Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
Anogenital Verrukaların Klinik, Patolojik ve Prognostik Özelliklerinin İncelenmesi: Retrospektif Analiz
Retrospective Evaluation of Clinic, Pathologic and Prognostic Characteristics of Anogenital Warts
Işıl Göğem İMRENa , Şule GÖKŞİNb , Sevilay ERTÜRKb , Neşe ÇALLI DEMİRKANc , Şeniz DUYGULUb
aDenizli Devlet Hastanesi, Deri ve Zührevi Hastalıkları Kliniği, Denizli, Türkiye
bPamukkale Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları ABD, Denizli, Türkiye
cPamukkale Üniversitesi Tıp Fakültesi, Tıbbi Patoloji ABD, Denizli, Türkiye
Turkiye Klinikleri J Dermatol. 2024;34(1):22-31
doi: 10.5336/dermato.2023-100350
Article Language: TR
Full Text
ÖZET
Amaç: Kliniğimizde takip ve tedavi edilen erişkin anogenital verruka olgularının demografik, klinik, patolojik ve prognostik özelliklerini inceleyip ülkemize dair güncel verileri ortaya koyarak, değişken dinamikleri olan bu hastalığın yönetimine katkı sunmayı amaçladık. Gereç ve Yöntemler: Bu kesitsel çalışmada, polikliniğimizde 2015-2021 yılları arasında, anogenital verruka tanısıyla takip edilen 18 yaş ve üzeri 329 hastanın klinik ve epidemiyolojik verileri retrospektif olarak değerlendirilmiştir. Bulgular: Çalışmaya dâhil edilen 329 hastanın %78,4'ü erkek, %21,6'sı kadın, ortalama yaş 35,2 (± 12,1) medyan yaş 32 (aralık 18-7) idi. En çok hasta 124 (%37,7) hasta ile 18-30 yaş aralığında bulunmaktaydı. Hastaların %10'unda ekstragenital verruka tespit edildi. Hiçbir hastada insan bağışıklık yetersizliği virüsü testi pozitif bulunmazken, 1 hastada VDRL, 3 hastada hepatit B yüzey antijeni, 4 hastada anti-hepatit C virüsü pozitif olarak saptandı. Lezyonlarından histopatolojik inceleme yapılan 27 hastanın 19'unda verruka ile uyumlu bulgulara rastlanırken, 3 hastada displazi, 5 hastada neoplazi tespit edilmiştir. Bir yıllık düzenli tedavinin sonucunda, hastaların %74,2'sinde gözle görünür verruka lezyonu kalmazken, %2,7'sinde tedavilere direnç, %0,9'unda kısmi cevap, %21,6'sında ilk 1 yıl içinde rekürrens gözlenmiştir. Sonuç: Sağlık kuruluşlarına zamanında başvuru, uygun tedavinin erken dönemde düzenlenmesi, düzenli takip ile malignite gibi ciddi komplikasyonların yaratacağı morbidite ve mortalitenin azaltılabileceğine inanmaktayız.

Anahtar Kelimeler: İnsan papilloma virüs; anogenital verruka; epidemiyoloji
ABSTRACT
Objective: We aimed to contribute to the management of this disease with variable dynamics by examining the demographic, clinical, pathologic and prognostic features of the adult anogenital verruca cases followed and treated in our clinic, presenting current data for our country. Material and Methods: In this cross-sectional study, we retrospectively evaluated clinical and demographic data of 329 patients aged 18 years and older who were followed up with a diagnosis of anogenital verruca at our clinic between 2015 and 2021. Results: Of the 329 patients included in the study, 78.4% were male and 21.6% were female, with a mean age of 35.2 (± 12.1) and a median age of 32 (range 18-7). The majority of patients were between 18 and 30 years of age, with 124 (37.7%) patients. Extragenital verrucae were detected in 10% of the patients. There was no positive case of anti-human immunodeficiency virus, however, Venereal Disease Research Laboratory positivity in 1 patient, hepatitis B surface antigen positivity in 3 patients and antihepatitis C virus positivity in 4 patients were detected. Histopathologic examination was performed in 27 patients, verruca vulgaris was detected in 19 patients, dysplasia in 3 patients and neoplasia in 5 patients. After one year of regular treatment, 74.2% of patients had no visible verruca lesion, 2.7% were resistant to treatment, 0.9% had a partial response, and 21.6% had a recurrence within the first year. Conclusion: We believe that morbidity and mortality from serious complications such as malignancy can be reduced through timely presentation to healthcare facilities, early initiation of appropriate treatment, and regular follow-up.

Keywords: Human papillomavirus; anogenital wart; epidemiology
REFERENCES:
  1. Kirnbauer R, Lenz P. Human papillomaviruses. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. London: Saunders; 2018. p.1383-99.
  2. Brianti P, De Flammineis E, Mercuri SR. Review of HPV-related diseases and cancers. New Microbiol. 2017;40(2):80-5. [PubMed] 
  3. Serrano B, Brotons M, Bosch FX, Bruni L. Epidemiology and burden of HPV-related disease. Best Pract Res Clin Obstet Gynaecol. 2018;47:14-26. [Crossref]  [PubMed] 
  4. Stanley MA, Sterling JC. Host responses to infection with human papillomavirus. Curr Probl Dermatol. 2014;45:58-74. [Crossref]  [PubMed] 
  5. Magalhães GM, Vieira ÉC, Garcia LC, De Carvalho-Leite MLR, Guedes ACM, Araújo MG. Update on human papilloma virus - part I: epidemiology, pathogenesis, and clinical spectrum. An Bras Dermatol. 2021;96(1):1-16. [Crossref]  [PubMed]  [PMC] 
  6. Shanmugasundaram S, You J. Targeting persistent human papillomavirus infection. Viruses. 2017;9(8):229. [Crossref]  [PubMed]  [PMC] 
  7. Gökşin Ş, İmren IG, Demirkan N, Duygulu Ş. Disseminated verrucae in a patient with rheumatoid arthritis: Abatacept effect on immunologic defense mechanism. Dermatol Ther. 2020;33(6):e14119. [Crossref]  [PubMed] 
  8. Salah E. Impact of multiple extragenital warts on quality of life in immune-competent Egyptian adults: a comparative cross-sectional study. Clin Cosmet Investig Dermatol. 2018;11:289-95. [Crossref]  [PubMed]  [PMC] 
  9. Veasey JV, Framil VM, Nadal SR, Marta AC, Lellis RF. Genital warts: comparing clinical findings to dermatoscopic aspects, in vivo reflectance confocal features and histopathologic exam. An Bras Dermatol. 2014;89(1):137-40. [Crossref]  [PubMed]  [PMC] 
  10. Patel H, Wagner M, Singhal P, Kothari S. Systematic review of the incidence and prevalence of genital warts. BMC Infect Dis. 2013;13:39. [Crossref]  [PubMed]  [PMC] 
  11. Ozgul N, Tuncer M, Abacioglu M, Gultekin M. Estimating prevalence of genital warts in Turkey: survey among KETEM-affiliated gynecologists across Turkey. Asian Pac J Cancer Prev. 2011;12(9):2397-400. [PubMed] 
  12. Ünal E, Gönül M, Çakmak S, Yalçınkaya Iyidal A, Kılıç A, Gül Ü, et al. Serological test results of sexually transmitted diseases in patients with condyloma acuminata. Postepy Dermatol Alergol. 2015;32(4):286-9. [Crossref]  [PubMed]  [PMC] 
  13. Aktaş H, Ertuğrul G, Benli AR. Genital siğilli hastalarda cinsel yolla bulaşan diğer hastalıklara ait serolojik test sonuçları: retrospektif bir değerlendirme [Serological profile of other sexually transmitted diseases in patients with condyloma acuminata: a retrospective view]. Arch Clin Exp Med. 2017;2(1):15-7. [Crossref] 
  14. Kaymak Y, Yüksel N, Ekşioglu M. Coincidence of condyloma accuminata with other sexually transmitted diseases. Turk Derm. 2004;38:48-53. [Link] 
  15. Yılmaz B, Hat BN, Yürekli Y, Oskay Ü. Genç erişkinlerin human papilloma virüs (HPV) ve HPV aşısına ilişkin bilgi ve görüşleri: kesitsel bir çalışma [Knowledge and attitude of young adults on HPV infection and HPV vaccine: a cross-sectional study]. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi. 2021;7(2):138-48. [Crossref] 
  16. Goldstone SE, Giuliano AR, Palefsky JM, Lazcano-Ponce E, Penny ME, Cabello RE, et al. Efficacy, immunogenicity, and safety of a quadrivalent HPV vaccine in men: results of an open-label, long-term extension of a randomised, placebo-controlled, phase 3 trial. Lancet Infect Dis. 2022;22(3):413-25. [Crossref]  [PubMed] 
  17. Adeli M, Moghaddam-Banaem L, Shahali S. Sexual dysfunction in women with genital warts: a systematic review. BMC Womens Health. 2022;22(1):516. [Crossref]  [PubMed]  [PMC] 
  18. Nia MH, Rahmanian F, Ghahartars M, Janghorban R. Sexual function and sexual quality of life in men with genital warts: a cross-sectional study. Reprod Health. 2022;19(1):102. [Crossref]  [PubMed]  [PMC] 
  19. Qi SZ, Wang SM, Shi JF, Wang QQ, Chen XS, Sun LJ, Liu A, Zhang N, Jiang N, Siva P, Xu XL, Qiao YL. Human papillomavirus-related psychosocial impact of patients with genital warts in China: a hospital-based cross-sectional study. BMC Public Health. 2014;14:739. [Crossref]  [PubMed]  [PMC] 
  20. Erdem Y, Özarmağan G. Genital siğilli hastalarda yaşam kalitesinin değerlendirilmesi [Evaluation of the quality of life in patients with genital warts]. Turkderm-Arch Turk Dermatol Venerology. 2016;50(1):21-4. [Crossref] 
  21. Kaya İslamoğlu ZG, Ünal M, Özaslan M, Akyürek M, Sarı N. Çoklu ekstragenital siğillerin dermatoloji yaşam kalitesi üzerine etkisi: kesitsel bir çalışma [The effect of multiple extragenital warts on dermatology quality of life: a cross-sectional study]. Türkiye Klinikleri Dermatoloji Dergisi. 2019;29(2):64-8. [Crossref] 
  22. Joly E, Desmoulin A, Tran PL, Derancourt C, Bertolotti A. Quality and consistency of clinical practice guidelines for the local management of anogenital warts: a systematic review using AGREE II score and RIGHT checklist. J Eur Acad Dermatol Venereol. 2023;37(4):e505-e7. [Crossref]  [PubMed]  [PMC] 
  23. Das S, Yemul V, Deshmukh R. Incidence and association of HIV and other STDs in 200 persons belonging to a high risk group in central Mumbai. Venereology. 1998;11(1):19-23. [PubMed] 
  24. Kowo M, Nzoume Nsope Mengang JM, Simeni Njonnou SR, Kouotou EA, Atangana PJA, Ankouane Andoulo F. Giant anogenital tumor of Buschke-Löwenstein in a patient living with human immunodeficiency virus/acquired immunodeficiency syndrome: a case report. J Med Case Rep. 2022;16(1):116. [Crossref]  [PubMed]  [PMC] 
  25. Ghys PD, Diallo MO, Ettiègne-Traoré V, Yeboué KM, Gnaoré E, Lorougnon F, Kalé K, et al. Genital ulcers associated with human immunodeficiency virus-related immunosuppression in female sex workers in Abidjan, Ivory Coast. J Infect Dis. 1995;172(5):1371-4. [Crossref]  [PubMed] 
  26. Tosun S. Viral hepatitlerin ülkemizdeki değişen epidemiyolojisi [The changing viral hepatitis epidemiology in our country]. Ankem Derg. 2013;27(2):128-34. [Link] 
  27. Simonart T, de Maertelaer V. Systemic treatments for cutaneous warts: a systematic review. J Dermatolog Treat. 2012;23(1):72-7. [Crossref]  [PubMed] 
  28. Lacey CJ, Woodhall SC, Wikstrom A, Ross J. 2012 European guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol. 2013;27(3):e263-70. [Crossref]  [PubMed] 
  29. Nygård S, Nygård M, Orumaa M, Hansen BT. Quadrivalent HPV vaccine effectiveness against anogenital warts: a registry-based study of 2,2 million individuals. Vaccine. 2023;41(37):5469-76. Erratum in: Vaccine. 2023. [Crossref]  [PubMed] 
  30. Solmaz Hasdemir P. Vulvanın benign hastalıklarının tanı ve tedavisi [Diagnosis and management of the benign diseases of vulva]. Dicle Med J. 2019;46(4):889-95. [Crossref] 
  31. Çetiner H, Kır G, Sakallı M, Karateke A. Zeynep Kamil Hastanesinde 2000-2006 yılları arasında tanı almış vulvar neoplaziler ve preneoplastik lezyonların dökümü [All vulvar neoplasms and preneoplastic lesions which were diagnosed in Zeynep Kamil Hospital between 2000-2006 year]. Marmara Med J. 2007;20(3):161-6. [Link] 

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com