STD Awareness: Genital Warts

A computer model of the surface of HPV-11, a leading cause of genital warts. Image: Scripps Research Institute

Human papillomavirus (HPV) is a hot topic these days thanks to the advent — and attendant controversy — of Gardasil, the vaccine that protects against four strains of this sexually transmitted virus. Discourse centers around HPV-16 and HPV-18, the two HPV strains that together are responsible for 70 percent of cervical cancers and 90 percent of anal cancers. However, Gardasil also protects against HPV-6 and HPV-11, two HPV strains that aren’t associated with cancer but rather with 90 percent of genital warts. While genital warts don’t have the potential to cause cancer and death, they can be very upsetting to the people who develop them.

Every year in the United States, about $200 million is spent to treat genital warts.

Many strains of human papillomavirus can cause warts, and not all of them are sexually transmitted. For instance, HPV-1, HPV-2, and HPV-4 cause warts on the hands and feet and are spread by skin-to-skin contact. About 40 strains of HPV can be transmitted sexually — they are called “mucosal” strains because of their affinity for mucous membranes such as the skin found in the genital, anal, and oral regions. Ninety percent of cases of genital warts are caused by two strains of HPV: HPV-6 and HPV-11. Genital warts are highly contagious and can be transmitted by any type of sexual activity.

Let’s start with a quick overview of genital warts. While it’s quite possible for someone infected with a wart-causing strain of HPV to be completely asymptomatic, the physical appearance of warts can take several forms. They can appear in the genital area, in or around the anus, and (very rarely) in the mouth, lips, palate, or throat. They can also rarely be found on the cervix and vaginal walls. They are soft to the touch and can be raised, flat, or bumpy. They may or may not be itchy or painful. Genital warts can be small or quite large. As you can see, there are a wide variety of ways they can manifest themselves, despite being caused by one type of virus. There are four types:

  • condylomata acuminata, which have a “cauliflower-like” appearance
  • papular warts, which are dome-shaped papules 1-4 millimeters in diameter
  • keratotic warts, which have a thick, “crust-like” layer
  • flat-topped papules, which can look like a freckle or might be slightly raised from the surface of the skin

Genital warts usually develop within six weeks to six months after exposure, but could take longer to appear. If our immune systems are healthy, our bodies may be able to fight off the virus — our immune systems are normally able to clear 90 percent of genital-wart infections within two years of exposure. Unfortunately, if the immune system can’t fight off the virus, the infection will become chronic, in which case warts can resurface throughout one’s lifetime. The warts can be removed by a doctor, but you could still transmit the virus to others and you might experience a recurrence of the warts. Smokers’ immune systems are less likely to be able to fight off the infection, and in the case of a chronic infection, smokers’ warts are more likely to return even after being removed by a health care provider.

You can reduce your risk of acquiring HPV by consistently and correctly using condoms and dental dams. The female condom (also known as the receptive condom, the internal condom, or the insertive condom) is more effective in protecting against HPV transmission because it covers more surface area than regular condoms. However, barrier methods are limited by how much of the skin’s surface they can cover. Because the virus can reside in skill cells that aren’t covered by a condom or dental dam, HPV can still be spread even when safer-sex methods are used. Aside from total abstinence, the best protection against genital warts is to be vaccinated with Gardasil before becoming sexually active. (If you are already sexually active, you still could benefit from the vaccine. Talk to a health care provider for advice.)

Genital warts by themselves are not life-threatening, though they can cause bleeding; when open wounds are present, the risk for the transmission of other STDs increases. Warts can also cause emotional distress, so most people who have them want to find ways to get rid of them. Old folk remedies included strategies such as rubbing a dead toad on the warts; these days there are many effective ways of getting rid of them, including surgical and nonsurgical methods. Talk to a health care provider to find out which option is best for you. They are easier to treat if therapy is sought within the first year of their appearance. Unfortunately, each treatment can cost several hundred dollars and the warts could return in the future (annually, about $200 million is spent to treat genital warts in the United States alone). Furthermore, evidence shows that warts can still be transmitted even when they have been removed because viruses can lurk in the surrounding skin cells. It is possible, however, that the removal of warts makes transmission less likely — but right now researchers don’t know for sure.

Genital warts could pose a problem during pregnancy. Hormonal changes can induce the warts to grow in size, and transmission to the infant during childbirth is possible, though rare. A congenital infection can lead to the growth of warts in the respiratory tract. This infection is called recurrent respiratory papillomatosis, and it can cause breathing problems. The warts can be removed, but they will usually keep growing back. This is a rare condition — only 1 in 200,000 children develops it — but it’s one more reason to consider Gardasil and always to use barrier methods during sexual activity.

Planned Parenthood health centers, as well as other clinics and health-care providers, can diagnose and treat genital warts. Additionally, Planned Parenthood carries Gardasil, the vaccine that protects against the strains of HPV responsible for 90 percent of genital warts.

Click here to check out other installments of our monthly STD Awareness series!

39 thoughts on “STD Awareness: Genital Warts

    • It’s very difficult to know from whom you acquired genital warts, unless you have engaged in sexual activity with only one person. Otherwise, you probably won’t be able to find out — it is possible to carry the virus without showing symptoms, or without noticing symptoms, so people can transmit the virus unknowingly.

      Check out this Q&A with Dr. Cullins at Planned Parenthood’s website for some more information.

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  5. I fear that I may have genital warts. Little clusters of skin have appeared on the visible portion of my vagina, and around my anus. But I don’t understand where I could have gotten it from, for my last sexual partner tested himself before we engaged in sexual activity, and he did not show to have any STI’s. I am worried that because for the last couple of months I have been too afraid to get myself tested that I have infected my current partner, though the furthest we have done is me giving him oral and him fingering me. Is it possible for some tests not to be able to detect the virus? Are there other vaginal infections besides genital warts it could be? And could him fingering me manually infect my current boyfriend?

    • Hi Sam. 🙂 First of all, it’s important to get your suspected genital warts checked out by a professional so you can be sure you have an accurate diagnosis. If your condition clears up, it might be difficult or impossible to know whether or not you actually carry the virus for genital warts. Genital warts are tricky, because the virus can be present in your body without actually causing symptoms — so when you have symptoms, you have the best chance of getting a good diagnosis.

      STD screenings do not test for genital warts if the person being tested is asymptomatic. It is quite possible that your boyfriend had been exposed to the genital wart virus and transmitted it to you without knowing he ever had it, and without ever showing symptoms. If you do have genital warts, it is possible to transmit them to your current partner by him performing oral sex on you or fingering you. The virus that causes genital warts can spread to his mouth, and it can also be transmitted manually (for example, if he touches you and then touches himself without washing his hands first). As for you performing oral sex on him, if you do not have the genital wart virus in your mouth, it is not likely that you will transmit it to him by performing oral sex.

      You can’t know what your next step will be until you get a diagnosis. Maybe it’s something else. Or maybe it’s genital warts. If it is warts, you can be treated, and you also have a high chance of clearing the infection within two years (meaning that you won’t carry the virus forever). Depending on what kind of lab tests your clinic does, it also might be possible to find out which viral strain you are carrying (assuming you are diagnosed with genital warts and not something else). If you are carrying one of the two viral strains protected against by Gardasil, your current partner can be vaccinated as a protective measure. (You might also consider vaccination as well, as Gardasil protects against four strains of the virus — two that cause warts and two that can cause cancer.)

      When you have time, you can re-read the above post — it answers many of the questions you asked in your comment. You might also be interested in the following posts, as they also have answers to your questions:
      STD Awareness: HPV in Males
      STD Awareness: “Can I Get an STD from Oral Sex?”
      Over 90 Percent of What Planned Parenthood Does, Part 6: Vaccinations

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  11. I guess I have two questions I was diagnosed with genital warts in August. I have read conflicting messages about if the body can suppress the virus or not. I was wondering if it is true that in 1-2 years it is most likely cured by the immune system? My other question is can my boyfriend get the vaccine, he’s over 26, and will it protect him from getting the virus? Thank you for your help!

    • Hi! Yes, while there is no medical cure for the virus that causes genital warts, the immune system can usually “clear” it within 13 months, which means that the virus is no longer in your body. To help your immune system, you can eat right, stop smoking (if applicable), and avoid stress. If you are on any immune-suppressing medications, you can talk to a doctor about the risks involved with those drugs. Unfortunately, there are no tests that can tell you whether or not you have FOR SURE cleared the virus. If you keep getting warts, then you’ll know you still carry the virus — but if you don’t get warts, then either you cleared the virus or you’re merely an asymptomatic carrier!

      As for your other question, yes, your boyfriend should be able to get the vaccine. Unfortunately, since he’s over 26, his insurance (if he has it) probably won’t cover it — but he can still double check. This means he’ll have to pay out of pocket. This is another thing he should discuss with a health care provider — he might have already been exposed to the virus, but as I said, there is no test that will tell him for sure whether or not he has. Luckily, the vaccine protects against a total of four strains of HPV, so he might receive protection from strains of the virus he hasn’t already been exposed to.

      These are definitely good questions to ask a health care provider. The staff at Planned Parenthood specialize in this stuff, so they should be able to answer any questions you have. So should any health care provider who specializes in sexual health.

      Other good sources of information are Planned Parenthood’s pages on genital warts and HPV; the book The HPV Vaccine Controversy (don’t be misled by the title — it’s about much more than the vaccine!); and our blog posts on HPV in males and the HPV vaccine.

  12. I have been with my husband over 11 years. He is the only man I’ve slept with… recently I have found a wart on his penis. I asked if he had cheated, He got offended and we stopped the activity. Initially he tried telling me that was a bump from him (taking care of himself), I’ve never seen a wart come of that… About two weeks after the incident I told him that I do not want to have intercourse until he gets checked, because I do not want anything. I had a full pap about 6-8 months ago and it was normal and no concern. He told me he has had this since he was 16 off an on it would come and go. (Although I’ve personally never seen it or felt it before.) I asked him why is he just telling me this now, and two weeks AFTER the finding. He said he never thought about it before. Is it possible for this to have laid dormant in him for over 11 years and never show symptoms and I not have it with my last pap or any of my paps for that matter? I’m pretty sure that after 11 years I would have shown something, if he has indeed had this for 25 years as he so claims.

    • Hi! Yes, it is possible for the virus that causes genital warts to be dormant for long stretches of time. Unfortunately, without symptoms (i.e., when warts aren’t present), there is no FDA-approved method for testing for the virus, so you can’t know for sure if someone is an asymptomatic carrier. It’s also possible for the warts to take on a wide variety of appearances, and sometimes they are so small or flat that they can escape notice.

      While someone performing a Pap test on you might look for warts, the primary purpose of a Pap is to screen for high-risk HPV, which can cause cancer. Genital warts are caused by low-risk HPV, and do not cause cancer.

      He should definitely go get checked, and if he’s comfortable with it perhaps you could go with him. To receive a proper diagnosis, he must get the wart looked at before it clears up on its own. This way, you can make sure that it really is a genital wart caused by HPV and not something else. He can also receive treatment for it. And, perhaps most important, you can have your questions and concerns addressed by a health care provider.

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  14. I’ve been with my boyfriend for almost three years. We both have the virus for genetal warts. Neither of us has had any warts reapear since we got them removed. My question is …
    If we give eachother oral sex without protection will we get warts in our mouths?
    If the warts later on apear on our vagina/penis, will they also reapear in our mouths even though there were no warts there when we had oral sex?

    • Hi Lucy!

      Yes, it’s possible for the virus that causes genital warts to spread to the mouth during oral sex, even when the warts aren’t present. Read our article HPV in Males to learn about a condition called recurrent respiratory papillomatosis, which occurs when warts develop in the airway. Because the virus can still be present in your skin cells even after the warts have been removed, transmission is possible.

      The good news is that this condition is very rare, and if you have no genital warts present your risk of transmission is probably even lower (though right now researchers don’t know for sure just how much less risky it is).

      I would strongly recommend discussing the risks with a sexual health provider, at Planned Parenthood or elsewhere, if you have concerns about the oral transmission of genital warts.

    • You can definitely get them in your mouth. I know from firsthand experience. I do not believe it is as rare as the medical field suggests, rather most people just don’t notice the symptoms because we only look in or mouths occasionally. I would not have realized I had it had it not been for the fact that I had bad tonsils at the time, and looked in my throat often as a result. That’s how I noticed the growth. Otherwise, they don’t hurt or anything and it wasn’t blocking my airway. If I had not looked and wasn’t familiar with the anatomy of the back of my throat, I never would have known it was there. Had it removed along with my troublesome tonsils and the healing process from where the wart was cut out was extremely painful, but I’ve been fine since. Only had unprotected oral with one person in my life btw.

      • Also, when the ENT doctor informed me that the growth was in fact a wart, he said he sees them in the throat of patients “all the time”. It’s not as rare as they say. Use flavored condoms to protect yourself.

  15. Thank you so much for these very informative articles!

    I’m female, and my male partner is currently being treated for warts. We are using condoms now, but had unprotected sex many times over the course of about 2-3 weeks before he found out that the bumps on his penis were actually warts, and not skin damage from over-enthusiastic masturbation. We are also not too careful about hands touching him and then me, or oral sex (which I wasn’t aware was a risk until reading the articles here). I have a few questions:

    * Since we had unprotected sex so many times while he had warts, does that mean it’s inevitable that I’m infected? And even if I’m not infected now, isn’t it just a matter of time before I am, even if we use condoms?

    * How likely is it for HPV to be transmitted if I do (unprotected) oral on him, kiss him, and he does oral on me?

    * Do I need to tell my other partners that I’ve been exposed, even though I haven’t shown any symptoms that I can see, at least?

    * He’s undergoing treatment for the warts. Assuming they go away, and assuming that I’m infected, can we pass the infection back and forth if we stop using condoms? Or is it more that once he’s been infected, it doesn’t matter if I expose him again?

    * If I do end up getting warts, is it really a big deal if I don’t get treatment (assuming they are small, and not like a photo in a medical book)? Are there any serious risks, complications, health impacts to warts, or is it just cosmetic? Since it’s fairly expensive to get them treated, could I just decide whether I care that much about how it looks? Or will they inevitably spread without treatment and eventually look like a photo in a medical book?

    • Hi Swan! Lots of good questions. I have tried to find some answers for you, but some of the information you want is just not available (or at least I can’t find it!).

      It’s not inevitable that you’re infected, but you might be. Obviously, risk increases with every sex act, and that risk increases further still when a condom is not used, but that doesn’t mean you’re 100 percent certain to have caught the virus. Unless you start showing symptoms, you probably won’t be able to find out.

      A lot of it depends on which strain of the virus he is infected with — it seems that HPV-6 is the most easily transmitted, while other strains might be more difficult to transmit. It’s possible that he has an HPV strain that has a lower “transmission efficiency,” meaning that your risk is lower. Unfortunately, I can’t find information on the transmission efficiency of any genital wart strains (meaning that I can’t find information in the form of, “Every time you have [type of sex act — vaginal intercourse, oral sex, etc.] with an HPV-positive person, you have a [number] percent chance of catching the virus”). It would be great to have this kind of data (it’s what most people are interested in!), but it’s just not very well-studied.

      As for whether or not it’s a matter of time, even if you are using condoms — I would recommend talking to a health care provider and considering being vaccinated with Gardasil. If you are not already infected, Gardasil can protect you from the two strains of HPV that are together responsible for 90 percent of genital warts. (Plus two additional strains of HPV that are responsible for 70 percent of cervical cancers.) You might also consider encouraging future partners to be vaccinated, just in case, because you have been exposed.

      It is possible that a couple could pass the virus back and forth to one another (the ping-pong effect). Most people clear the virus within a couple of years, so it is likely that he will receive treatment for his warts, they’ll stop coming back, and the infection will be cleared by the immune system. Unfortunately, there is no way for him to know for sure if he’s cleared the virus or if he’s an asymptomatic carrier. If he clears the virus but you still have it, you could conceivably pass it back to him.

      A natural infection with HPV confers some immunity (just as a vaccination confers immunity, but without the effects of an actual infection). However, it seems that immunity from a natural infection declines over time, and furthermore some emerging data seem to indicate that vaccine-related immunity might last longer. Unfortunately, this is not well-studied, and most of the data I found related to cancer-causing HPV strains, not wart-causing strains. For instance, this study of HPV-16 (the predominant cancer-causing strain) found that a natural infection didn’t confer much immunity and that reinfection was possible. Is the same true for whichever wart-causing strain that your partner has? Maybe.

      I know those aren’t particularly satisfying answers to your questions. But your partner doesn’t know which HPV strain he is infected with, and even if he did, HPV researchers probably don’t currently have information on that strain’s transmission efficiency and the duration of natural immunity to reinfection. We also don’t currently have definitive testing methods to find out who is HPV-free and who is carrying the virus without symptoms.

      You’ll have to decide for yourself how you deal with your warts, if they do show up. Usually very large warts (“like a photo in a medical book”) were able to grow to that size because the person had a compromised immune system. If you are otherwise healthy, that’s probably not something to worry about, unless you want to get rid of them for cosmetic reasons.

      According to Planned Parenthood’s website, genital warts are not dangerous. It’s possible for them to be uncomfortable (burning, itching, painful, bleeding), but that’s not the usual experience of people with genital warts — although if they bleed, that could make you more vulnerable to other STDs, so using protection and getting tested with your partner is still a good idea. There can be rare complications with a future pregnancy (and warts can grow to larger sizes during that time, as pregnancy messes with the immune system). That’s something to bring up with an ob/gyn if you are pregnant in the future.

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  21. My boyfriend has genital warts. We haven had any sexual contact other than mutual masturbation, and I’m always careful to make sure that he hasnt touched himself prior and that we wash our hands after. If he were to perform oral on me, would he be spreading the virus? I don’t have any warts and am protected to an extent by gardasil shots.

    • For him to transmit the wart-causing strain of HPV to your genitals via oral sex, he would need to have an HPV infection in his mouth/throat. Otherwise, there will be no virus in his mouth for him to transmit to your genitals. Unfortunately, there aren’t definitive diagnostic tests for HPV, so it would be difficult for him to know for sure if there is an HPV infection in his mouth/throat, especially since HPV so often does not have symptoms. He might ask for an HPV DNA test to be performed on an oral swab, but I don’t believe those are FDA-approved for diagnosing oral HPV infections, and there is also the possibility of false negatives. Luckily, Gardasil protects you against the two HPV strains that cause 90% of genital warts. It’s up to you to figure out what is and is not an acceptable risk for you. Some people wouldn’t want to risk contracting genital warts, while others are fine with it. MOST cases of genital warts are asymptomatic, and MOST cases clear up within a couple of years. But they CAN have symptoms and they CAN persist if the immune system can’t fight the infection effectively.

  22. My husband has been recently diagnosed with hpv genital warts. I’ve been with him for almost 5 years and he’s never had an outbreak before. I’ve had two of the three gardisel shots but I couldn’t get the third because I got pregnant before I could get it. Is it possible that I’m being protected from the virus from the shots I did have or am I infected and it’s just laying dormant like it did with him? I’m showing no symptoms and I am going to the dr to get checked out (even though I just had a pap in January) I’m just trying to process all of this.

    • Thanks for your question! Off the top of my head, I can tell you that getting two out of the three shots does offer you some protection. When I have more time (later today, I hope), I’ll peruse the medical literature to see if I can get you more specific information. There has been a lot of study on Gardasil, including on people who didn’t complete the three-shot series, so I’m optimistic that I’ll be able to get you a more detailed answer than “some protection.”

    • Hello again. There are a few things to consider. One, when receiving an HPV vaccine, the immune response is stronger in younger people. One study found that girls 9-13 years of age gain as much protection from two shots of Gardasil as young women ages 16-26 who received three shots. (You can see an interview with one of the researchers here, but it’s pretty dry.) There are other studies as well showing that two doses of Gardasil provide good protection. I don’t know when you received your Gardasil shots, but the younger you were, the stronger the immune response was likely to be.

      Even if you were a little older when you received your shots, two shots would still give you more protection than one shot or no shots. Some researchers (for example, here) think that the third shot might make someone’s immunity last longer, but that the first two shots provide many years of protection. (How long this immunity lasts is still uncertain, given how new the vaccine is. But the above-linked study says “two doses are likely to protect vaccinees for more than a decade.”)

      Another thing to consider is that most people who become infected with an HPV strain that causes genital warts never actually have symptoms, and most of them can clear the virus within a year or two. You can increase your chances of clearing the virus (assuming you became infected with it — my guess is that you probably did not if you received your shots before you were exposed to HPV through sexual activity) by quitting smoking (if applicable) and otherwise striving to live a healthy lifestyle, to keep your immune system in good shape.

      Lastly, when you see the doctor for your checkup, make sure you’ve written down all your questions so you can ask them and take notes. You can ask if it might be worthwhile to get your third Gardasil dose. If you’re 26 or younger, it might be covered by insurance.

  23. Last nov 25 2016upon my ob check up I was told i have genital warts. on 2015 i had liqui prep pap smear and its negative. and it was my last sexual activity. I think i got from my ex. I wonder why it only appear this year. I never had any sex or even oral after then. Did i get it from him? The ob did the tca twice yet im not sure if its already remove as i notice a bump near the anal area and dot like thing near the left side if cervix moreover i feel itchy down there too. Is there other way to remove this as some treatments are expensive or the body can remove the existing warts on its own. And also i had the 1st shot of gardasil upon d tca treatment and i will finish it this may 2017.Question can this vaccine will prevent the recurrent growth of the existing wart break out?

    • Hi Rheaj!

      The vaccine will not treat an existing HPV infection, but it will protect you from acquiring other strains of the virus in the future. You can ask your doctor if you’re receiving Gardasil-9, which protects against two wart-causing strains of HPV, and seven cancer-causing strains of HPV. Most people haven’t been exposed to all nine strains of this virus, which means the vaccine can still protect them in the future, even if they have already had one type of HPV.

      Unfortunately, there is really no way to know who you got HPV from, as most people don’t have symptoms and there isn’t a good test for it in asymptomatic people.

      You can talk to your doctor about all your options for removal, and you can also help your body clear the virus by staying healthy — avoiding stress, not smoking, etc.

  24. Hello, I recently found out that my boyfriend has hpv because he had a genital wart break out on him. My question is how long can hpv lay dormant for? How long can genital warts lay dormant for? We have been together for three years now without any symptoms of this showing. Also, once infected with hpv, can it lay dormant for a very long time without it showing any signs until now? I see a lot of questions about hpv and cheating (my boyfriend insists he did not cheat in our relationship) I should also mention he was a heavy smoker prior to being with me.

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