Some types of HPV can cause genital warts, which can appear as fleshy, painless, cauliflower-shaped skin growths. Warts are often small and hard to see, but they can vary in appearance. They can be smooth or rough, large or small. There can be just one wart, or there can be multiple warts.
Genital warts may appear within a few weeks of having sex with someone who has the HPV that causes warts, or they may take months or years to appear. Warts may not appear at all. This makes it difficult to know exactly when or from whom you contracted the virus.
Warts can appear on or around the vulva, in or around the vagina, in or around the anus, in the groin (where the genital area meets the inner thigh), on the penis, on the scrotum (testicles), or on the cervix (less commonly than external warts). Warts usually do not cause itching, burning, or pain. However, most HPV infections do not result in visible warts, and most people do not know that they have the virus.
Genital warts may or may not recur after the first episode. Some people only get warts once, while others recur when they reappear. When you have a wart, the virus is considered active. When the wart disappears, the virus lies dormant (latent) in your skin cells. At this point, you may or may not be contagious.
A healthy immune system can usually clear the virus over time.
How are warts transmitted?
The types of HPV that cause genital warts are usually spread through direct skin-to-skin contact during vaginal, anal, or oral sex with someone who has this infection. Anyone who is sexually active can get genital warts.
Although you are more likely to transmit HPV if you have warts, the virus can be transmitted even when you don't have noticeable symptoms.
The types of HPV that cause genital warts are usually different from the types that cause warts on other parts of the body, such as the hands. People cannot get genital warts by touching warts on their hands or feet.
Because warts are not commonly found in the mouth, some experts believe that the likelihood of transmitting them through oral sex is lower than the likelihood of transmitting them genital-to-genital or genital-to-anus.
Diagnosis of genital warts
A health care provider may examine a person's genital area and even use a magnifying glass to find and identify warts. Sometimes warts can be very difficult to see. It can also be difficult to tell the difference between a wart and a normal bump on the genital area.
To find warts or other abnormal tissue, your healthcare provider may apply acetic acid (vinegar) to the genitals. This will whiten the warts, making them easier to see, especially when viewed with a magnifying glass such as a colposcope. However, vinegar can sometimes highlight other normal bumps, making this diagnostic method misleading.
A biopsy is not necessary to diagnose genital warts. This is only done if the bumps look unusual or are discolored.
The HPV DNA test is approved only as part of cervical cancer screening and is not used to diagnose warts. It is not a blood test that can be used clinically to diagnose HPV in humans.
Genital Warts Treatment
There is no medical cure for HPV, but there are several treatment options for genital warts. The goal of all treatments is to remove visible warts to eliminate bothersome symptoms. Treating warts can help reduce the risk of transmitting the infection to a partner who has not been exposed to the type of HPV that causes warts.
When choosing which treatment to use, the health care provider considers the size, location, and number of warts, changes in the warts, patient preference, treatment cost, convenience, side effects, and the patient’s own experience with the treatment. There is no one treatment that is best for all cases. Some treatments are performed in a hospital or doctor’s office, while others are prescription creams that can be used at home for a few weeks.
Treatments provided in hospitals include:
- Cryotherapy (freezing the wart with liquid nitrogen). This can be relatively inexpensive, but should be done by a trained medical provider.
- Podophyllin (a chemical compound that must be applied by a medical professional). This is an older treatment and is not widely used today.
- Trichloroacetic acid (TCA) is another chemical that health care providers apply to the surface of warts.
- Excising the wart. This has the advantage of being able to remove the wart in one office visit.
- Electrocautery (burning the wart using an electric current)
- Laser treatment (using intense light to destroy warts). This is used for larger or more extensive warts, especially those that do not respond well to other treatments. Lasers can also be expensive. Most health care providers do not have lasers in their offices, and providers must be well-trained in this method.
- Interferon (a substance injected into warts). It is rarely used these days because of its wide range of side effects and high cost. Less expensive treatments are just as effective, but with fewer side effects.
Prescription creams for home use (available by prescription only):
- Podophyllox cream or gel (Condylox®). This is a self-applied treatment for external genital warts. It may be less expensive than a doctor's office treatment, is easy to use, and is safe, but must be used for about 4 weeks.
- Imiquimod cream (Aldara®). This is also a self-applied treatment for external genital warts. It is safe, effective, and easy to use. This cream is different from other commonly used treatments that work by destroying the wart tissue. Aldara® can actually strengthen the immune system to fight HPV and reduce the chances of recurrence.
important: Over-the-counter wart treatments should not be used on the genital area.
Risk reduction
Anyone who is sexually active can contract this common virus. Here’s how to reduce your risk:
- If someone has visible signs of genital warts, they should not have sex until the warts are removed. This can help reduce the risk of spreading the virus.
- Condoms, when used correctly from start to finish, can help provide protection every time you have sex. However, they only cover the skin covered by the condom. Condoms do not cover all of the genital skin, so they do not provide 100% protection.
- Spermicidal foams, creams, and jellies (and condoms coated with spermicide) have not been shown to prevent HPV, and they can cause microscopic abrasions that make you more susceptible to STIs. Spermicides are not recommended for routine use.
- The vaccine can protect against the types of HPV found in most genital warts.
Once someone has HPV, they are unlikely to be reinfected if they are exposed to the same type again. This is probably because their immune system responds to the virus. However, they can get a different type of HPV from a new partner. It is important for partners to understand the “big picture” of HPV so that both of you can make an informed decision based on facts rather than fear or misunderstanding.
Pregnancy and Genital Warts
Most pregnant women who have had genital warts before but no longer have them are less likely to have complications or problems during pregnancy or childbirth. Most babies are born healthy to women who have a history of genital warts.
During pregnancy, hormonal changes in the body can cause warts to grow in size and number, cause bleeding, and in very rare cases, make delivery more difficult. In very rare cases, babies who are exposed to the type of HPV that causes warts during birth can develop a tumor in the throat. However, this is so rare that women with genital warts usually do not need a cesarean section unless the warts block the birth canal.
It is important for pregnant women to tell their health care provider or hospital if they or their partner have ever had genital warts. This will help determine whether the warts should be treated during pregnancy.