HPV Warts: The Misunderstood STD

Many individuals worry about STDs, such as syphilis, gonorrhea, chlamydia, or herpes. But there’s another extremely common one you need to be aware of.

If you’re sexually active, you’ve likely been exposed to the virus that causes genital warts, called the human papillomavirus (HPV). Genital warts appear as growths or bumps that are flesh-colored or whitish. They may be small or large, raised or flat, and appear singly or in groups.

While genital warts generally do not cause such symptoms as itching or pain, many people find them embarrassing, and they can be spread from person to person.

Fast Facts About the Human Papillomavirus

More than 42 million Americans are thought to have an active HPV infection at any given time, according to the Centers for Disease Control and Prevention (CDC). An additional 13 million people become newly infected with HPV each year.

But not all strains of HPV cause genital warts. Some cause common skin warts, and some can cause cellular changes that can lead to cancer of the cervix, vagina, vulva, anus, penis, and oropharynx — the area at the back of the throat that includes the base of the tongue and tonsils.

For many people, an HPV infection never causes any symptoms or harm because the body is able to clear the virus naturally.

But in some cases, according to one study, the virus may still be present in the body and may become active if a person’s immune system is weakened because of illness or age.

“I’ve had older women show up with the warts for the first time in their lives, and they’re widows who haven’t had sex for 20 years,” says Anita L. Nelson, MD, a professor of obstetrics and gynecology and a staff physician at Harbor-UCLA Medical Center in Torrance, California.

“Suddenly, their bodies can’t cope with a virus that they’ve been walking around with for decades, and it shows itself,” Dr. Nelson says.

Your Common HPV Questions Answered

Discovering you have a sexually transmitted infection is never a pleasant surprise, but knowing more about it and the treatments available can help to set your mind at ease.

Here, Nelson answers some common questions about HPV.

Q. What causes genital warts?

A. Genital warts are caused by certain types of sexually transmitted HPV. There are more than 40 HPV types that can affect the genital area of women and men. But more than 90 percent of genital warts are caused by just two types: HPV 6 and 11.

Q. How common are HPV 6 and 11?

A. One percent of all sexually active women and men get genital warts every year. We see them in everyone — women who are pregnant, young adults exploring their sexuality, older women and men.

Q. How soon after contact do the warts typically occur?

A. That’s one of the most frequently asked questions because a person’s really asking, “Who gave it to me?”

Typically, you get warts within one to four months of being infected with HPV. But the virus can be kept in check by the immune system for longer than that.

Q. Does everyone exposed to HPV 6 and 11 get warts?

No. Warts can appear after a person is infected, or you can have none at all, as the body’s immune system fights the virus.

Q. Can HPV warts surface at any time in your life — even years after exposure?

A. Yes. Sometimes, we’ll see them later in life, when people get sick or their immune system gets compromised by chemotherapy or other drugs.

So they don’t just occur when you have a new sex partner.

Q. How can sexually active individuals avoid getting HPV warts?

A. Using condoms — or “finger condoms” for manual stimulation — consistently reduces the risk of acquiring or transmitting the virus that causes the warts.

Also, interestingly, HPV infects rapidly dividing cells. So anywhere there’s a little trauma, tear, or abrasion, the body can pick up the virus and bring it inside the cells.

Sometimes, we’ll see the warts in younger women because it’s the first time they’ve had sex and the vaginal tissue isn’t quite elastic. It’s the same with some older women who have vaginal dryness.

Q. Does the number of sex partners a person has over a lifetime increase the risk of HPV warts?

A. Yes, people who have had more than 10 sexual partners over their lifetime are more likely to report a diagnosis of genital warts than those who’ve had one or two.

The more sex partners you have, the more likely you are to have different types of HPV infection as well.

And there’s no limit to how many different HPV types you can have. Limiting the number of partners and using condoms are very important to reducing your risk.

Q. Are HPV warts spread only through genital contact?

A. No, you can spread the virus from any moist source to another. The same type of warts that develop on the genitals can also grow in the mouth and throat and even in the insides of the eyelids.

But there has to be a source, and generally, you’re going to be carrying the virus in the genitals.

We have to be quite frank about sexual practices today. There’s a lot of oral-genital contact. If one partner has a wart in their mouth, the other partner can wind up with warts on the genitalia if there’s oral-genital contact.

Q. Can HPV warts lead to cervical cancer?

A. The two types of HPV that cause most genital warts — types 6 and 11 — do not cause cancer.

However, some types of HPV that are associated with cancer have been found in genital warts.

It’s also possible to have or get more than one type of HPV at once, including those that can cause cancers in the genital area, such as cervical, vulvar, or anal cancer, or cancers of the mouth and throat.

Having genital warts caused by noncancer-causing HPV strains doesn’t mean you don’t also have potentially cancer-causing HPV.

Q. Are genital warts more a psychological issue than a health danger?

A. Genital warts may cause some physical discomfort, such as burning and itching, or even bleeding in an intimate situation.

The various treatments to remove genital warts can also cause pain and irritation and can be expensive, depending on what type of treatment you use and what kind of health insurance coverage you have.

For many people, though, there is significant psychological discomfort in realizing they’ve been exposed to a virus they’re going to live with for the rest of their lives and could transmit to others.

Q. Are women more likely than men to get the warts?

A. No, but we have more statistics on women because doctors tend to see women much more routinely. Gynecologists, for example, do Pap smears and visually inspect a woman’s genitals.

Q. Can Pap tests detect HPV warts?

A. No. Pap tests detect abnormalities in cervical cells that may be cancerous or precancerous. A newer HPV test detects the presence of the virus in cervical cells.

RELATED: New Analysis Suggests Cervical Cancer Screenings Should Continue After Age 65

Q. How are genital warts diagnosed?

A. You want to have them professionally diagnosed. Usually, physicians just eyeball them and don’t have to do a biopsy. A doctor can often tell it’s a wart because warts have a little attachment to the skin and multiple protuberances from the single stalk.

Q. What do the warts look like?

A. They can look soft and fleshy, almost like a skin tag, or they can be rock-hard and large with branches like a cauliflower.

They can be a small little dot or bigger than your fist.

Q. Are they easier to treat if discovered early?

A. Yes. Don’t wait if you think you might have genital warts. When you feel a bump, especially around the opening of the vagina, or behind the vagina, see your doctor.

Also, it’s important to know that once you get infected, it’s a regional infection. For example, you can get a wart inside your anus even if you haven’t had anal sex.

Q. How soon should a wart be treated?

A. It’s not a medical emergency. But the HPV warts that are really hard to treat have been there for months and have hardened.

If you can’t get an appointment for two to three weeks after feeling the bump, don’t freak out. But don’t wait months.

Most women will get the HPV virus, and their body can handle it. But women with persistent HPV infections are the ones we want to identify.

I want to see a young woman three or four years after her first sexual encounter to see if her body can handle the virus.

Is she having persistent infections, which could be a predictor of cervical cancer? Those are the women we want to find, so we can treat any precancers.

For women over age 30 who got the virus earlier in life, we’re testing to see if they show cells that go awry and also to determine if they’re still shedding the virus.

Q. When a woman has visible HPV warts, should she stop having sex?

A. When we’re treating women for warts, we ask them to be particularly careful and maybe even abstain from sex.

That’s because as we’re treating it, there are inflammatory changes and maybe even a little ulcer, and those tissues are more vulnerable to acquiring another infection.

So take it easy for a while, or use condoms. Abstain from oral sex, too.

Q. Once you have HPV warts, are you always contagious?

A. You spread more viral particles when you have a concentration of warts. But with treatment, you rev up the body’s immune system, and it will help reduce the amount of viruses you have and spread.

You also can avoid spreading it through practicing safer sex.

Q. What’s the recommended treatment for HPV warts?

A. Get rid of the warts. We can treat fresh warts with easy topical therapies. There are three creams your doctor can prescribe for external genital warts that can be applied at home.

• Imiquimod topical (Aldara) 5 percent is a cream that’s applied three times a week for up to 16 weeks.
• Imiquimod (Zyclara) 3.75 percent is a cream you use daily for up to 8 weeks.
• Podofilox topical (Condylox), a prescription gel or liquid you use for 3 days, and then you take off 4 days, for up to four cycles.

Q. How do these work?

A. Podofilox works by destroying the skin of the wart. The two imiquimods are really groundbreaking because they don’t play with the wart at all but instead turn on the body’s immune system, which attacks the virus in the wart so it melts away.

These therapies have really simplified things. When a new wart comes, just put cream on it.

Q. Are there natural remedies?

A. Sinecatechins (Veregen) is a green tea extract, which is applied three times a day for up to 16 weeks. We’re not quite sure how it works, but some people really like the idea because it’s natural. Green tea is an antioxidant. You use it in ointment form.

Q. How are hardened warts treated?

A. If you’ve had them for a while and they’ve hardened, then you’re talking doctor-administered destructive therapies.

We can snip them off if they have a tiny base. Or we can freeze them with acids to dehydrate them and kill the cells.

For the ones that are really hard to deal with, we’ll surgically excise them or do laser treatments.

Q. Are women more likely to get HPV warts if they’re on oral contraceptives?

A. It isn’t that the pill causes more problems but that condoms protect against HPV infection, and a woman who’s on the pill may be less likely to use condoms.

That said, if someone’s warts don’t disappear after treatment, it may be that her immune system is teetering on the edge, and the pill pushed it over.

But I would never stop prescribing a woman’s birth control pill just because she had a wart.

Q. Are HPV warts a danger during pregnancy?

A. The virus can be passed on before or during birth, but the warts don’t pose a major risk to the baby’s health.

Symptoms of genital warts can get worse during pregnancy, however, because a woman’s immune system gets suppressed.

Warts can grow so large they’ll obstruct delivery of the baby. And you have to treat the warts in a way that’s not harmful to the baby.

Q. Does the HPV vaccine protect against genital warts?

A. Yes, Gardasil 9, which is the HPV vaccine used in the United States today, as well as the original Gardasil vaccine, protect against the HPV 6 and 11, which cause 90 percent of genital warts.

Cervarix, a vaccine that is no longer available in the United States but is available elsewhere in the world, protects only against HPV type 16 and 18, which significantly raise the risk of cervical, genital, and oropharyngeal cancers. Cervarix does not protect against the strains of HPV that cause warts.

RELATED: What Are HPV 16 and 18?

Q. What are the top things a woman should keep in mind about HPV warts?

A. Use condoms, and be choosy in your partners. People ought to take a good look at what they’re being exposed to when they’re getting into a relationship where there’s going to be sex. But keep in mind that a person can have the virus that causes genital warts without having visible warts.

Also, make sure you’re paying as much attention to health in your genital area as you are to other parts of your body. Some women are more in tune with the bottoms of their feet than they are with their genitalia.

Examine your genitalia, and feel if there are any bumps or areas of soreness where there shouldn’t be.

And don’t hesitate to see your doctor if you do find anything.