Everything You Need to Know About Genital Warts
*Taps microphone.* Good evening, ladies and femmes, gentlemen and gentlethems! We have gathered you all here (the internet) today to talk about genital warts.
Genital warts are a sexually transmitted infection typically caused by strain 6 and strain 11 of the human papillomavirus, better known as HPV. (FYI, there are more than 150 different strains of HPV.) Far more common than you might guess, about 1 percent of sexually active people in the United States is infected with genital warts at any given time. So, if you're having sex, you'd be wise to learn more about this infection. (Also read: What's the Difference Between an STI and STD?)
To the rescue are sexual health experts Amy Pearlman, M.D., with Promescent, a sexual health product retailer, and Natalie Hinchcliffe, D.O., medical provider with Nurx, a virtual sexual healthcare provider. Below, they explain common genital wart symptoms, as well as how to test for, treat, and protect yourself against the viral infection.
What Are Genital Warts, Exactly?
"Genital warts is a sexually transmitted infection caused by some strains of HPV, that is primarily spread through skin-to-skin sexual contact," says Dr. Pearlman. Some STIs such as chlamydia and gonorrhea are primarily spread through bodily fluids (think: ejaculate, anal and vaginal secretions, breast milk, and blood), she explains, but this is not the case for genital warts — or other strains of HPV for that matter.
Genital warts are more easily transmissible when the mucosal-dense region of someone with genital warts comes into contact with a mucosal-dense region with an uninfected individual. In other words, through mouth-to-genital, mouth-to-anus, genital-to-genital, or genital-to-anus contact, says Dr. Hinchcliffe. "Keep in mind that you don't need to have penetrative sex to be at risk for HPV and genital warts," she adds.
Genital warts get a bad rep due to their reptilian appearance, but in reality, genital warts are pretty much no biggie. That's because the strains of HPV that cause genital warts are not the same HPV strains that can cause cancer. "The two strains that most commonly cause most HPV-related cervical, penile, vulvar, vaginal, anal, head and neck cancers are strains 16 and 18," explains Dr. Pearlman. Reminder: Genital warts are typically HPV strains 6 and 11.
Sometimes the HPV or genital warts virus will go away on its own, but sometimes it doesn't. Some people's bodies will actually clear the virus on its own over time — though doctors have no data on why this works for some and not for others, as well as how long it takes on average for the body to clear the virus instances that it does. However, because there's no cure for HPV or genital warts, it's possible for the virus to stay in your system indefinitely and for you to infect others even when you don't have symptoms (warts or otherwise), according to the Cleveland Clinic.
The Most Common Genital Wart Symptoms
Named for the primary symptom it produces, genital warts usually present as small, flesh-colored bumps in the genital region. But what do genital warts look like? Sometimes these warts are standalone and resemble pink or brown skin tags, says Dr. Pearlman. Other times they grow all together in a cluster, taking on a cruciferous-vegetable-like appearance, she says. "And sometimes these warts are so flat and small that they are not visible at all," she says.
In infected individuals, these warts most frequently show up on the vulva, vagina, perineum, penis, cervix, and along the vaginal or anal canal walls, depending on the infected individual anatomy. But these warts can also show up in the mouth or throat. (See: Everything You Should Know About Oral STIs, But Probably Don't)
Visible or not, and across all locations, warts themselves can be uncomfortable or itchy — and in some cases, become susceptible to further irritation and bleeding. In most cases, though, the warts are accompanied by no physical discomfort.
How to Test for Genital Warts
Simply looking for warts is not an adequate indicator of whether or not you have genital warts because, as mentioned, some can be very small, flat, or otherwise imperceptible. (For the record: Sight alone isn't adequate for assessing STI status on any infection, considering more than half of STIs are totally asymptomatic.) The only way to know you have the strain of HPV that can cause genital warts is to get tested. And you should get tested so that you know whether or not you're at risk of transmitting the virus to your partner. (See: How Often Should You Get Tested for STIs?)
"If warts are visible, sometimes health care providers will diagnose genital warts from appearance alone," says Dr. Pearlman. Other times, the provider will biopsy a wart — meaning, remove a tiny piece of it — to sample it for abnormality, she says. After all, sometimes it's not a genital wart at all, but a skin tag, or symptom of another STI altogether. (Here's more on decoding below-the-belt bumps.)
For individuals who don't have visible symptoms, however, a provider might conduct an anal and/or pelvic exam, depending on your anatomy as well as the sex acts in your repertoire. During an anal exam, a health care provider will use to anoscope to check for anal warts, and biopsy potential warts. "During a pelvic exam, a health care provider can perform a pap smear to see if there have been any changes to the cervix that could have been caused by genital warts," says Dr. Pearlman. (See: How to Decipher Your Abnormal Pap Smear Results)
A pap smear will also allow the provider to screen for cervical cancers that may have been caused by other strains of HPV, notes Dr. Hinchcliffe. "After all, having one type of HPV does not prevent you from being infected with another type; you can be infected with multiple HPV strains at once."
How Often Should You Get Tested for Genital Warts?
If you recently had sexual contact with someone who is currently experiencing symptoms, get tested for genital warts ASAP. Ditto goes if you're currently experiencing symptoms or think you might be experiencing symptoms. "There are other sexually transmitted infections that cause skin color bumps that can be confused with genital warts, so it's smart to see your medical provider if you have a bump you think could be a wart in your genital region or mouth," says Dr. Hinchcliffe.
What should you do if symptoms aren't present and you haven't had sex with someone positive for genital warts? Genital warts testing is not included in the run-of-the-mill STI screening that your doc does because the strains that cause HPV can not be detected via vaginal swab or blood. And in people with penises, it's actually not possible to test for genital warts when warts are not physically present.
For vagina-havers, the best thing to do is get a pap smear as often as your health care provider recommends, she says. "How often to get cervical pap smears will depend on your age and your cervical pap history," she explains. Most people should get pap smears every three to five years, according to The American College of Obstetricians. (More here: How Often Do You Really Need to Get a Pap Test?)
"Whether or not you are living with HIV will also impact how often you're recommended to get cervical or anal pap smears as well," she notes.
Exactly How to Treat Genital Warts
There's some good news and some not-as-good news. First, the positive: The majority of the time, genital warts go away on their own within a few months, according to Dr. Pearlman.
In the case that warts don't go away without intervention, there are a few things you can do to get them removed. The most common solution is to have warts frozen off with liquid nitrogen. This process, known as cryosurgery, involves a doctor applying liquid nitrogen to the wart and its surrounding area to freeze the wart. Over time, as the area thaws, warts will shrink in size or scab before falling off, depending on their size and thickness. Another removal option is a prescription topical called Aldara, which slowly shrinks warts until they're gone.
"Regardless of treatment choice, the goal is to damage the wart to the root of the wart," explains Dr. Hinchcliffe. (Yes, there is a "root" of the wart under the skin). Typically, these procedures take several weeks to work.
So what's the not-so-positive news? Again, HPV is a virus, so even when the symptoms go away naturally (or are treated by, say, freezing off a wart), the virus cannot be cured and will often remain in your system. ICYMI above, in some cases, people's bodies will fully clear the virus on its own, it's unclear why this happens in some people and not others.
The fact that the virus can remain in the body forever means a few things for you. First, even if you undergo treatment for warts, they can come back — though whether they do return, how frequently or severe, also varies. It also means that, regardless of whether or not you have symptoms, you can still transmit the HPV infection to your future partner(s). Luckily, there are plenty of ways to protect your partner from the virus if you're positive and vice versa.
How to Protect Yourself Against Genital Warts
"The best thing you can do to protect yourself against genital warts is to get the HPV vaccine," says Dr. Hinchcliffe. The vaccine protects against most strains of HPV that cause genital warts, as well as the strains that most commonly cause cancer. It's ideal to receive the vaccine prior to becoming sexually active. But the vaccine is now recommended for people of all genders up to age 26, and approved for most people up to age 45 because it can still protect you from any high-risk HPV strains you haven't encountered yet, she explains. (Related: Your HPV Vaccine Excuses Are Total BS)
In fact, Dr. Hinchcliffe recommends that even people in monogamous relationships receive the vaccine. Why? "Because no one knows the future, and we are talking about preventing cancer... With the vaccine only recommended up to age 45, if your relationship status unexpectedly changes, you may find that you are unable to be vaccinated and having new sex partners over age 45," she says.
Another thing you can do to protect yourself from genital warts (and other forms of HPV) is to quit smoking. "Studies have shown, among HPV-negative women, those who do not smoke are more likely to clear the virus without any treatment than those who do smoke," says Dr. Hinchcliffe. (For support quitting, talk to your health care provider.)
Finally, use barrier methods during sex with individuals who have genital warts or whose current STI status you don't know. For penetrative anal and vaginal intercourse, Dr. Hinchcliffe recommends using internal condoms, which cover more skin surface area compared to external condoms and therefore offer slightly more protection. But using an external condom during penetration is better than foregoing barriers altogether. She also recommends using dental dams or condoms during oral sex.
It's also wise to use condoms on shared sex toys, saysDr. Hinchcliffe. "Studies show that HPV can linger on sex toys for a while," she explains. "Play it safe and use condoms on shared sex toys and change the condom after each person — plus, this is much quicker than running to the clean your sex toy between partners."