Last updated: March 2, 2020
Kate Killoran M.D.
Obstetrics & Gynecology
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You could have genital warts and not even know it. Genital warts can take months or even years to manifest and in some cases only develop inside of your body. Learn how to minimize your risk.
Each year nearly 20 million Americans will get a sexually transmitted infection. Before HPV vaccines, about 350,000 women and men had genital warts caused by HPV. In fact, one in 100 sexually active adults in the U.S. has genital warts.
In England, genital warts are the second most common STI after Chlamydia.
What are Genital Warts?
Genital warts are soft growths, bumps or skin changes that grow in the genital region. They are often seen in small groups and may resemble cauliflower. While often growing in small clumps, genital warts can also be a single bump. They can also only grow inside the body.
Genital warts are considered a sexually transmitted infection (STI) as they are caused by the Human papillomavirus (HPV). In addition to causing genital warts, HPV is found in about 99% of cervical cancers. There are over one hundred different types of HPV, most of which are considered low-risk and do not cause cervical cancer or genital warts.
Genital warts are generally painless. Unfortunately, having genital warts can be a difficult conversation to disclose to new sexual partners. It also often takes many courses of treatment to fully remove.
Genital Warts and HPV
HPV is common in the general population. Approximately 79 million Americans are infected with HPV. The majority of those infected are in their late teens and early twenties.
HPV is the most common STI. There are over 100 strains of HPV. Most are harmless and will go away without any medical intervention. Unfortunately, there are over 40 strains that can cause serious sexual side effects.
While HPV is often closely associated with cervical cancer, it is not the only cancer that HPV can be responsible for. HPV can also cause vulva, vagina, penile, anal and oropharyngeal cancer (cancer in the back of the throat).
Other strains do not cause cancer. Instead, they can highly contagious genital and anal warts.
How is HPV Spread?
HPV is a sexually transmitted infection that is spread through skin to skin contact. Unlike other STIs, HPV does not spread through body fluids and does not require penetrative sex to be spread.
HPV is commonly spread through vaginal and anal sex, but can also be spread through oral sex. This transmission can occur if you are performing oral sex on someone who has HPV on their genitals or if someone performs oral sex on you and has HPV in their throat.
The transfer takes place when an uninfected person’s skin or mucous membrane (ex mouth, vagina) gets touched by or exposed to an infected person’s skin or mucous membrane.
You can be infected even if your partner is not showing any symptoms. In some cases, it can take months or even years for any genital warts to appear.
Risk Factors for Contracting Genital Warts
Any sexually active person can contract genital warts. However, research shows that certain lifestyles may pose a bigger risk. The following factors may increase your chances of contracting genital warts:
- Your mother had HPV at the time you were born
- Under 30 years old
- Your immune system is compromised due to a health condition or organ transplant
- You are a smoker
- Sexual abuse as a child
There are also risk factors that apply to any STI including:
- You have multiple male partners
- Being diagnosed with any other sexually transmitted disease or infection
- You are a male who has sex with males
- Becoming sexually active at a young age
- You have multiple male partners who have high-risk factors (becoming sexually active at an early age and having multiple male partners)
How are Genital Warts Diagnosed?
Genital warts are diagnosed through a physical exam by your healthcare practitioner. Your doctor may also ask questions about your sexual history, including how many times you have had sexual encounters, including oral sex, without a condom or dental dam.
For females, your doctor will likely need to do a pelvic exam as genital warts often grow inside of the vagina. Your doctor may apply a mild acidic solution which can help make the warts easier to see and diagnose.
Your doctor may also do a pap test. A pap test is done when a doctor inserts a speculum into your vagina to help them visualize your cervix. They will then insert either a cyto-broom or a cytobrush and plastic spatula to get a few cells from your cervix to test for abnormalities.
HPV can also cause cancer of the cervix. The strain that causes genital warts is considered low risk, although it is possible you could also have a high-risk strain. If you have an abnormal pap that is also +HPV you will likely need additional evaluation with colposcopy and possible biopsies. If your pap is normal but +HPV you will need to repeat the pap with HPV, otherwise known as co-testing in a year.
How are Genital Warts Treated?
While visible genital warts will often go away on their own over time, the HPV virus tends to linger in your skin cells. This means that you can experience several ‘outbreaks’ over the course of your lifetime. It also means you are able to spread HPV to a partner even if you don’t have any visible symptoms.
It is important to seek medical advice from your doctor to treat your genital warts. Over the counter wart treatments designed for the hands or feet are not meant to be used in the genital area. It is also not recommended to try natural remedies for HPV.
Treatment for genital warts will vary depending on the location and severity of the outbreak. There are prescription topical wart treatments such as:
- imiquimod (Aldara)
- podophyllin and podofilox (Condylox)
- trichloroacetic acid, or TCA
In some cases, warts may need to be frozen off using cryotherapy. This is usually a treatment path for small areas where warts have become bothersome. Freezing is not usually used when warts have become widespread.
Cryotherapy is done using liquid nitrogen to freeze the warts. The liquid nitrogen is applied to and around the warts which freezes them. They are then allowed to thaw. This process is usually done in the doctor’s office or clinic.
In some cases, the process needs to be repeated several times in order to remove the warts. This is often the case when warts are located in the anus or urethra.
It is normal to experience a mild to moderate burning sensation during this process.
Recovery from cryotherapy is usually about 1 to 3 weeks. Recovery time will vary depending on the location the warts were removed from as well as the number of warts. During healing you may experience:
- Shedding of dead tissue
- Sores or blisters in the area
- Mild pain, soreness and irritation
External Genital Wart Removal
During your recovery, it is important to look for signs of infection. Report to your doctor immediately if you notice the following:
- Persistent pain
- Continued Bleeding
- Bad smelling discharge that may be yellow in color
- Avoid sexual intercourse until the treated area heals and the soreness is gone
Healing Tips for Vaginal or Cervical Warts
- Avoid sexual intercourse until fully healed (between 1 and 3 weeks)
- Do not use tampons until healed
- A watery discharge may occur during healing
Healing Tips for Genital Warts on the Penis, Scrotum or in the Urethra
- Avoid intercourse until the area is healed and no longer sore.
In some cases, other methods may be used to remove the warts surgically, such as:
- electrocautery, or burning warts with electric currents
- laser treatments
- excision, or cutting off warts
- injections of the drug interferon
How Long Does HPV Last?
Genital warts are only a symptom of HPV. So while they may be treated, it is also possible for them to come back again and again. Fortunately, research has shown that this usually only occurs in about 10 to 20% of HPV infections.
According to the World Health Organization (WHO), about 90 percent of HPV infections clear within two years.
There are factors that can increase your chances of a persistent HPV infection. These include smoking, alcohol use, a compromised immune system and unprotected sex.
Protect Your Partner from Genital Warts
It is possible to spread HPV to your partner even if you do not have any genital warts present. This is because the virus will often continue to live in your skin even between outbreaks. Some people will only get one outbreak of genital warts and others will have several outbreaks over the course of months or even years.
It is also possible that a new outbreak could be the result of a new HPV infection.
Reduce the Risk
It is important to protect any sexual partner you have from contracting HPV. Latex condoms help to minimize the risk, but cannot offer full protection. As well as practising safer penatrative sex, it is also important to protect yourself during oral sex by using a condom or dental dam.
Another way to protect yourself and your partner is to get vaccinated against HPV. There are two HPV vaccines on the market, Gardasil and Gardasil 9. These vaccines offer protection against the most common HPV strains that cause genital warts, and can also protect against strains of HPV that are linked to cervical cancer.
Lower your Risk of HPV
HPV vaccinations are ideally given to male and female children before they become sexually active. It is usually administered at age 11 or 12, but can be given as young as age 9. When given to a pre-teen, the vaccine is administered as two injections, six months apart.
When started at age 15 or older, the individual will need three doses of the vaccine. If you are considered to have a weakened immune system, you will need three doses regardless of your age.
It is suggested that women get vaccinated up to age 27 and men up to age 22. However, transgender males are able to get vaccinated up to age 27 as well as males who have sex with males or have conditions causing a weakened immune system.
Those who already have the HPV virus may still benefit from receiving the vaccine as it may offer protection against other strains of the HPV virus. However, getting the HPV vaccine will not treat any current HPV infections.
Are you Concerned about Your Sexual Health?
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Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.
About Kate Killoran M.D.
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