Genital warts is a viral infection that creates lesions called condyloma, which are raised from the skin in the genital area, is transmitted by sexual contact, the causative agent is human papilloma virus (HPV), and its spread has increased rapidly in recent years. Patients with the potential for occult transmission, that is, individuals who carry the infection but do not have visible lesions, cause the infection to become more serious in terms of epidemiology. Considering that 50-75% of the sexually active male and female population in the USA has encountered HPV at least once in their lifetime, the severity of the infection will be better understood.
The most important complication of HPV infection is the risk of malignant transformation in the cervix in women, that is, it paves the way for the development of cancer. For this reason, annual check-ups with “Pap smear” in HPV-infected women are of great importance in terms of catching cervical cancer before it progresses. Considering that HPV DNA (HPV 16 and 18) is detected in 90% of cervical cancer cases, it will be better understood how strong the cancer-causing potential of the virus is.
The time it takes for the lesion to appear after infection can range from a few weeks to 18 months. More than 100 subtypes of HPV have been identified. HPV cannot be produced in tissue culture in the external environment and cannot be transmitted to experimental animals. This limits experimental research on HPV. Again, there is no serological diagnosis method that defines acute and past infection.
HPV classification cannot be done serologically. It is classified according to genotype. This is done by molecular hybridization techniques. This method is currently accepted as the gold standard in the laboratory diagnosis of HPV. Again, it is possible to detect specific viral genomes of HPV DNA by polymerase chain reaction (PCR) techniques. However, since the method is expensive, it is only used in research for now. In the detection of occult infections, the method of seeing acetowhitening after 1-5 minutes with 3-5% acetic acid solution is used. Examination with acetic acid is especially important in detecting infected areas during vaginal colposcopic examination. For this purpose, acetic acid solution called vinegar is used abroad.
HPV’s E 6 and E7 genes are responsible for its cancer-causing potential, and HPV vaccines have been developed against the E6 and E7 gene proteins of HPV16 and 18. Vaccines are prepared for prophylactic (preventing the onset of infection) and therapeutic (treating existing infection) purposes. The newly introduced prophylactic protective vaccines are viral recombinant vaccines developed against the L1 and L2 capsid antigens of HPV 16. Therapeutic therapeutic vaccines are being developed against the E1, E2, E6 and E7 gene proteins of HPV 16 and are not yet in practical use. Although the primary target of therapeutic vaccines is the treatment of infection, the fact that they have been developed against E6 and E7 oncogenic gene proteins will also provide long-term protection from the development of cancer secondary.
Various methods are used in the treatment of genital warts. Physical methods such as electrocauterization, cryotherapy, cytotoxic agents such as podophylline, and immunomodulatory agents such as imiquimod are the treatment methods that are widely used in the treatment of genital warts. While eradication of the wart occurs in all treatment options, since it is not possible to eliminate the virus, relapses may occur from time to time, which requires the patient to stay under the control of the physician for a long time.
