The population studied were young adult patients confirming the higher prevalence of GW among young population . Half of the patients declared that they had heard about HPV. This result is lower than awareness of HPV in general population in an international comparison (61%)  and contrasts with data indicating very low awareness of HPV in a previous Colombian study , but is similar to a nation-wide survey where 44% of the women between 13 and 69 years of age had heard about the HPV virus . The data are also similar to a study in Latin American immigrants in the United States, where 47% of women surveyed were aware of HPV . Nevertheless, considering that the study population consisted of patients with GW, the results indicate a low level of knowledge of HPV, as has been reported in a systematic review . In Australia, 63% of women are aware of HPV while another study of Latin American women found 65% awareness of the virus [22, 23].
We found no differences in HPV awareness based on gender or age. Although reports in the literature vary on whether sex and age are associated with HPV knowledge [21, 23, 24], the bottom line of most results on HPV awareness is poor knowledge about HPV in both men and women, independent of age [8, 25]. In our study, more than 80% of the patients knew that HPV can cause cervical cancer and almost all knew that it can cause genital warts. This result show higher knowledge on HPV as a cause of cervical cancer than a report among Hispanic women in US  but similar results to a German study where 97% of young women knew that HPV causes cervical cancer . On the contrary, in the same study only 49% of the population knew that HPV causes genital warts, which contrast with the results of our study. It has to be considered that in the present study patients already had genital warts and an information bias due to the procedures cannot be ruled out, as the interview was performed after the biopsy had taken place. Although almost all patients aware of HPV knew that HPV was sexually transmitted, only half of them actually knew that HPV infection can be transmitted through non-penetrating sexual intercourse. This highlights the importance of educating the population about HPV. In fact, education level was the only factor positively associated with HPV awareness in men and women in our study. Higher levels of HPV knowledge among patients with higher levels of education has also been reported elsewhere [9, 14, 27].
There were differences in knowledge of the HPV vaccine among men and women. In women, knowledge of the HPV vaccine was similar to knowledge of HPV. While half of women knew about the HPV vaccine, only 26% of men had heard about it. A possible explanation may be related to more frequent health consultations among women and to a closer involvement with cervical cancer screening , exposing them to receive more and better information on health issues and cervical cancer prevention. As for HPV, education level was also associated with HPV vaccine knowledge. This probably also explains partially that patients from the contributive regime (that in general had a better educational background) had better knowledge on HPV and the HPV vaccine than patients from the subsidized regime or patients without affiliation to the health care system.
The majority of participants reported that GW lesions influence their self-esteem and cause a severe impact on sexual life, especially in women. These results reflect the emotional distress caused by GW that has been found in several studies around the world [2, 19, 29, 30]. A greater distress in women with external GW lesions is aligned with previous observations where the psychological impact of a sexually transmitted disease diagnosis (regardless of which one) seems to be greater in women than in men . Nevertheless, our results showed that knowledge of HPV and age was associated with impact on sex life in men. Thus, older men who recognize genital warts as a sexually transmitted disease might be more affected in their sexual life. Recently, a study in the UK reported that male individuals with genital warts (age 25–44) had a lower quality of life than population controls of the same age group . It is worth mentioning that the same study reported a higher impact among women, but without significant variation with age. Although that study observed a recovery trend in quality of life scores after clearance of genital warts, it was not significant, suggesting that the negative impact of genital warts may still be present long after clearance.
A strength of this study is the fact that the study included individuals from a broad age group with a diagnosis of GW. Most previous reports have been based on people with previous diagnoses of GW or general population samples (most focusing on students). To our knowledge it is the first study in Latin America evaluating awareness, knowledge and attitudes towards HPV in male and female patients affected by GW. The majority of the studies in our region have focused on cervical cancer and pre neoplasic lesions. The main limitation of the present study is that we didn’t use a pre-established validated questionnaire nor any cognitive testing or focus groups to assess the impact of GW in individuals. As such, ratings of the impact on sexual life remain subjective and without explanation on the issues lying behind. However, we explored 2 of the domains included in such instruments  that have shown significant relation to genital warts in other studies [15, 32–34]. However, our results are consistent with the literature and could be a starting point for further evaluations of health quality life impact. Finally, the patients attending the out-patient clinic where the study was performed may not represent all patients with genital warts in the country.