Questions and Answers about HPV and Genital Warts

What is HPV?

Human Papillomavirus (HPV) is the name of a group of viruses that infect the skin. There are more than 100 different types of HPV. Certain types of HPV cause warts on the hands or feet, and other types can cause warts or abnormal cell changes on the genitals. Many people with HPV in the genital area do not know they have it since they do not have noticeable symptoms.

What do Genital Warts look like?

Genital warts are growths or bumps that appear on the vulva, in or around the vagina or anus, on the cervix, or on the penis, scrotum, or groin (where the genital area meets the inner thighs). They may be raised or flat, single or multiple, small or large.

Can you have HPV and not have Warts?

Sometimes HPV causes very tiny changes on the skin that can’t be seen with the naked eye. Doctors and nurses can find these “microscopic warts” only with the help of special instruments that magnify (make larger). These small HPV lesions are called “subclinical” HPV infection. When HPV lives in the skin without causing any warts or other skin changes, this is called latent HPV infection. Subclinical and latent HPV are more common than visible genital warts.

Who gets HPV or Genital Warts?

HPV infection, including genital warts, can infect sexually active men and women of all ages, races, social classes, and sexual orientation. Infants can be infected by their mothers during birth, but this is very rare. HPV is so common that most sexually active people are exposed to it sometime during their life, and many will never know it.

How do you get HPV or Genital Warts?

HPV and genital warts are usually spread by direct skin-to-skin contact during vaginal, anal or (possibly) oral sex with someone who has an active infection. Warts on other parts of the body, such as the hand, are caused by different types of HPV. People do not get genital warts by coming in contact with warts on the hands or the feet.

Warts may appear within several weeks after sex with a person who has HPV; or they may take months or years to appear; or they may never appear. This makes it hard to know exactly when you got the virus or from whom you got it.

Very little is known about passing subclinical HPV infection to sex partners. Some experts think it may be less contagious than genital warts you can see.

How do you know if you have HPV or Genital Warts?

Often, it’s hard to know if you have HPV or genital warts. Sometimes people do not notice warts because they are inside the vagina or in the anus. Warts are often skin-colored and do not hurt. For some people, warts cause itching, pain or bleeding. The presence of subclinical HPV changes, which are the most common changes on the cervix, would not be suspected unless a Pap test is abnormal.

Sometimes warts are found during a man’s physical exam or a woman’s pelvic exam. For women, an abnormal Pap test may be the first warning sign that HPV is present, but a Pap test is not a direct test for HPV. The Pap looks for cells that are changed by HPV.

You should go to a doctor or clinic if:

• you notice any unusual growths, bumps or skin changes on or near your penis, vagina, vulva, or anus; or

• you notice any  unusual itching, pain or bleeding; or

• your sex partner tells you that he or she has genital HPV or genital warts.

How are Genital Warts Diagnosed?

You can check yourself and your partner for warts, but remember: warts sometimes can be very hard to see. Also, sometimes it’s hard to tell the difference between a wart and normal bumps or pimples. If you think you have warts or have been exposed to HPV, go to a doctor or clinic. A doctor or nurse will check you more closely and may use a magnifying lens to find small warts. To detect warts or other abnormal tissue, doctors or nurses may put acetic acid (vinegar) on the genitals. This causes warts to turn white and makes them easier to see, especially if they are viewed through a magnifying lens such as a colposcope. This is not a real test for HPV, but this is commonly used in detecting cervical HPV infection. Sometimes t his can help check t he penis and vulva for HPV, although it can also cause normal bumps on the skin to turn white, making it easier to get a misleading result.

How is Subclinical HPV Infection Detected?

A Pap test is used to find abnormal cell changes in the cervix before they turn into cancer (precancerous changes). Precancerous cervical changes are caused by HPV. Women with abnormal Pap results should be examined further for cervical problems (such as through a colposcope) or followed closely by a doctor or nurse.

In some situations a test for HPV may be used. This is a test that checks directing for the genetic material (DNA) of HPV. Currently the only commercially available test for HPV is Hybrid Capture II. The test is approved for use in two different cervical cancer screening situations:

1. As a follow-up test to determine which women with borderline normal-abnormal Pap tests (called “ASC-US”) are most likely to have precancerous changes on the cervix (HPV positive) and which are most likely to be normal (HPV negative).

2. As a cervical cancer test in combination with a Pap test for women at or over age 30. Research shows that screening using both an HPV test and a Pap test is more likely to find abnormal cervical cell changes than either test alone in women of t his age.

How are Genital Warts Treated?

There are several treatments for genital warts. The goal of any treatment should be to remove visible genital warts to get rid of annoying symptoms. No one treatment is best for all cases.

There are many ways to treat genital warts. The guidelines of the US Centers for Disease Control and Prevention (CDC) include the following:

•  Podofilox liquid or gel (Condylox) is a self-applied treatment for external genital warts. It doesn’t cost much, is easy to use and is safe. This treatment is not recommended for use in pregnant women.

• Imiquimod cream (Aldara) is self-applied treatment for external genital warts and warts near the anus. It is safe, effective and easy to use. The cream is not too harsh on the skin and does not cause scarring like some other treatments. This treatment is not recommended for use in pregnant women.

• Cryotherapy (freezing off warts with liquid nitrogen) is relatively inexpensive, but must be done by a trained doctor or nurse.

•  Podophyllin is a chemical compound that must be applied by a doctor or nurse. This treatment is not recommended for use in pregnant women.

•  Trichloracetic acid (TCA) is another chemical applied to the surface of the wart by a doctor or nurse.

•  Laser therapy (using an intense light to destroy warts) or surgery (cutting off warts) has the advantage of getting rid of warts in a single office visit. However, laser treatment can cost a lot, most doctors do not have lasers in their offices, and the doctor or nurse must be well trained in these methods.

• The drug interferon is rarely ever used since less expensive therapies work just as well with fewer side effects.

•  IMPORTANT: Podofilox and imiquimod (both self-applied treatments) are sold by prescription only for use at home. Over-the-counter wart treatments should never be used in the genital area.

When choosing what treatment to use your doctor or nurse will consider the size, location and number of warts; changes in the warts; patient preference; cost of treatment; convenience; adverse effects; and their own experience with the treatments.

Whatever the treatment, here are some important points to remember:

•  As your doctor or nurse to tell you all about the treatment, including its costs and likely benefits.

•  Avoid treatments that cause bad side effects or scarring.

•  Be sure you  know what to do after you have the treatment done, like what to do about any itching, burning or pain, and when to come back to the office or clinic.

•  Be patient – most people may have to be treated more than once, or your doctor or nurse may have to try more than one treatment.

• If you are pregnant or think you might be, tell your doctor or nurse to he or she can choose a treatment that won’t be harmful to you or to your baby.

•  Don’t use drug store treatments meant for hand or foot warts. These are not to be used on sensitive genital skin.

•  Some doctors and nurses may tell you not to have sex while having treatment. This is to protect the treated area of skin and help it heal.

How is Subclinical HPV Infection Treated?

According to the CDC, there is no proven benefit to treating subclinical HPV unless it has caused enough abnormal cell changes on the cervix to call for treatment. Your doctor or nurse should watch carefully for precancerous changes on the cervix.

Can HPV and Genital Warts be Cured?

Treating genital warts can sometimes be frustrating for the patient and for the doctor or nurse. The average patient may need a few treatments to clear genital warts, and for some, it may take many treatments.

None of the treatments listed above is a cure for HPV. The virus can remain in nearby skin even after treatment. Because the virus can lie dormant in cells, warts can return months after treatment. Sometimes warts may come back years after they’ve cleared, but that doesn’t happen very often. Also, when warts return, it is hard to know if the warts are a return of the old warts or a new case. However, once clear for several months, most people with genital warts never have any come back. Some experts believe this may be because a person’s own immune system helps to either suppress, or possibly clear, the virus after some time.

What about HPV, Genital Warts and Cancer?

The types of HPV linked to cervical cancer usually are not the types that cause raised, external genital warts. But if you have genital warts, you may also have come in contact with the types of HPV that are linked to cervical cancer since most sexually active individuals are likely to be exposed to at least one or more types in their lifetime. Like any other sexually active woman, a woman with genital warts should get Pap tests on regular basis.

Having Pap tests is the best way to keep from getting cervical cancer. The Pap test find abnormal cells that are on the surface of the cervix that may eventually become cancer if not monitored or treated. Cervical cancer almost always can be stopped before it occurs by finding abnormal cells early.

What about HPV, Genital Warts and Pregnancy?

If a woman has genital warts at the time of pregnancy, sometimes there are problems during pregnancy and delivery. Because of hormone changes in the body during pregnancy, warts can grow in size and number, bleed, or, in rare cases, make delivery harder. Very rarely, babies exposed to HPV during birth may develop warts in the throat. Despite these risks, a woman with genital warts does not need to have a Caesarean section delivery unless warts are blocking the birth canal. This is because the risk of a Caesarean section is greater than the very rare risk to the baby of getting warts.

It is important that a pregnant woman notify her doctor or clinic if she or her partner has had HPV or genital warts. However, it is uncommon for warts to return during pregnancy if they have been gone for months or years before the pregnancy. Women who have had HPV previously but no longer have any evidence of genital warts or other HPV changes should not have any problems with HPV during pregnancy.

How can you avoid getting HPV or Genital Warts?

Ways that lower your risk of getting other sexually transmitted diseases (STDs) may also work to lower your risk of getting HPV or genital warts:

You can reduce your risk of getting HPV or genital warts by not having sex with anyone or by having sex only with one uninfected partner who has sex only with you. People who have many sex partners are at higher risk of getting STDs.

Latex condoms (rubbers), used the right way from start to finish each time you  have sex, may provide some protection, but only for the area of the skin that they cover. Condoms should be used with all new or casual sex partners. Because it takes about three to eight months for warts to show up after a person comes in contact with HPV, a new partner may still be at risk of developing genital warts from a previous relationship months into the new relationship. Using condoms for at least three to eight months is a good idea.

Spermicidal foams, jellies, and creams are not proven to work against HPV and genital warts, nor other STDs. If you use these products as birth control, use them along with condoms, not in place of condoms.

Is it normal to feel emotional or upset about having HPV or Genital Warts?

Yes. Some people feel very upset. They feel ashamed or less attractive or less interested in sex. They feel angry at their sex partner, even though it is usually not possible to know exactly when or from whom the virus was spread. Some people are afraid that the infection could lead to cancer. It is normal to have all, some or none of these feelings.

If you are worried about HPV or Genital Warts, remember:

•  Symptoms of genital HPV can be managed.

•  Cervical cancer, the most serious problem associated with some types of genital HPV, is easily prevented through Pap tests on a regular basis and follow-up for any precancerous cell changes.

•  Knowing that facts about HPV may help you to understand and manage it.

• You are not alone. It is estimated that tens of millions of Americans have HPV. For those who do experience symptoms, it tends to be a minor problem that can be resolved.

Genital ulcer disease and HPV infections can occur in genital areas that are covered or protected by a latex condom. They can also occur in areas not covered or protected. Latex condoms, when used consistently and correctly, can reduce the risk of genital herpes, syphilis, chancroid, and HPV infection, only when the infected areas are covered or protected by the condom. In addition, the use of latex condoms has been associated with a reduction in risk of HPV-associated diseases, such as cervical cancer.

Where can you get more information about HPV?

•  Contact the STD clinic at your local health department.

•  Check with your doctor or nurse.

•  Call the National HPV Hotline (1-919-361-4848) for in-depth information and counseling. It’s open 2 pm to 6 pm, ET, Monday through Friday.

•  Call the CDC National STD and AIDS Hotlines (1-800-227-8922 OR 1-800-342-2437). It’s toll-free and open 24 hours a day, every day.

Disclaimer: This information was put together for personal educational purposes and is used for anybody requesting information through the Omaha HELP group contact number OR the Omaha HELP site. If you are a healthcare professional and found this information useful then you might want to contact the American Social Health Association and ask how you can receive professional looking brochures for your patients when they come to visit your offices.

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