Quality of life among partners of women with newly diagnosed and recurrent genital warts: a cross-sectional study

Abstract

AimAnogenital warts may affect patients and their partners. However, the effect of recurrent disease on partner-related quality of life remains poorly defined. This study compared quality of life among partners of women with newly diagnosed and recurrent anogenital warts using the Family Dermatology Life Quality Index (FDLQI). MethodsThis cross-sectional study included 60 women with clinically diagnosed anogenital warts and their partners. Participants were divided into newly diagnosed (n = 30) and recurrent disease (n = 30) groups. Partners completed the FDLQI. Multivariable linear regression was used to identify factors associated with higher FDLQI scores. ResultsPartners of women with recurrent disease had higher FDLQI scores than those of women with newly diagnosed disease (18.8 ± 7.1 vs 11.4 ± 6.6, P < .001). The mean difference was 7.43 points (95% confidence interval [CI]: 3.88 to 10.98), with a large effect size (Cohen’s d=1.08). After adjustment for partner age and selected covariates, recurrent disease remained associated with higher FDLQI scores (B=8.97, 95% CI: 5.22 to 12.72, P < .001). In exploratory adjusted analyses, partner smoking (B=3.91, 95% CI: 0.37 to 7.45, P = .031) and older partner age (B=0.25 per year, 95% CI: 0.02 to 0.48, P = .033) were also associated with higher FDLQI scores; however, these secondary findings should be interpreted cautiously. ConclusionRecurrent anogenital warts were associated with greater partner-related quality-of-life impairment than newly diagnosed disease. Given the cross-sectional design and limited sample size, these findings should be considered preliminary and require confirmation in larger prospective studies.

Keywords

Introduction

Anogenital warts are among the most common clinical manifestations of human papillomavirus (HPV) infection and are predominantly associated with low-risk HPV types 6 and 11.¹ Although anogenital warts are benign, they may cause considerable psychological and social distress because of concerns regarding sexual transmission, recurrence, and stigma. Previous studies have shown that genital warts can negatively affect emotional well-being, sexual relationships, and self-esteem.^2-5 This burden may be particularly pronounced in recurrent disease because repeated treatments and continuing concerns about relapse may sustain distress over time. The effects of dermatologic diseases may extend beyond the affected individual, with chronic or stigmatizing conditions impairing the quality of life of partners and family members through emotional distress, social limitations, sleep disturbance, and caregiving burden.^6-11 To quantify this secondary burden, Basra et al. developed the Family Dermatology Life Quality Index (FDLQI), a 10-item instrument designed to measure the impact of a patient’s dermatologic condition on the quality of life of family members and partners.¹² A Turkish version of the FDLQI has been used in previous research involving partners of patients with dermatologic disease.¹³
Despite the recognized psychosocial burden of genital warts, their impact on the quality of life of intimate partners remains poorly characterized. This evidence gap may be particularly relevant in recurrent disease, in which continuing uncertainty about transmission, relapse, treatment, and sexual relationships may affect both members of the couple. Therefore, this study aimed to compare quality of life among partners of women with newly diagnosed and recurrent genital warts using the FDLQI.

Materials and Methods

Study Design and ParticipantsThis single-centre cross-sectional study was conducted at the gynecology outpatient clinic of a tertiary care hospital between 15/01/2026 and 15/06/2026. Women aged 18 years or older with clinically diagnosed anogenital warts were eligible if an adult intimate partner also agreed to participate. Women were excluded if they were pregnant or breastfeeding, had a known malignancy, had cognitive impairment that prevented completion of the study questionnaire, or declined to participate. Couples were excluded if the partner was younger than 18 years or declined participation. Consecutive women presenting with clinically diagnosed anogenital warts during the study period were assessed for eligibility. Eligible women were enrolled together with their adult intimate partners after both individuals verbally agreed to participate. Anogenital warts were diagnosed clinically by an obstetrics and gynecology specialist based on the presence of characteristic lesions. Women and their partners were assigned to two groups according to the woman’s disease status. The newly diagnosed group comprised women presenting with their first episode of clinically diagnosed anogenital warts and no history of previous treatment for the condition. The recurrent disease group comprised women who developed clinically visible anogenital warts after documented complete clinical clearance of a previously treated episode. The final study population comprised 60 women and their partners, including 30 couples in the newly diagnosed group and 30 couples in the recurrent disease group.Data Collection and Outcome MeasuresDemographic and clinical data were collected at enrolment using a structured study questionnaire and data collection form. Variables recorded for the participating women included age, educational level, smoking status, marital status, and disease status. For women in the recurrent disease group, the time to recurrence was also recorded in months. Partner-related variables included age, educational level, smoking status, and self-reported history of anogenital warts. Each partner completed the Family Dermatology Life Quality Index (FDLQI) to assess the impact of the woman’s anogenital warts on the partner’s quality of life. The FDLQI is a validated 10-item instrument designed for adult family members and partners of patients with dermatologic conditions.¹² Each item is scored from 0 to 3, producing a total score ranging from 0 to 30. Higher total scores indicate greater impairment in the partner’s quality of life. The Turkish-language version of the FDLQI previously used in a Turkish population was administered in this study.¹³ The questionnaire assesses the impact of the dermatological condition on the family member or partner during the preceding month. The primary outcome was the between-group difference in mean total FDLQI scores among partners of women with newly diagnosed and recurrent anogenital warts.
No formal a priori sample size calculation was performed. A pragmatic target of 30 couples per disease-status group was established based on the anticipated feasibility of recruitment during the predefined study period. Recruitment was discontinued once 30 eligible couples had been enrolled in each group, resulting in a total sample of 60 couples. Given the limited sample size, the multivariable analyses were considered exploratory.Ethical ApprovalThis study was approved by the Ethics Committee of Afyonkarahisar Health Sciences University Hospital (Date: 09.01.2026, Decision No: 2026/1).Statistical AnalysisStatistical analyses were performed using IBM SPSS Statistics version 22.0 (IBM Corp., Armonk, NY, USA). The distribution of continuous variables was evaluated using visual and analytical methods. Normally distributed continuous variables were presented as mean ± standard deviation and compared between groups using the independent samples t test. Continuous variables that did not follow a normal distribution were presented as median and interquartile range and compared using the Mann Whitney U test. Categorical variables were presented as number and percentage and compared using the chi-square test or Fisher’s exact test, as appropriate. Cohen’s d and Hedges’ g were calculated to quantify the magnitude of the between-group difference in mean FDLQI scores.
Multivariable linear regression analysis was performed to identify demographic and clinical factors associated with total FDLQI scores. To reduce, although not eliminate, the risk of overfitting given the limited sample size, the primary multivariable model was restricted to five clinically relevant covariates. The model included disease status, partner smoking status, marital status, partner history of anogenital warts, and partner age. Partner age was selected for the primary model because the FDLQI was completed by the partners and because partner age differed significantly between the disease groups. Because patient age and partner age were highly correlated, they were not included simultaneously in the same model. A sensitivity analysis was performed by replacing partner age with patient age to evaluate whether the association between disease status and FDLQI scores was robust to the choice of age variable. The reference categories were newly diagnosed disease for disease status, non-smoking for partner smoking status, single for marital status, and absence of anogenital warts for partner history of anogenital warts.
Unstandardised regression coefficients were reported with 95% confidence intervals and p values. Model fit was summarised using R², adjusted R², and the overall model p value. Model assumptions were evaluated by examining the distribution of residuals, residual plots for homoscedasticity, variance inflation factors for multicollinearity, and Cook’s distances for influential observations. There were no missing data for the variables included in the analyses; therefore, no imputation was performed. A two-sided p value below 0.05 was considered statistically significant.Reporting GuidelinesThis study was reported in accordance with the STROBE guideline.

Results

A total of 73 consecutive women with clinically diagnosed anogenital warts were assessed for eligibility. Thirteen women were not included: one was pregnant, one had a known malignancy, one had a partner younger than 18 years, three declined participation, and seven were excluded because their partners declined participation. The final analysis included 60 women and their partners, comprising 30 couples in the newly diagnosed group and 30 couples in the recurrent disease group. No participants were excluded because of missing data. Among women in the recurrent disease group, the median time to recurrence was 12 months (interquartile range: 12 to 18 months). Baseline demographic and clinical characteristics are presented in Table 1. Women in the recurrent disease group were younger than those in the newly diagnosed group (27.9 ± 7.4 vs 32.9 ± 8.2 years, P = .017). Similarly, partners in the recurrent disease group were younger than those in the newly diagnosed group (31.4 ± 7.4 vs 36.8 ± 8.2 years, P = .009). The groups did not differ significantly in educational level, smoking status, marital status, or partner history of anogenital warts. Mean FDLQI scores were higher among partners in the recurrent disease group than among those in the newly diagnosed group (18.8 ± 7.1 vs 11.4 ± 6.6, P < .001). The mean difference between the groups was 7.43 points (95% confidence interval [CI]: 3.88 to 10.98). The magnitude of the between-group difference was large (Cohen’s d=1.08; Hedges’ g=1.07). The distribution of FDLQI scores by disease status is presented in Figure 1. Multivariable linear regression analysis was performed to identify factors associated with total FDLQI scores (Table 2). The results of the primary multivariable model are illustrated in Figure 2. After adjustment for partner age and the other selected covariates, recurrent disease remained associated with higher FDLQI scores (B=8.97, 95% CI: 5.22 to 12.72, P < .001). Partner smoking status was also associated with higher FDLQI scores in the primary model (B=3.91, 95% CI: 0.37 to 7.45, P = .031). Older partner age was associated with higher FDLQI scores (B=0.25 per year, 95% CI: 0.02 to 0.48, P = .033). Given the limited sample size and the number of covariates examined, the associations involving partner smoking and partner age were considered exploratory secondary findings. Marital status (B=−1.25, 95% CI: −5.03 to 2.54, P = .512) and partner history of anogenital warts (B=−2.96, 95% CI: −7.60 to 1.67, P = .205) were not significantly associated with FDLQI scores. The primary model explained 37.2% of the variance in FDLQI scores (R²=0.372, adjusted R²=0.314; overall model P < .001). In the sensitivity analysis replacing partner age with patient age, the association between recurrent disease and higher FDLQI scores remained similar (B=8.86, 95% CI: 5.14 to 12.58, P < .001). No substantial violations of the assumptions of linear regression or evidence of problematic multicollinearity were identified in the primary model.

Discussion

In this study, partners of women with recurrent anogenital warts reported substantially higher FDLQI scores than partners of women with newly diagnosed disease. Because of the cross-sectional design, the observed association should not be interpreted as evidence that recurrent disease causes greater partner-related quality-of-life impairment. The between-group difference was large, and recurrent disease remained associated with higher FDLQI scores after adjustment for partner age, partner smoking status, marital status, and partner history of anogenital warts. These findings suggest that recurrent disease is associated with a greater psychosocial burden at the couple level and that the impact of anogenital warts may extend beyond the affected individual. Previous studies have reported impaired emotional well-being, sexual function, and quality of life among individuals with anogenital warts, whereas the quality-of-life burden experienced by their partners remains less clearly defined.^2-5 The higher burden observed in recurrent disease is clinically plausible. They may raise concerns regarding transmission, recurrence, fidelity, stigma, and future sexual relationships. Such concerns may become more pronounced when lesions recur following treatment. Partners may experience anxiety about their own risk of infection, changes in intimacy, and uncertainty regarding the recurrent course of the condition. Recent studies have similarly highlighted the broader clinical, psychosocial, and relationship-related burden associated with anogenital warts.^14-16 The between-group difference corresponded to a large standardised effect size. However, to our knowledge, no established minimum clinically important difference is available for the FDLQI in partners of women with anogenital warts. Therefore, although the observed difference was statistically significant and quantitatively large, its clinical significance cannot be definitively established.
By using the FDLQI, we were able to assess the secondary impact of anogenital warts on partners in a structured manner. Dermatological conditions may affect family members and partners through emotional distress, embarrassment, social limitations, sleep disturbance, and changes in daily life.^6-11 Although the FDLQI was developed to measure the impact of dermatological diseases on patients’ family members and partners, its application among partners of individuals with anogenital warts remains limited.¹² Our findings support the value of incorporating partner-related quality of life into the evaluation of sexually transmitted dermatological conditions. In the adjusted model, older partner age and partner smoking status were also associated with higher FDLQI scores. The association with partner age may reflect age-related differences in relationship characteristics, health perceptions, or responses to recurrent disease; however, these factors were not directly assessed in our study. The association between partner smoking and higher FDLQI scores should also be interpreted cautiously and regarded as exploratory. Previous epidemiological research has suggested that anogenital warts may be associated with sociodemographic and behavioural factors, including smoking, education, and sexual behaviour.¹⁷ Larger studies are needed to determine whether partner age and smoking are reproducible predictors of partner-related quality-of-life impairment or markers of residual confounding.
These findings may have practical implications for the clinical management of anogenital warts. Although management generally focuses on lesion clearance, symptom control, and the prevention or treatment of recurrence, our results suggest that the concerns and quality of life of partners may also warrant attention, particularly in recurrent cases. Partner-inclusive counselling could provide an opportunity to address uncertainty regarding transmission, recurrence, treatment expectations, and the generally benign nature of low-risk HPV-related lesions. Discussions addressing sexual concerns, stigma, and relationship-related anxiety may also facilitate communication between couples. A strength of this study is its specific focus on partner-related quality of life among women with newly diagnosed and recurrent anogenital warts. Most previous studies have primarily evaluated quality of life, sexual function, or emotional well-being in affected individuals rather than the burden experienced by their partners.^2-5,14,16 The use of the FDLQI enabled a structured assessment of this secondary burden and demonstrated a strong association between recurrent disease and greater partner-related quality-of-life impairment after adjustment for relevant covariates.

Limitations

This study has several limitations. First, its cross-sectional design precludes causal inference. No formal a priori sample size calculation was performed, and the relatively small sample size and single-centre setting may limit the statistical power, precision, and generalisability of the findings. Although the multivariable model was restricted to five clinically relevant covariates, the number of covariates may still be relatively large for a sample of 60 couples, resulting in potential model instability and overfitting. Accordingly, the adjusted associations involving partner age and smoking should be regarded as exploratory rather than as established independent predictors. Second, participation required the involvement of both members of the couple, and seven otherwise eligible women were not included because their partners declined participation. The enrolled couples may therefore differ from those in whom the partner was unwilling or unable to participate, resulting in possible selection bias. Third, although partner age was included in the adjusted model, residual confounding cannot be excluded. Potentially relevant factors, including relationship duration, psychological status, sexual activity, previous treatment history, number of previous recurrences, and HPV-related knowledge, were not assessed and may have contributed to the observed between-group difference in FDLQI scores. In addition, anogenital warts were diagnosed clinically, and HPV genotyping was not routinely performed. The psychometric properties of the Turkish-language FDLQI have not been specifically established among partners of women with anogenital warts, and the self-reported nature of the instrument may have introduced perception and social desirability bias. Larger multicentre prospective studies with predefined sample size calculations and broader assessment of potential confounders are needed to confirm these findings.

Conclusion

Recurrent anogenital warts were associated with greater partner-related quality-of-life impairment than newly diagnosed disease. However, given the cross-sectional design, limited sample size, potential model instability, and residual confounding, this finding should be considered preliminary and should not be interpreted as evidence of a causal relationship. Partner-related concerns may warrant consideration during counselling, particularly in recurrent cases. Larger prospective multicentre studies are needed to confirm these findings and to evaluate the potential value of partner-inclusive interventions.

Declarations

References

1. Satija T, Singh A, Kumari R. Genital warts. J Colposcopy Low Genit Tract Pathol. 2025;3(1):15-18. doi:10.4103/jclgtp.jclgtp_7_25
   Article · PubMed · Google Scholar
2. Habibpour H, Omidvar S, Bakhtiari A, Hajian-Tilaki K, Ghorbani H. The effect of human genital warts virus on the quality of women’s sexual life: a look at the effective factors. J Educ Health Promot. 2026;15:122. doi:10.4103/jehp.jehp_1935_24
   Article · PubMed · Google Scholar
3. Zaky MS, Obaid ZM, Youssef AM, Elmenawy AD, Elsaie ML. Sexual dysfunction in women with genital warts: a cross-sectional study. BMC Womens Health. 2025;25:188. doi:10.1186/s12905-025-03691-6
   Article · PubMed · Google Scholar
4. Adeli M, Moghaddam-Banaem L, Shahali S. Sexual dysfunction in women with genital warts: a systematic review. BMC Womens Health. 2022;22:516. doi:10.1186/s12905-022-02073-6
   Article · PubMed · Google Scholar
5. Elhamady MM, Atallah RB, Hashem OA, Abdelaty MA, Elsaie ML. Sexual dysfunction and quality of life in males with genital warts. Basic Clin Androl. 2025;35:25. doi:10.1186/s12610-025-00274-1
   Article · PubMed · Google Scholar
6. Gisondi P, Puig L, Richard MA, et al. Quality of life and stigmatization in people with skin diseases in Europe: a large survey from the “burden of skin diseases” EADV project. J Eur Acad Dermatol Venereol. 2023;37(suppl 7):6-14. doi:10.1111/jdv.18917
   Article · PubMed · Google Scholar
7. Fournier H, Calcagni N, Morice-Picard F, Quintard B. Psychosocial implications of rare genetic skin diseases affecting appearance on daily life experiences, emotional state, self-perception and quality of life in adults: a systematic review. Orphanet J Rare Dis. 2023;18:39. doi:10.1186/s13023-023-02629-1
   Article · PubMed · Google Scholar
8. Agrawal M, Garg T, Chander R, Verma D. Quality of life and sexual function in women with sexually transmitted infections and reproductive tract infections: a hospital-based study. Indian J Postgrad Dermatol. 2025;3(2):121. doi:10.25259/ijpgd_37_2024
   Article · PubMed · Google Scholar
9. Elaidy AM, Elsheikh AA, Lateef AGAE, Elsadek HM. Family-related quality of life and burden in caregivers of patients with chronic skin diseases. Middle East Curr Psychiatry. 2025;32:75. doi:10.1186/s43045-025-00568-0
   Article · PubMed · Google Scholar
10. Mozyrska O. Study of the impact of atopic dermatitis in children on the quality of life of families. Child Health. 2023;18(1):18-22. doi:10.22141/2224-0551.18.1.2023.1554
    Article · PubMed · Google Scholar
11. Baskaran N, Arunima A, Shah S, Narang T, Kumaran MS. Psychological morbidity in chronic dermatological disorders: a review. Indian Dermatol Online J. 2025;16(3):381-388. doi:10.4103/idoj.idoj_458_24
    Article · PubMed · Google Scholar
12. Basra MK, Sue-Ho R, Finlay AY. The Family Dermatology Life Quality Index: measuring the secondary impact of skin disease. Br J Dermatol. 2007;156(3):528-538. doi:10.1111/j.1365-2133.2006.07617.x
    Article · PubMed · Google Scholar
13. Gurel G, Süncak B, Özdemir N. Skabiyezli hastaların ailelerinin yaşam kalitesinin değerlendirilmesi. Kocatepe Tip Derg. 2025;26(1):16-20.
    PubMed · Google Scholar
14. Khodashenas Z, Pourkalhor H. Impact of genital human papillomavirus warts on sexual function and marital relationships: a systematic review of studies from 2018 to 2025. J Skin Sex Transm Dis. 2026. doi:10.25259/jsstd_148_2025
    Article · PubMed · Google Scholar
15. You X, Valente S, Machalek DA, et al. Epidemiologic, clinical, and economic burden of anogenital warts among adults: a global systematic review. Int J Infect Dis. 2025;161:108029. doi:10.1016/j.ijid.2025.108029
    Article · PubMed · Google Scholar
16. af Klinteberg M, Seyer A, Andersson N. Genital herpes and genital warts affect quality of life and emotional well-being. Int J STD AIDS. 2026. doi:10.1177/09564624261438901
    Article · PubMed · Google Scholar
17. Faramarzi H, Jofreyi H, Marandi NH, Ghahartars M, Aliabadi N. Epidemiology and associated factors of genital warts among patients in Iran: a cross-sectional study highlighting the impact of education and sexual behavior. Clin Epidemiol Glob Health. 2025;32:101945. doi:10.1016/j.cegh.2025.102146
    Article · PubMed · Google Scholar

Additional Information

Publisher’s Note
Bayrakol MP remains neutral with regard to jurisdictional and institutional claims.

Rights and Permissions

Acknowledgements

The authors thank Saygin Alkan for assistance with table formatting.