HPV and genital warts: 2 strains cause 90% of them

Genital warts are caused by genital human papillomavirus (HPV) infection. HPV is the most common sexually transmitted infection (STI); over 80% (NFID, 2019) of sexually active people become infected with it at some point in their lives. There are over 100 different types of HPV, and at least 40 affect the genital area. HPV is usually harmless and often causes no symptoms. Some strains, however, can cause genital warts, other non-genital skin warts, and still others lead to cancer, such as cervical cancer.

Genital warts can occur in both men and women. Their appearance varies; they can be small, large, raised, flat, or cauliflower-like in appearance. Sometimes they appear singly or in clusters. They may itch, bleed, or feel somewhat tender. Genital warts can appear on the surface of the vulva, cervix, vagina, or around the anus in women, and on the penis, scrotum, or around the anus in men. It is estimated that around 1% of sexually active adults have genital warts (CDC, 2017).

How do you know if you have genital warts? If you have any new warts or bumps in the genital area, see your healthcare provider. He or she can usually diagnose genital warts by just looking at them. If your warts look unusual or suspicious, your provider can confirm the diagnosis with a biopsy. A biopsy is also useful if the lesions don’t respond to standard therapy, if they get worse during treatment, or if you have a weakened immune system (as happens with HIV or certain medications).

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While it is true that HPV can cause cancer, the types that cause genital warts are NOT the same as the ones that cause cancer. Approximately 90% of cases of genital warts are caused by HPV strains 6 and 11 (CDC, 2018). Fortunately, these types are referred to as “low-risk” HPV because they generally do not lead to cancer. The cancer-causing strains are the “high-risk” HPV types, and these include types 16 and18. These high-risk HPV types are linked to cervical cancer, oropharyngeal cancer, anal cancer, and penile cancer, as well as other types of cancer.

HPV gets into the skin and causes the skin cells to multiply, forming a wart. Some people’s immune systems are better at fighting off HPV than others, so not everyone with an HPV infection gets a wart; in fact, most people have no symptoms at all. Others may not develop symptoms until months or years after the initial infection.

Cancer and genital warts are not the only manifestations of HPV. It can also cause other warts, depending on the type.

HPV is still contagious even if there are no warts or other visible symptoms. The good news is that there is no evidence that HPV is spread by touching inanimate objects, like doorknobs or toilet seats.

Genital warts are contagious, and you should avoid sexual contact until the warts are gone or removed. They can be transmitted by vaginal, anal, and oral sex as well as non-sexual skin-to-skin contact. Be aware that you may still harbor the HPV virus even if the warts are gone. HPV is an STI, so consider getting tested for other STIs to know the status of your sexual health.

Things you can do to decrease your chances of developing genital warts (CDC, 2017):

• Get the HPV vaccine; this will not treat any existing genital warts, but it does protect against getting infected with the HPV types that cause genital warts.

• Practice safe sex and use condoms. Know that wearing a condom does not provide complete protection against infection as genital warts (and HPV) may be present in areas not covered by a condom.

• HPV is an STI; the more partners you have, the more likely you are to get it. To decrease your risk of getting HPV, it’s a good idea to limit the number of your sexual partners.

In people with a healthy immune system, HPV infections usually resolve on their own. Genital warts may go away, remain unchanged, or even get larger if left untreated.

Having genital warts is distressing, even if it is not dangerous, and most people want them resolved as quickly as possible. No one treatment works for everyone every time, so you should talk to your healthcare provider about which treatment option is best for you. Genital warts are not the same as skin warts on your hands, despite both being caused by the same virus. Don’t use over-the-counter skin wart remedies on genital warts; these treatments are for the tough skin of the hands and fingers and not the sensitive tissues of the genital areas.

Several prescription medications work to help you get rid of your genital warts. Some you apply yourself, and others require your healthcare provider. No “magic pill” exists, so sometimes a combination of different treatments is recommended. None of these treatments cure you of HPV; they only act on warts themselves. Medical options include:

• Imiquimod cream—applied to the site of the wart; stimulates the immune system to help the body fight off the virus.

• Podofilox gel—works to kill the skin of the warts; should not be used in pregnant women.

• Trichloroacetic acid or bichloroacetic acid—acids destroy the proteins holding the wart together.

• Sinecatechins cream—derived from green tea extracts; how it works is not well understood; should not be used in pregnant women.

Surgical options are available and have the advantage of being able to treat most of the warts quickly and in one visit. However, surgery is not without risks and is certainly not for everyone.

• Cryotherapy—liquid nitrogen is applied to warts to freeze and kill them.

• Excision—warts can be removed using a scalpel, electrocautery (electric current), laser treatment, or curettage (scraping).

Talk to your healthcare provider about the different treatments available to choose which one is right for you.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

September 10, 2019

Written by

Chimene Richa, MD

Fact checked by

Tzvi Doron, DO

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About the medical reviewer

Tzvi Doron, DO

Dr. Tzvi Doron is Board Certified in Family Medicine by the American Board of Family Medicine.