Genital warts are a common symptom of an infection with a virus group called human papillomavirus (HPV). Close to one million cases of genital warts are diagnosed in the U.S. every year. Genital warts have been afflicting humans since antiquity and until about a century ago, were thought to be connected to syphilis and gonorrhea. Today, we know that they are triggered by HPV infections. There are 120 different HPV types, but 90% of genital wart cases are caused by HPV types 6 and 11.
An HPV infection is considered a sexually transmitted infection (STI) since sexual contact (oral, vaginal, anal) is the primary route of infection. So, as Americans over the past four decades have become sexually active at an increasingly earlier age, HPV infections and genital warts have become more common. In fact, the15-24 age group, is the segment of the population where genital warts have the highest rate of occurrence.
Genital warts are soft, upward-growing tissue bumps. At first, their color is no different from your skin color. Warts initially grow alone, but later on, they can form clusters that take on a greyish color. When running your finger over these clusters it will feel a bit like the surface texture of cauliflower.
The size and shape of genital warts can be very diverse and sometimes can be mistaken for syphilis or vice versa. It is therefore important that you see a doctor and get yourself tested Testing will also determine which HPV type you are infected with.
The HPV infection is the globally most widespread STI, and it is estimated that nearly every adult will get at least one HPV infection sometime in his or her lifetime. In the vast majority of cases, the infection has no noticeable symptoms (i.e., no warts or lesions), and will resolve spontaneously within 12 to 24 months. It’s possible to be infected by more than one HPV strain simultaneously — after all there are about 40 sexually infectious HPV types. But, as mentioned before, only HPV 6 and 11 cause 90% of all genital warts.
Whether an infection triggers a wart outbreak may depend on how strong your immune system is. At any given time, only 1% of sexually active American adults have genital warts. Women have an increased risk of developing genital warts as compared to men.
Regardless of whether you have warts or not, an HPV infection is always very contagious. You can pass it on to your partner even if you are free of symptoms. You may not even know at the time that you have it. As a woman, the risk of contagion for each time you have sex with an infected partner is about 75%. This includes oral, anal, and vaginal sex. Moreover, it’s not just body fluids which can trasmit the virus. HPV can be transmitted simply by coming in touch with an infected skin area.
In 4 out of 5 cases, genital warts will disappear in two years or even earlier. Since the HPV virus stays inside the body, in people with a weak immune system, warts can appear again after some time. This is rare however, and in most cases, the immune system will contain the virus and prevent warts from reappearing.
If you notice unusual tissue growths that could be genital warts, seek medical help to find out for sure and rule out any other STIs. While they need to be checked by a doctor and may need treatment to resolve, genital warts are not dangerous. There are about 13 HPV strains that can lead to cancer if left untreated, but the wart-causing HPV 6 and 11 don’t belong to them. So, if you have HPV and genital warts, you don’t need to worry about HPV-induced cancers such as cancer of the cervix.
The best prevention is sexual abstinence. The next best thing is the HPV vaccine that, aside from the cancer-causing HPV types, also includes HPV 6 and 11. For the vaccination to work well, it needs to be given at a young age (around 12-13), before a person becomes sexually active.
Condoms only provide limited protection since the virus can still be contracted through skin-to-skin contact. Female condoms work a little better than male condoms for this purpose, but also don’t offer 100% protection. Aside from using condoms, another way to lower the risk of transmission is to limit the number of sexual partners and only sleep with people you trust.
If used early, prescription antiviral creams such as Imiquimod, can treat genital warts and hasten their disappearance. The active ingredient in Imiquimod spurs immune cells to attack warts and similar abnormal skin growths. Treatment can take 3-4 weeks for full resolution of warts. Talk to your gynecologist or general physician to learn more about available medications.
When antiviral creams are not effective, your doctor may suggest surgical removal. This can be done with freezing, lasers or chemicals, all of which are relatively safe routine surgeries. Of course, removing warts doesn’t eliminate the underlying viral infection. HPV will still be in your body and can only be suppressed by your own immune system.
Reviewed by Dr Roy Kedem, MD
Information last reviewed 10/13/21