What causes Genital Warts?
Genital warts are caused by human Papillomavirus (HPV). There are 100 types of HPV, about 40 of which can infect genital skin.
Most genital warts are caused by HPV types 6 and 11. These are known as low risk HPV types because they are unlikely to cause a cancer. High risk types of HPV sometimes go on to cause a cancer in the cervix, genital skin or anus. The most common high risk types are HPV 16 & 18. High risk HPV types usually cause infection of the genital skin without causing visible warts.
How common are HPV and Genital Warts?
HPV is a very common condition. In some studies, HPV can be found in up to 45% of men and women. It is more common the more partners you have had sex with, and for women it is more common the more partners your male partner has had sex with.
Not everyone who catches HPV will show visible warts.
How is HPV transmitted?
HPV is passed on through having sex. This may be vaginal sex, anal sex or close genital contact. It is also possible HPV may be passed on through oral sex.
It is thought to be possible for HPV to be passed on from hands to genitals. However if this occurs it is uncommon.
It is unlikely HPV can be passed on from touching non-living objects such as toilet seats or towels.
What are the symptoms and signs of genital warts?
Warts appear as fleshy growth on the skin. They may be small or large, one or many. They can grow anywhere on the genital and anal skin. In women, they tend to be on the vulva, vagina, cervix or anus. In men, they tend to be on the penis and sometimes in the urethra, or at the anus.
How are genital warts treated?
There are several ways to treat genital warts including:
Liquid Nitrogen (freezing the warts)
Imiquamod Cream (Aldara)
Chemicals like podophyllin paint, podophyllotoxin paint and TCA (Trichlorocetic Acid)
Most of these methods need to be used several times before all the warts are gone. Surgical methods can remove all warts at one visit but can be expensive and may require anaesthetic.
Can HPV infection be cured and how long will I be infectious for?
Treatment of warts is aimed at clearing warts but cannot cure the HPV infection.
Most HPV infections go away by themselves within one to two years. It is possible high risk HPV types (like HPV type 16) may take longer to clear, and in some people they can persist long term.
While warts are present, it is possible to pass HPV onto your sexual partner. HPV may also be infectious when it cannot be seen on the genital skin.
It is not known whether treating warts reduces the risk of passing the HPV infection to your partner.
How long does it take for the warts to go?
Appropriate treatment generally clears genital warts by 3 months. If the warts are not responding, changing the treatment method can speed up clearance. The number of warts present at the start of treatment is the best way to tell how long it will take to clear all the warts. If there are three or fewer warts, fewer treatment episodes are needed.
It is possible that after all the visible warts are gone some wart virus may still remain in the skin.
Can warts come back once they are treated?
Yes, because wart virus affects a large area throughout the genital skin sometimes new warts appear after treatment has cleared all visible warts. These can be treated again as needed. The number of people who have a recurrence varies from 10% to 90% in different studies.
Warts may be less likely to reappear when treated with Imiquamod than with other methods of treatment.
What other tests should I have?
High risk types of HPV can sometimes go on to cause cancer of the cervix and less often cancer of the vulva, vagina, penis or anus.
A Pap smear test can find pre-cancerous changes caused by HPV at the cervix. These changes can be treated so the cancer is prevented.
In Singapore, all women who have ever had sex are recommended to have a Pap smear every 3 years starting from age 25.
This applies whether a woman has had genital warts or not, as HPV infection can be invisible.
If you have had or your partner has any sexually transmitted infection (STI/STD), including genital warts, you should have a check up for other STIs/STDs including Chlamydia, Gonorrhoea, Syphilis, HIV/AIDS and Hepatitis B.
Can warts affect my pregnancy and baby?
Genital warts can increase in number and size or recur during pregnancy.
Rarely HPV can be passed from mother to baby during birth. As it is rare for a baby to catch the wart virus at birth, Caesarean section is only recommended if there are very large warts blocking the birth canal.
Visible warts in pregnancy can be treated by freezing, TCA or surgery. Podophyllin or Podophyllotoxin should not be used in pregnancy.
It is also acceptable not to treat warts at all during pregnancy, as they usually go away by themselves after the pregnancy is over.
You do not need to avoid having a baby if you had HPV. Most babies of mothers with HPV have no problems related with HPV. However you should inform the doctor looking after your pregnancy if you have or have had HPV.
Do condoms prevent me giving HPV to my partner or prevent me from catching HPV again?
Research has not been able to answer this question for sure. Some research suggests condoms do protect against passing HPV to your sexual partner, and some suggests condoms don’t.
If you use condoms every time you have sex they may protect you from catching HPV. If you and your partner have both already caught HPV, using condoms may prevent you continually exposing each other to HPV.
Using condoms correctly, every time you have sex will protect you from many STIs/STDs including HIV/AIDS, Chlamydia, Gonorrhoea and Hepatitis B. Condoms also reduce your risk of catching other STIs/STDs such as syphilis and herpes.
Why do people who have never had anal sex sometimes get anal warts?
Anal warts often occur in people who have never had anal sex. After the wart virus gets into the genital skin at one site, it can spread throughout the rest of the genital and anal skin, even though it may cause visible warts at all genital sites.
What is HPV vaccination? Will it stop me getting genital warts again?
Two safe and effective HPV vaccinations are now available in Singapore, Gardasil and Cervarix.
These vaccines do not treat or prevent HPV infection with a type you have already caught. They prevent you from catching HPV types you have not caught yet.
It is safe to have the HPV vaccine even if you have already had genital warts, but it won’t protect you against any types of HPV you have already caught.
These vaccines are most effective when given before you have had many sexual partners.
In Singapore, the HPV vaccines are recommended for females aged 9 to 26. If you are male or over age 26 you can also talk to your doctor about whether the HPV vaccination may be a good idea for you.
Women who have the HPV vaccine still need to continue having regular Pap smears.
Should I stop smoking now I have HPV?
Some evidence suggests stopping smoking when you have genital wart virus is important. Smoking may make treatment of warts less effective and may increase risk of HPV progressing to a genital cancer.
Safer Sex
The safest way to have sex is to have only one sexual partner at any one time.
Safer sex means using condoms every time you have vaginal, oral or anal sex. Using a water based lubricant with condoms can increase the sensitivity and safety of sex.
Always use condoms (and water based lubricant if available) with casual or paid sex partners.
Correct and consistent condom use provides protection against most STIs/STDs including HIV, Chlamydia, Gonorrhoea, Hepatitis B and Trichomonas. Condom use also reduces your risk of catching syphilis, herpes and genital wart virus. Condoms are also effective contraceptives if used every time you have sex.
When you start a new sexual relationship, talk to your partner about safer sex, and having only one partner at a time. Use condoms every time you have sex until you have both had a check up for STIs/STDs and HIV. HIV testing is most accurate three months after your last unprotected sex.
You can have this check up at DSC or your local doctor. Anonymous HIV Testing is available at Action for AIDS (AfA). More details are available at www.afa.org.sg