Where They Come From
There are several facts about genital warts and genital human papillomavirus (HPV) infections, some more known than others. Genital warts are the only visible symptom of HPV, appearing as flat lesions, tiny cauliflower-like bumps or tiny stem-like protrusions. There are approximately 100 strains of HPV, more than 40 of which are transmitted through sexual contact. According to the Centers for Disease Control and Prevention, genital HPV is the most common sexually transmitted infection, affecting 6.2 million Americans every year. The other HPV varieties cause harmless growths such as common warts, plantar warts and flat warts on other parts of the body. Although they too can be spread through skin-to-skin contact, these other HPV strains do not cause genital warts. Most genital warts are caused by HPV types 6 and 11.
Genital warts can be spread through vaginal, anal and oral sex. In men, genital warts most commonly surface on the penis, in the pubic region, in the anal canal, and in the area between the penis and the scrotum. In some cases, warts may grow within the urethra, inside the penis. In women, warts usually grow on the vulva, but may also occur in or around the anus and in the pubic area; however, due to women having a more complex sexual anatomy than men, genital warts can also surface inside the vagina or on the cervix, making them impossible for a woman to detect. Having oral sex with someone infected with HPV can also lead to recurrent respiratory papillomatosis (RRP), which results in genital warts in the throat.
People with depressed immune systems are more likely to get warts than their healthy counterparts. However, HPV is a virus, and can be transmitted unknowingly despite no presence of genital warts. The infection can have a long incubation period, meaning that months can pass between the time a person contracts the virus and when genital warts appear. Sometimes, the warts can take years to develop, if they appear at all. Condom use does offer some protection but is not a fool-proof method as condoms do not create a complete barrier against bodily fluids and skin contact around the genital area. The only guaranteed way of not passing on or contracting HPV is through total celibacy.
Complications from HPV and Genital Warts
As annoying and embarrassing as they can be, genital warts generally pose no further health risks for men. Some strains of HPV, however, can cause penile and anal cancers. In addition, because there is no way to test for HPV in men or know whether people who have HPV will develop cancer–as well, the fact that these types display no symptoms–it’s important to restress the importance of using protective-barrier contraceptives.
In women, the higher-grade HPV strains, most commonly types 16 and 18, are less likely to resolve and some may advance to cervical cancer. Less often, they can also cause cancers of the vulva or vagina, and anal cancer.
RRP can sometimes block the airway, resulting in a hoarse voice or breathing difficulties. In rare instances, cancers of the head and neck (i.e., the tongue, tonsils and throat) can occur.
HPV Screening, Vaccines and Treatment
Besides visible external genital warts, there is no screening process for HPV in men. Sexually active women, however, should adhere to annual gynecological exams to check for genital warts surfacing internally. The risk of cancers from HPV is generally low, but early detection proves better for treatment. As well, both men and women who have genital warts or who have had sex with someone known to be infected with HPV should see a doctor. Tissue samples taken from genital warts can determine the type or strain of HPV, thus providing important information to both the patient and doctor regarding possible risk factors for other complications.
Among the most unknown facts about genital warts and genital HPV is how they can be cured and/or treated. Although there is no cure for the HPV virus once it has been contracted, there are two HPV vaccines available for types 6 and 11–which cause genital warts in both males and females–and types 16 and 18, the two strains most responsible for causing cervical cancers. A note of caution: the virus running its natural course (i.e., leaving the body) does not instill immunity or make one less susceptible to other HPV strains or other STIs.
The good news is that genital warts are treatable. While this does not remove the virus itself (you can still pass the virus on to others), there are several options available for treating warts. Some can be done at a doctor’s office and others can be prescribed for use at home.
Imiquimod is a prescription medication that helps by enhancing the immune system in fighting against genital wart growth. Podofilox works by destroying genital wart tissue. Both creams can be prescribed for use at home.
Podophyllin and trichloroacetic acid (TCA) are topical treatments administered by a doctor.
Cryotherapy and Electrocauterization
Cryotherapy involves using liquid nitrogen to freeze off genital warts. Electrocauterization, or electrocautery, uses an electrical current that burns warts off.
Surgical and Laser Removal
The loop electrosurgical excision procedure (LEEP) removes genital warts by passing a sharp loop-shaped instrument under warts to cut them out of the affected skin. Other surgical procedures involve making surgical excisions using a scalpel. The use of lasers for removing genital warts is also an option.
For RRP, a combination of both surgical and antiviral treatments is most commonly administered.
American Academy of Family Physicians (2009). Genital Warts. Retrieved from https://familydoctor.org/online/famdocen/home/common/sexinfections/sti/215.html
Centers for Disease Control and Prevention (2009). Genital HPV Infection – CDC Fact Sheet. Retrieved from https://www.cdc.gov/std/HPV/STDFact-HPV.htm#common
Markowitz, L. E., Dunne, E. F., Saraiya, M., & Lawson, H. W., et al. (2007). Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5602a1.htm
MedlinePlus (2010). Genital Warts. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/000886.htm
The Mayo Clinic (2010). HPV Infection. Retrieved from https://www.mayoclinic.com/health/hpv-infection/DS00906
The Voice Problem Website (2004). Treatment of Recurrent Respiratory Papillomatosis. Retrieved from https://www.voiceproblem.org/disorders/rrp/treatment.asp