Certain types of HPV can cause genital warts, which can appear as fleshy, painless, cauliflower-shaped skin growths. Warts are often small and difficult to see, however, and can have different appearances: they can be smooth or rough, or large or small. There may be just one wart or many.
Genital warts may appear within several weeks of having sex with someone who has the types of HPV that cause warts, or they may take several months or years to appear. It is also possible that warts may never appear. This makes it difficult to know exactly when or from whom someone contracted the virus.
Warts can appear around the vulva, in or around the vagina, in or around the anus, the groin (where the genital area meets the inner thigh), the penis, the scrotum (balls) or on the cervix (although this is less common than external warts). Warts usually do not itch, burn or hurt. However, most HPV infections will not result in visible warts, and most people will not know they have the virus.
Genital warts may or may not return after the first episode. Some people only have one episode of warts, while others have recurrences, when the warts reappear. When warts are present, the virus is considered active. When the warts disappear, the virus lies dormant (sleeping) in the skin cells – it may or may not be contagious at this time.
A healthy immune system is usually able to clear the virus over time.
How are warts spread?
The types of HPV that cause genital warts are usually spread by direct skin-to-skin contact during vaginal, anal, or possibly oral sex with someone who has this infection. Any person who is sexually active can develop genital warts.
HPV may be more likely to be transmitted when warts are present, but the virus can be transmitted even when there are no visible symptoms.
The types of HPV that cause genital warts are usually different from those that cause warts on other parts of the body, such as the hands. People do not get genital warts by touching warts on their hands or feet.
Warts are not commonly found in the mouth, so some experts believe transmission through oral sex is not as likely as genital or genital-to-anal contact.
Diagnosis of genital warts
A healthcare provider will check a person’s genital area and may even use a magnifying glass to find and identify warts. Sometimes, warts can be very hard to see. Also, it can be difficult to tell the difference between a wart and normal bumps in the genital area.
To look for warts or other abnormal tissue, your healthcare provider may put acetic acid (vinegar) on the genitals. This makes the warts white and easier to see, especially if viewed through a magnifying lens, such as a colposcope. However, vinegar can sometimes cause other normal lumps to be labeled, so this method of diagnosis can be misleading.
A biopsy is not necessary to diagnose genital warts. This is only done if the lump has an unusual appearance or discoloration.
HPV DNA tests are only approved for use as part of cervical cancer screening and are not used on diagnosed warts. These are not clinically available blood tests to diagnose a person for HPV.
Treatment for genital warts
Although there is no medical cure for HPV, there are several treatment options available for genital warts. The goal of any treatment should be to remove the visible warts to get rid of the bothersome symptoms. Treating the warts can potentially help reduce the risk of passing the infection on to a partner who may never have been exposed to the wart types of HPV.
When choosing which treatment to use, the healthcare provider will consider the size, location and number of warts, changes in the warts, patient preference, cost of treatment, convenience, side effects and their own experience with the treatments. No one treatment is best for all cases. Some treatments are done in a clinic or doctor’s office. Others are prescription creams that can be used at home for several weeks.
Treatments performed at the office include:
- Cryotherapy (freezing the wart with liquid nitrogen). This can be relatively inexpensive, but should be done by a trained health care provider.
- Podophyllin (a chemical compound that must be applied by a healthcare provider). This is an older treatment and is not as widely used today.
- TCA (trichloroacetic acid) is another chemical that is applied to the surface of the wart by a healthcare provider.
- Excision of warts. This has the advantage of getting rid of warts in just one office visit.
- Electrocautery (burning of warts with electricity)
- Laser treatment (using bright light to destroy warts). It is used for larger or widespread warts, especially those that have not responded well to other treatments. Laser can also cost a lot of money. Most health care providers do not have a laser in their office and the provider must be well trained in this method.
- Interferon (a substance that is injected into the wart). This is now rarely used due to extensive side effects and high cost. Less expensive treatments work just as well with fewer side effects.
Prescription home creams (these are only available with a prescription):
- Podofilox (Condylox®) cream or gel. This is a self-administered treatment for external genital warts. It can be less expensive than treatment done in a health care provider’s office, is easy to use, and is safe, but must be used for about 4 weeks.
- Imiquimod cream (Aldara®). This is also a self-administered treatment for external genital warts. It is safe, effective and easy to use. This cream is different from other commonly used treatments, which work by destroying the wart tissue. Aldara® actually strengthens the immune system to fight HPV and can make recurrences less likely.
GREAT: Over-the-counter wart treatments should not be used in the genital area.
Reducing your risk
Any person who is sexually active can encounter this common virus. Ways to reduce the risk are:
- If someone has had visible symptoms of genital warts, they should not have sexual activity until the warts are removed. This can help reduce the risk of spreading the virus.
- Condoms used correctly from start to finish every time you have sex can help provide protection – but only for the skin covered by the condom. Condoms do not cover all of the genital skin, so they do not protect 100%.
- Spermicidal foams, creams, gels (and condoms coated with spermicide) are not proven effective in preventing HPV and can cause tiny abrasions that make it easier for STIs to contract. Spermicides are not recommended for routine use.
- Vaccines can protect against the types of HPV found in most cases of genital warts.
Once someone has HPV, they are not likely to get re-infected if they are exposed to the same type again. This is likely due to the immune system’s response to the virus. However, it is possible to be infected with a different type of HPV from a new partner. It’s important for partners to understand the “whole picture” about HPV so that both people can make informed decisions based on facts, not fear or misconceptions.
Pregnancy and genital warts
Most pregnant women who previously had genital warts but no longer have them are unlikely to have complications or problems during pregnancy or childbirth. Most children are born healthy to women with a history of genital warts.
Due to hormonal changes in the body during pregnancy, warts can increase in size and number, bleed or, in extremely rare cases, make childbirth difficult. Very rarely, babies exposed to the wart types of HPV at birth may develop growths on the neck. This happens so rarely, however, that women with genital warts do not usually need to have a C-section unless the warts are blocking the birth canal.
It is important that a pregnant woman notifies her health care provider or clinic if she or her partner has genital warts. This way they can determine if they need to treat warts or not during pregnancy.
