HPV and Genital Warts
What are genital warts?
Warts are never welcome, but finding them on your genitals is particularly disagreeable. Genital warts (also called venereal warts) are flesh-colored, pink, or grayish-white growths that appear on the genital and anal areas of the body.
Like all warts, they're caused by a type of human papilloma virus (HPV). Skin-to-skin contact during sexual activity is what allows them to spread, and spread they have. An estimated 20 million Americans have the HPV virus that causes the warts today, with some 6.2 million of us contracting it each year. To put it another way, at least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives, according to the Centers for Disease Control and Prevention.
What is HPV?
Human papilloma virus is a virus with more than 100 different types, which are responsible for conditions that range from the relatively harmless and common plantar warts found on the soles of the feet to the more worrisome genital warts. (One type of HPV causes warts on the hands and feet; another kind produces them in the genital region.) Some types of genital HPV don't cause warts at all, while others have been linked to cervical cancer.
What are the symptoms of genital warts?
Most people who who are infected with HPV do not know it. Sometimes women will notice painless flesh-colored or grayish growths on the vulva (the outer, visible part of the female genitals), inside the vagina, or around the anus. A man might notice them on the tip or shaft of the penis. These growths, which might be itchy or mildly sore, can increase in size and develop a cauliflower-like appearance.
Other possible symptoms include mild irritation, burning, itching, or pain around the genitals or anus; increased or foul-smelling vaginal discharge or vaginal bleeding; or pain accompanying intercourse.
Often the virus will remain in the skin or mucous membrane and never produce warts. And if it does, there's a very good chance you won't notice them, especially if they're hidden inside the vagina, on the cervix, or inside the urethra (the tube that carries urine from the bladder out of your body). The warts may also be small and flat, so that they're not easily noticed even if they're on the outside of the body.
If genital warts are left untreated, they may disappear on their own within six months. The HPV virus will still be in your system, however, so the warts could reappear later.
How is HPV diagnosed?
Most women are diagnosed with HPV after they receive an abnormal Pap test, the cancer-screening test women receive during their annual gynecological exams. Many pre-cancerous changes to the cervix are related to HPV, although it is still very rare that HPV will cause cancer. Another test, called the HPV DNA, is available to test for HPV in women and can help health care providers decide if further tests or treatment is necessary. No HPV tests are currently available for men.
Can genital warts cause cancer?
The warts themselves are benign and don't cause cancer. But some types of the HPV virus (whether they give rise to warts or not) are major risk factors for cervical cancer. This is one reason it's so important for women to get Pap tests as part of their regular gynecological exams.
According to the Centers for Disease Control, cancers of the penis, vulva, vagina, and anal area are linked to certain types of the HPV virus as well.
What are my treatment options?
Currently, there is no treatment to cure HPV. There are very good treatments, however, for the problems HPV can cause, like genital warts and cervical cell changes.
Genital warts can be removed, which may help reduce discomfort, although experts disagree about the value of removing warts. In 20 to 30 percent of cases, external genital warts will disappear by themselves if left alone, a fact that leads some doctors to recommend a "wait and see" approach. Other physicians, however, advise that the warts be removed immediately. Although this isn't certain, some researchers believe that the HPV virus may spread to sexual partners more readily if genital warts are visible. Warts may be removed in a clinic or doctor's office through cryotherapy (freezing off the warts with liquid nitrogen), electrocautery (burning them off with an electrical current), chemicals, lasers or knives. Some procedures may require a local anesthetic. Patients have reported that the acid is excruciatingly painful when applied to anal warts, so review all the options with your doctor. Most chemical methods of wart removal aren't approved for pregnant women.
Your doctor might also want to remove the less common internal warts (in the vagina, on the cervix, inside the anus, or in the man's urethra).
Depending on the size and location of your warts, your doctor may recommend imiquimod, a cream you apply at home. Imiquimod enhances your immune system, helping your body rid itself of the warts and delaying or even preventing their recurrence.
It is very important that you not try to get rid of genital warts by using over-the-counter medicines that are meant to be used on the types of warts found on the hands and feet. They're too harsh for the genital area.
How effective is the treatment for genital warts?
If the warts are going to reappear, they'll usually do so within the first three months after treatment. In 70 to 80 percent of cases, there's no recurrence within the first six months. Remember, though, that the HPV virus will remain in your body. As with other sexually transmitted diseases, your partner must be treated as well, since an infected partner can easily spread genital warts to you.
How can I keep from getting HPV and genital warts?
Getting regular PAP tests will help detect problems if they occur. And in June 2006, the US Food and Drug Administration approved the first vaccine (HPV4) developed to prevent cervical cancer, genital warts, and other diseases related to genital human papillomavirus (HPV). In June, 2009, the FDA licensed a second vaccine, HPV2. The vaccines protect against certain types of HPV that are responsible for 70 percent of cervical cancers. Only HPV4 protects against 90 percent of genital warts. The Advisory Committee on Immunization Practices recommends the vaccine for all girls between the ages of 11 to 12-years-old, and for females between the ages of 13 to 26-years-old who have not been vaccinated. These vaccines are administered in 3 doses with the final dose given a minimum of 24 weeks after the initial dose. The U.S. Centers for Disease Control and Prevention advises using safe sex and PAP tests in addition to the vaccine since it does not work for all HPV types. Some critics of the vaccine, including Norwegian physician Dr. Charlotte Haug, have also noted that cervical cancer is extremely rare in developed countries and that it can almost always be prevented through regular PAP screenings.
If you're not in a monogamous relationship, be sure you don't have unprotected sex; condoms can help prevent the spread of genital warts. But since warts can occur on parts of the genital and anal areas that condoms don't cover, the virus can be still be spread through sexual contact. If you're considering a new sexual partner, both of you should be tested for sexually transmitted diseases before having sex, according to federal health agencies.
FDA Licensure of Bivalent Human Papillomavirus Caccine (HPV2, Cervarix) for Use in Females and Updated HPV Vaccination Recommendations from the Advisory Committee on Immunizaiton Practices (ACIP). Morbidity and Mortality Weekly Report (MMWR). Centers for Disease Control and Prevention. May 28, 2010
Centers for Disease Control, Division of Sexually Transmitted Diseases. Genital HPV Infection Fact Sheet. May 2004. http://www.cdc.gov/std/HPV/STDFact-HPV.htm
American Social Health Association. HPV: Get the Facts. 2001.
Kwasniewska A, et al. Dietary factors in women with dysplasia colli uteri associated with human papillomavirus infection. Nutr Cancer 1998;30(1):39-45
National Institute of Allergy and Infectious Diseases Fact Sheet. Human Papillomavirus and Genital Warts. March 2001.
Moore RA, et al. Imiquimod for the treatment of genital warts: a quantitative systematic review. BMC Infect Dis 2001;1(1):3.
Centers for Disease Control. HPV and HPV Vaccine Information for Healthcare Providers. August 2006.
Centers for Disease Control. Genital HPV Infection. April 2008.