Human papillomavirus (HPV)

Genital warts are caused by infection with a subgroup of the human papillomaviruses (HPVs)

Over 100 types of human papillomaviruses (HPVs) infect humans. Of these, more than 40 types can infect the genital tract and anus (anogenital tract) of men and women. Sometimes, they cause genital lesions known as condylomata acuminata or genital warts.

There are two types of genital HPV infection - low-risk and high-risk. Low-risk strains tend to cause genital warts and rarely cause cancer. High-risk strains have been linked to certain cancers (oral, cervical, penile, and anal) and often cause no symptoms.

HPV infection is the most common sexually transmitted disease (STD, sexually transmitted infection, STI) in the U.S. About 75% of people of reproductive age have been infected with sexually transmitted genital warts at some point. Approximately 6 million people become infected with HPV every year in the US, and approximately 50% of those infected are between the ages of 15 and 25.

HPV infection is common and does not usually lead to the development of warts, cancers, or even symptoms. Most people clear the infection on their own. Sometimes, though, the infection becomes chronic and when it’s caused by high-risk strains, it can lead to cancer.

Asymptomatic people infected with HPVs (those without HPV-induced warts or lesions) are still able to spread the infections to others through sexual contact.

• Genital warts appear as raised, flesh-colored lumps or bumps.
• They may have a corrugated (cauliflower-like) appearance.
• Many people with genital warts have no symptoms, but sometimes they may occur at the location of the warts, and include:
  • Itching
  • Burning
  • Tenderness
• Size of the warts may vary, and multiple warts may be present at the same time.
• They may appear anywhere on body surfaces that are exposed in sexual contact, including the vulva, vagina, cervix, penis, scrotum, thigh, or groin. Warts can also appear in the anus.

Women who have genital warts inside the vagina may experience symptoms such as bleeding following sexual intercourse or an abnormal vaginal discharge. Rarely, bleeding or urinary obstruction may occur if the wart involves the urethral opening or anus.

HPV sometimes can be suspected by changes that appear on a Pap smear, since Pap smears identify infected abnormal cells that may be precursors to cancer. HPV infection can lead to precancerous changes in the cervix that are recognized on a Pap smear. If a woman has an abnormal Pap smear, more advanced tests may be performed. HPV also can be seen on biopsy (for example, from a genital wart or from the uterine cervix).

The HPV Test can be done on women, either alone or with her Pap test, This looks for high risk strains.

Currently, there is no HPV test for men.

No treatment will cure genital warts or HPV infection. The only treatment is to remove the lesions caused by the virus. Unfortunately, even removal of the warts does not necessarily prevent the spread of the virus, and genital warts frequently recur. None of the available treatment options is ideal or clearly superior to others.

Available treatments for genital warts include medications applied directly to the warts, or sometimes, surgical removal or laser treatments. Removing warts does not guarantee they will not return.

• It is important to note that you should not use home remedies or treatments for common skin warts on genital warts.

In some people, genital warts may go away on their own within months to a few years. In other cases, they may persist if not removed and may grow larger and form clusters.

In most cases, the virus will clear itself from the body within 2 years. 

If HPV is detected through a Pap test, your doctor will perform a test called a colposcopy. This looks closely at the cervix to find any areas that look abnormal. Your gynecologist may take biopsies of these areas of the cervix. 

If precancerous lesions are found, they need to be removed to ensure that these cells do not progress to cancer. In this case, treatment usually involves surgical removal or destruction of the involved tissue.

• Conization is a procedure that removes the precancerous area of the cervix using a knife, a laser, or by a procedure known as LEEP (loop electrosurgical excision procedure, which uses an electric current passing through a thin wire that acts as a knife). LEEP is also referred to as LLETZ (large loop excision of the transformation zone).
• Cryotherapy (freezing) or laser therapy may also be used to destroy tissue areas that contain potentially precancerous changes.

A vaccine is available against common HPV types associated with the development of genital warts and cervical and anogenital carcinomas. This vaccine (Gardasil 9) has received FDA approval for use in females and males aged 9 through 45 in the US.

It confers immunity against 9 HPV types: 6, 11, 16, 18, 31, 33, 45, 52, and 58.

• Condom use decreases the risk of transmission of HPV during sexual activity, but it does not completely prevent HPV infection.
• Abstinence from sexual activity can prevent the spread of HPVs that are transmitted via sexual contact.