts using a device (cautery) that generates electric current. Usually requires local or regional anesthesia. Can be used especially for widespread or large warts. Produces smoke, and healing time may be somewhat longer.
• Laser Treatment (CO2 Laser Ablation): Vaporization or excision of warts using a laser beam. Can be preferred especially for very widespread, large warts, or warts resistant to other treatments. Usually requires anesthesia and is more costly than other methods. Requires special equipment and experience.

Treatment Choice and Follow-up: Prof. Dr. Nuray Bozkurt will determine the most suitable treatment method for you and create your post-treatment follow-up plan. It should be remembered that no treatment method completely eliminates the HPV virus from the body. Treatment only destroys the visible warts. Until the immune system brings the virus under control, there is a possibility of recurrence of warts (between 25-65%). For this reason, regular follow-up after treatment is important.

The Relationship Between HPV Infection and Cervical Cancer: The Importance of Screening and Prevention

Although genital warts are usually caused by low-risk HPV types, the most important health problem that comes to mind when HPV infection is mentioned is cervical cancer. High-risk HPV types are the main cause of this cancer. For this reason, protection against HPV and cervical cancer screening are of great importance:

• Regular Screening: The most effective way to detect cervical cancer and precancerous lesions at an early stage is through regular gynecological checkups and screening tests. In line with Turkey’s national screening program and current guidelines, a Pap smear test every 3 years is generally recommended for ages 21-30, while for ages 30-65, either a combined Pap smear and HPV test (co-testing) every 5 years or HPV testing alone is recommended. If your screening results are abnormal, Prof. Dr. Nuray Bozkurt will perform further evaluations such as colposcopy.
• HPV Vaccines: The most effective way to protect against HPV-related cancers and genital warts is HPV vaccination. The vaccines available on the market (Gardasil, Gardasil 9, Cervarix) provide a high level of protection against the HPV types that most commonly cause cancer (such as Type 16, 18) and/or genital warts (such as Type 6, 11). It should be remembered that vaccines are preventive and do not treat an existing infection or lesion. Ideally, vaccination is recommended for girls and boys aged 9-14, before the onset of sexual activity. However, vaccination can also be given at older ages (up to age 26, sometimes up to age 45 on a doctor’s recommendation) and can still provide benefit. Prof. Dr. Nuray Bozkurt provides guidance on the vaccination schedule and its suitability for you.
• Safe Sexual Life: Monogamy or limiting the number of partners reduces the risk of HPV transmission. Condom use is always recommended; although it does not provide complete protection against HPV, it significantly reduces the risk of transmission.
• Not Smoking: Smoking weakens the immune system, increasing the risk of HPV infection becoming persistent and progressing to cancer.

HPV and Genital Wart Treatment in Ankara: A Reliable and Comprehensive Approach with Prof. Dr. Nuray Bozkurt

Prof. Dr. Nuray Bozkurt provides her patients in Ankara with an evidence-based, up-to-date, and comprehensive service regarding HPV infections, genital warts, and other HPV-related gynecological problems:

• Accurate Information and Counseling: She informs her patients accurately and clearly about what HPV is, how it is transmitted, its risks, prevention methods, and treatment options.
• Effective Screening and Diagnosis: She performs cervical cancer screenings (Pap smear, HPV test) in accordance with current guidelines. She thoroughly evaluates patients with abnormal results using colposcopy. She accurately diagnoses genital warts.
• Personalized Wart Treatment: She selects and applies the most suitable treatment method (cryotherapy, TCA, electrocautery, surgical excision, etc.) based on the number, size, location, and preferences of the patient’s warts.
• HPV Vaccine Counseling: She provides her patients with information about HPV vaccines and guidance on the vaccination schedule.
• Patient Privacy and Psychological Support: Aware of the sensitivity of HPV and genital warts, she provides service to her patients in a non-judgmental, understanding, and supportive manner. She pays the utmost attention to patient privacy.
• Easy Accessibility: You can easily reach her clinic with any questions regarding the treatment process or follow-up (0538 983 18 78)(0312 284 00 12).

If you have noticed wart-like growths in your genital area, if you have learned that you carry HPV, if you have questions about your Pap smear or HPV test, or if you would like information about the HPV vaccine, you should not hesitate to consult a specialist physician. By making an appointment with Prof. Dr. Nuray Bozkurt at our clinic in Ankara, you can get answers to all your questions, undergo the necessary evaluations, and create a treatment or follow-up plan tailored to you. For an appointment, contact us at 0538 983 18 78.