SEXUALLY TRANSMITTED INFECTIONS
HPV (genital warts)
There are over 100 types of human papillomavirus (HPV). HPV is the virus that causes genital and anal warts, also sometimes called condyloma. HPV can also cause cervical, anal, and oropharyngeal (throat) cancer. HPV strains that cause warts are referred as “low-risk” strains, while those that can cause cancer are referred to as “high-risk” strains.
Warts caused by HPV are not the same warts commonly found on hands and feet, and the type of wart on another part of your body cannot be passed to your genital area and vice versa. The virus that causes genital warts is spread by direct skin-to-skin contact from one person to another during anal or vaginal sex, and can be transmitted even when warts are not present.
HPV is considered to be the most common sexually transmitted disease (STD) in the U.S. It is estimated that 80% of sexually active people in the U.S. have contracted HPV at some point in their lives. However, most people with HPV will never know they have been infected.
There are many different types of HPV. Most are harmless—especially the strains which cause the external warts you can see. There are a few high-risk types which can cause changes in the cells of the cervix (opening to the uterus) or the cells of the anus, and could lead to cancer. Cervical cancer often does not cause symptoms until it is advanced so for this reason, it is recommended that all women age 21-65 years should have a Pap smear test every three years to look for any abnormal cells that could turn into cancer.
The HPV virus may cause wart-like bumps to form on the penis or scrotum, in and around the vagina, on the cervix, and/or around the anus or groin area. They may appear as wart-like growths, bumps, or may be flat and only slightly raised from the skin. The bumps may be single or multiple, small or large. They tend to be flesh-colored or whitish in appearance. The warts usually do not cause itching, burning, or pain.
Warts can appear several weeks after being exposed, but it's possible to have been exposed to the wart virus months or years before warts appear, or for symptoms never to appear at all after coming into contact with the virus.
Not everyone who has the wart virus will have visible warts. Some people have only one episode of warts, while others may have recurrences.
A complete examination for HPV includes answering questions about your sexual history and checking any symptoms you might be having. Sometimes, warts can be very hard to see, even for trained medical staff. Also it can be hard to tell the difference between a wart and normal bumps on the genital area. A biopsy is not necessary for diagnosing genital warts. This would only be done if the bump is unusual-looking or discolored.
A Pap test detects changes in the cells (dysplasia) of the cervix or anus that could lead to cancer caused by HPV. There is also an HPV test that checks for DNA from high-risk strains of the virus that could eventually lead to cancer. This test is usually done on the same sample from the Pap test.
Blood tests are not used to diagnose HPV. There are no tests to detect HPV in the penis or throat.
Currently, there is no treatment to cure HPV. It may live in your body forever, although most people’s bodies will naturally get rid of HPV over time. Treating the warts may possibly help reduce the risk of transmission to a partner who doesn’t have the types of HPV you might be carrying.
The goal of any treatment should be to get rid of annoying symptoms. There are several options available for removing warts and no particular treatment is best for all cases. When choosing which treatment to use, your healthcare provider will consider the size, location and number of warts, changes in the warts, your preference, cost of treatment, convenience, adverse effects, and their own experience with the treatments. Some treatments are done in a clinic or doctor's office; others are prescription creams that can be used at home.
Treatments done in the doctor's office include:
- Cryotherapy—freezing off the wart with liquid nitrogen.
- Podophyllin—a chemical compound to get rid of the warts. This is an older treatment and is not widely used today.
- TCA (trichloracetic acid)—a chemical compound applied to the surface of the wart.
- Cutting off warts—this gets rid of warts in a single office visit.
- Electrocautery—burning off warts with an electrical current.
- Laser therapy—using an intense light to destroy warts. This is used for larger or extensive warts, especially those that have not responded well to other treatments. Laser can be very expensive and is not available everywhere.
At-home creams available by doctor's prescription:
- Imiquimod cream (Aldara®) boosts the immune system to fight HPV and treat external genital warts. Although expensive, it is safe, effective and easy to use.
- Podofilox cream or gel (Condylox®) destroys the tissue of external genital warts over about four weeks. It is inexpensive, easy to use and safe.
IMPORTANT: Over-the-counter wart treatments should not be used in the genital area. They will not be effective.
If you have an abnormal Pap test, there are also multiple evaluation and treatments that can be done, depending on the extent of the cell changes. This may involve repeating the test more frequently for close monitoring, colposcopy (looking carefully at the cervix with a magnifying lens), or carefully freezing or removing the abnormal area. If you have an abnormal Pap test your clinician will be able to discuss with you the best options in your particular case.
Learn more about cervical cancer related to HPV and abnormal Pap smear results.
If you're sexually active, using condoms consistently and correctly for anal and vaginal sex is your best bet for staying sexually healthy. However, using condoms will only reduce your risk of getting warts from an infected partner because the wart virus can be on the skin near the vagina, rectum or penis—areas not always protected by a condom. Some data suggest condoms reduce the risk of cervical cancer in women who have certain types of high-risk HPV. Also, condoms can reduce the risk of recurrent HPV in those who already have the virus.
There is now an HPV vaccine (Gardasil®9) that prevents infection with nine types of HPV.