Let’s talk about genital warts, shall we? If you’re like, “Mmm, no, we shan’t,” hear us out. About one in 100 sexually active adults in the United States has genital warts at any given time, according to the Centers for Disease Control and Prevention (CDC). As for human papillomavirus (HPV), the virus that causes genital warts, 79 million people in the United States have it, and many have no idea. So, yeah, it’s smart to learn about genital warts and HPV, because knowing this kind of stuff is an integral part of taking care of your sexual health.
HPV, the virus that causes genital warts, spreads through skin-to-skin contact during sex.
“Some sexually transmitted infections, like gonorrhea and chlamydia, are transmitted through biologic fluids,” Peter Leone, M.D., adjunct associate professor of epidemiology at the Gillings School of Global Public Health and adjunct professor of medicine at the School of Medicine at the University of North Carolina, tells SELF. Think: semen, vaginal lubrication, blood. “Other infections pass most easily through “mucosal surface touch,” Dr. Leone explains, as in, contact between the moist surfaces that make up areas like the mouth, vagina, and anus. These include herpes and human papillomavirus.
HPV is the most common sexually transmitted infection in the United States, according to the CDC. There are over 150 strains of the virus. If you’re sexually active, you’ve probably gotten at least one of them, Dr. Leone says. (Unless you’ve had the HPV vaccine, which we’ll describe in more detail below.)
Most of the time, if you contract HPV, your body pulls off an impressive biological feat, mounting an immune response against the virus that eventually clears it from your system before it’s caused any ill effects. Over 90 percent of new HPV infections become undetectable within two years, according to the CDC, often within six months after infection.
In a minority of cases, though, HPV can lead to genital warts or cancer (typically cervical, though HPV can also cause cancer of the penis, anus, vagina, vulva, and back of the throat, the CDC notes). Experts have identified the HPV strains most likely to cause genital warts (HPV types 6 and 11) and cancer (HPV types 16 and 18). It’s possible to have the infection for years before developing either of these health issues.
Even if you do contract a strain of HPV that causes genital warts, you may not actually get them. But if you do wind up with genital warts, there are a few different ways they can manifest.
Genital warts can show up as small flesh-colored or gray bumps in your genital area, according to the Mayo Clinic (there are images of genitals at that link, FYI). That might include bits like the vulva, inside the vagina, the perineum (the skin between your genitals and anus), inside the anus, the cervix, the penis, and the scrotum. You can also get HPV-induced warts in your mouth or throat.
Although they can be separate, distinct growths, these warts can grow together and take on a cauliflower-like appearance, Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF. You may experience symptoms like itching, discomfort, or bleeding during sex, but Dr. Minkin says that many people report the warts as their only symptom. Sometimes, though, the warts are so small and flat, you may not be able to see them at all.
If you have a strain of HPV that causes these growths, you can pass it along to others during sex, even if you can’t pick up on any warts with your naked eye (or never develop warts to begin with).
The best way to avoid genital warts is to get the HPV vaccine, which can prevent you from contracting the virus that causes the warts in the first place.
The HPV vaccine is recommended for people who are 9 to 26 years old, according to its prescribing information, although many children first get it around the ages of 11 or 12. (The goal is for people to get vaccinated before they’ve engaged in any sexual activity and potentially been exposed to the virus, Dr. Leone explains.)
The vaccine protects against HPV types 6, 11, 16, and 18, the ones most likely to cause warts and cancer, along with five additional strains that can cause cancer. Depending on your age, you’ll either get two or three doses of the injection.
If you’re over 26, that doesn’t mean you can’t get the vaccine. It’s more likely that you’ll have been exposed to various strains of HPV at that point, Dr. Leone says, but it may still be helpful for you. Talk to your doctor to figure out whether or not getting the vaccine makes sense based on your sexual habits and health history.
Also, even if you’ve already gotten certain strains of HPV, the vaccine may still protect you against others, so don’t necessarily chalk it up to a lost cause. Read more about who should get the vaccine, and talk to your doctor if you have questions. “The more HPV we can prevent, the better,” Dr. Minkin says.
Using safe-sex tools like condoms and dental dams is always a good idea. But they’re not as effective against HPV as they are with many other STIs because of the whole skin-to-skin transmission thing.
If you’re not in a mutually monogamous sexual relationship in which you’ve both been tested as recently as necessary, you know the drill: You should protect yourself from STIs by using internal/external condoms and oral sex barrier methods like dental dams. But things get a little complicated when it comes to specifically preventing HPV-induced issues such as genital warts.
Remember, you can spread or contract the virus simply through skin-to-skin contact, even if you don’t ever notice a wart. “[Barrier methods] work in terms of reducing the risk of mucosally transmitted infections like HPV, but it’s not a home run,” Dr. Leone says. (This doesn’t mean you just shouldn’t use them, since they do protect against other STIs, and condoms also offer protection against pregnancy.)
In some instances it can also be possible to pass HPV via sex toys, Dr. Leone explains, so clean your sex toys properly and use protection with them when necessary during sex.
Diagnosing genital warts involves a physical exam, but treatment can be nuanced since there are a lot of methods available.
Doctors can typically diagnose genital warts on sight, so testing for it isn’t recommended, according to the CDC. (Your doctor may use a solution to turn the lesions white for better identification if they deem it necessary, but not always.)
When left untreated, genital warts can go away or stay the same, according to the CDC. They may also grow or multiply. That doesn’t mean you should just take your chances and wait it out. “If you see the warts, do see your health care provider,” Dr. Minkin says. Even if they start to go away or you’re realizing you once had warts but then they disappeared, it’s smart to have a discussion with your doctor about your sexual health.
If you currently have genital warts and decide to get them treated, you have a lot of options. “We have a host of things available if somebody’s got warts,” Dr. Minkin says.
These include topical medications that aim to destroy the growths or increase your immune system’s wart-fighting capabilities, among other tactics, the Mayo Clinic explains. Don’t go into a drug store and pick up regular wart-removing creams for this. Those aren’t meant for the delicate skin affected by genital warts. Instead, you need to see your doctor to discuss which topical treatment might make sense for you.
Your doctor can also counsel you on the surgical options at your disposal for genital warts, which involve freezing, burning, or excising the lesions. They may even be able to use lasers to try to get rid of the warts, according to the Mayo Clinic.
Even after treating or removing genital warts, the virus can remain in your system, making it possible to pass along to a partner. It's your responsibility to tell anyone you're going to have sex with about your HPV. That might sound unnecessary, since so many people have it, but since it can cause serious health effects, it really is important.
Treating genital warts can involve trial and error, Dr. Leone says, especially since the warts can recur as long as the virus is in your system. It’s frustrating, but patience might be a huge part of the process. Try to remember that having genital warts (and HPV by extension) is simply a sign that you have a virus that presents in a specific way, not that you’re tainted, a bad person, or anything else that little nagging voice in your head might try to tell you.