Genital warts are very common. They are caused by a virus, the human papillomavirus (HPV).
Genital warts may occur in the following sites:
Images of genital warts
Normal anatomical structures may be confused with warts. These do not require any treatment.
Visible genital warts and subclinical HPV infection nearly always arise from direct skin to skin contact:
Neonatal infection may arise by passing through an infected birth canal. This can lead to rare complications, such as laryngeal papillomatosis i.e. warts in the throat. Because this complication is unlikely, a caesarean section is rarely indicated simply because a pregnant woman has genital warts.
In small children, genital warts raise the possibility of sexual abuse but in many cases it is due to vertical transmission (see above).
Transmission is common as genital warts often go unnoticed. Subclinical infections can also be infectious.
Often, warts will appear three to six months after infection but latency periods of many months or even years have been reported. Developing genital warts during a long-term relationship does not necessarily imply infidelity.
Visible warts are probably more infectious than subclinical HPV infection. Treating warts seems to decrease the chance of passing on the infection. We cannot tell whether the immune system completely clears the virus from the body, or whether the virus remains hidden but undetectable, capable of re-emerging years later if the immune system weakens. As a result, it is unclear how long someone remains infectious.
The risk of HPV transmission is extremely low if no warts recur a year after successful treatment.
Condoms provide a physical barrier and lower the risk of passing on HPV. They do not, however, prevent all genital skin-to-skin contact.
Use a condom to protect against other STDs, particularly with new sexual partners. For couples in long-term monogamous relationships, the value of condoms is more debatable.
The primary goal of treatment is to eliminate warts that cause physical or psychological symptoms such as:
The underlying viral infection may or may not persist if the visible warts clear.
If left untreated, warts may resolve, remain unchanged, or increase in size or number.
Most people have a small number of warts that clear with a course of treatment but no one treatment is ideal for everyone.
To be successful you must identify and reach the warts, and follow the application instructions carefully.
The HPV types that cause external visible warts (HPV Types 6 and 11) rarely cause cancer.
Other HPV types (most often Types 16, 18, 31, 33 and 35) are less common in visible warts but are strongly associated with penile and vulvar intra-epithelial neoplasia (pre-cancerous changes) and squamous cell carcinoma (SCC) of the genital area especially cervical cancer and less frequently invasive vulvar cancer.
However, only a very small percentage of those infected will develop genital cancer. This is because HPV infection is only one factor in the process; cigarette smoking and the immune system are also important.
Cervical smears, as recommended in the National Cervical Screening guidelines, detect early abnormalities of the cervix, which can then be treated. If these abnormalities were ignored over a long period, they could progress to cancer.
If your skin problem is troublesome and/or persistent, seek the advice of your general practitioner, dermatologist or a sexual health physician.
Two vaccines are available to prevent HPV infection, Gardasil™ and Cervarix®.
Gardasil is a vaccine that is effective against HPV types 6, 11, 16 and 18; the 4 types of HPV that cause most cases of genital warts and cervical cancer. Gardasil is now approved in many countries for use in young females for the prevention of cervical cancer, cervical pre-cancer and genital warts. In New Zealand it is funded and recommended for 12 year old girls, with a catch-up programme for those aged 11 to 18.
Cervarix is effective against HPV types 16 and 18. Available in many countries for prevention of cervical cancer, it is not subsidised in New Zealand.
HPV vaccination is most effective when offered at a young age, before the onset of sexual activity. However, girls who are already sexually active may not have been infected with the types of HPV covered by the vaccine and may still benefit from vaccination. It is important to note that women who receive HPV vaccine must continue to participate in cervical screening programmes, as about 30% of cervical cancers will not be prevented by the vaccine.
HPV vaccines are also effective in boys. Although not yet funded in New Zealand, vaccination of boys is recommended to reduce transmission of HPV to unvaccinated females. It is expected to reduce the incidence of penile and anal cancers related to HPV infection, as well as some non-genital cancers affecting the oropharynx and larynx.
There has been interest in developing therapeutic HPV vaccines for the treatment of genital warts and cervical cancer in those already infected. However, at present, there is limited evidence that they are effective in humans.