Genital Warts and HPV
Genital warts are one of the most common sexually transmitted
infections in Australia. They are caused by the human papilloma virus
(HPV, "wart virus"). There are about 100 strains of HPV, but
most do not affect the genitals.
Infection by the wart virus may result in:
These are growths that appear around the genitals or anus, and
sometimes in the vagina, rectum or urethra.
They may be raised or flat, single or multiple, small or large, and
may cluster together with a cauliflower-like appearance. They are
painless and rarely cause discomfort.
No warts are visible but microscopic changes in cells show evidence
of the virus.
HPV is spread by direct skin contact with a partner during vaginal or
anal intercourse. Infection may occur by contact with a visible wart, and
possibly also from an area of skin with no visible wart (subclinical
After sex with an infected person, warts may take a few weeks to many
months (or even years) to appear.
Genital warts are diagnosed by looking for them.
Subclinical HPV infection is difficult to diagnose. However, if present
on the cervix, it may show up on a Pap smear.
There are no blood tests or swab tests to diagnose genital warts.
Treatment removes visible warts, but does not eradicate the wart virus.
There are several types of treatment. Each may cause mild irritation, but
if you experience significant discomfort or inflammation you should tell
your doctor. An alternative treatment may be required.
Warts are frozen by applying liquid nitrogen or dry ice once a week. It
usually takes several applications before the warts disappear. You may not
be able to see the warts yourself, so it is important to continue the
treatment until the doctor says the warts have gone.
Podophyllotoxin paint (Condylline) is a plant extract that is
easily absorbed through the skin. It should be carefully applied to the
warts twice daily for 3 days, followed by a break of 4 days. This
treatment may be repeated for several cycles. Podophyllotoxin does not
need to be washed off after application, but it should not be applied
inside the vagina, urethra or anus.
Podophyllotoxin should not be used by pregnant women.
Imiquimod 5% cream (Aldara) helps stimulate the immune system to
destroy cells infected with HPV. Studies suggest it works better in women
Rub a small amount of cream on to the warts, avoiding the surrounding
skin. Wash the cream off with soap and water after 6 to 10 hours. Apply
the treatment 3 times a week (on alternate nights) for up to 3 months.
Imiquimod must be prescribed by a doctor. It is expensive, but private
health insurance may reimburse you for some of the cost.
Imiquimod should not be used by pregnant women.
Laser treatment is used when warts are in places that are difficult to
reach, very extensive or resistant to other treatments. If a Pap smear reveals evidence of HPV on the cervix, laser treatment
may be used to remove the affected cells.
Laser treatment is administered in hospital under a general
Recurrence after treatment
Most treatments destroy cells that are infected by the wart
virus, but do not remove the virus from the body.
Because the virus may persist in the skin, it is possible for warts to
return after treatment. If warts reappear, it does not necessarily mean
that you have caught the infection again.
In most people, warts go away eventually and do not reappear. This is
thought to be due to the body’s natural defences.
HPV and cancer
When some strains of HPV infect the cervix, they cause changes to its
cells. These changes can be detected on a Pap smear, and they may be
present in women who have never had visible genital warts.
Often these cells return to normal without any treatment, but sometimes
the abnormalities persist and there may be an increased risk of developing
cancer of the cervix in future. The risk is further increased in women who
Fortunately, cancer can be prevented by treating the abnormal cells.
Women with a history of genital warts or HPV need regular Pap smears.
Your doctor can advise how often smears are needed.
More information about Pap smears can be found on the South
Australian Cervix Screening Program web site.
Prevention of HPV and warts
HPV is easiest to pass on when there are visible warts present, but
there is an infectious period before they appear and after they resolve.
The length of this period is unknown. People with visible warts can reduce
the risk of spreading HPV infection by having warts treated as soon as
they appear. Those with subclinical HPV infection may pass it on without
realising they have the infection.
Condoms will help to prevent spreading warts, but they will only
protect the area they cover. As HPV may be present anywhere in the anal
and genital area, they may not provide full protection. For people in
steady sexual relationships, the benefit of condoms is less clear,
especially if both partners have warts. Discuss this with your doctor.
Coping with warts
It is common for people with warts or HPV infection to feel upset,
ashamed or concerned about the risk of cancer. This is normal, and it may
help to remember the following points:
Genital warts can be managed. With patience and persistence, the warts
will go away.
Cervical cancer, the most serious problem associated with HPV, is
easily prevented by regular Pap smears and treatment of abnormal cells.