Warts – Fast Facts
HPV causes at least 360,000 diagnoses of anogenital warts every year in the US, although estimates of new wart diagnoses can reach 1,000,000. In the UK, HPV causes about 39,250 new warts cases in women and 47,550 new warts cases in men annually.
Genital warts generally occur in the anogenital epithelium or within the anogenital tract. 90% of anogenital warts are caused by HPV types 6 and 11, with the remaining 10% caused by other types of HPV. HPV types 16, 18, 31, 33 and 35 are also occasionally found in visible genital warts, usually as co-infections with HPV 6 or 11. HPV Types 6 and 11 have also been associated with conjunctival, nasal, oral and laryngeal warts.
Genital warts are generally considered low risk of progressing to cancer, but can be treated nonetheless.
Warts can appear in the following locations:
In both men and women:
- Anus (both in and around).
- Nasal passages.
- Perenium (area between the anus and the scrotum or vulva).
Additionally, in women:
Additionally, in men:
- Under the foreskin if uncircumcised.
- Penis shaft.
Genital warts are usually asymptomatic, but can be painful or itchy in some instances. Diagnosis is usually done through visual inspection and in some cases may need to be confirmed through a biopsy.
The primary treatment goals for genital warts are to alleviate symptoms, and ultimately to remove the warts. If left untreated, genital warts may either increase in size or number, remain unchanged or go away on their own.
It is still unclear if treating HPV-infected genital warts reduces the infectiousness of the virus. People may still be able to pass the virus on to sexual partners even after the warts have been treated.
The treatment for warts is dependent on the patient, available resources, and the expertise and experience of the healthcare provider. Multiple other factors that weigh into the decision of treatment include wart size and number, location of the wart, how and if the wart is changing, patient preference, treatment cost, convenience and possible adverse effects.
Treatment can be administered as a one-time dose or in multiple doses, depending on the regimen selected and responsiveness of the warts. The treatment method should be reviewed or altered if recovery is not seen after three months and/or if there are adverse side effects. The patient should be monitored for these side effects regularly.
Factors affecting treatment efficacy include the presence of immunosuppression, and whether the patient adheres adequately to treatment. Recurrence is common, especially within the first three months after treatment. It is not possible to tell if the wart is due to the same strain of the virus, or an infection with a new HPV strain.
Treatments can be separated into provider-applied and patient-applied methods. Please be sure to speak with your provider about your individual needs and options, and do not be shy to ask about their experience with these methods.
Please note that the information contained on this page is not intended to provide medical advice. Any questions regarding your medical health should be directed towards your primary care physician.
These are preferred by many patients as they can be applied in the privacy of one’s own home. They must be prescribed by a doctor and follow-up visits are not required, though seeing a provider after several weeks of treatment may help assess the response to treatment as well as any side effects. For maximum effectiveness, patients must be sure to comply with all instructions as well as be able to identify and reach all genital warts.
Patient-applied methods typically involve application of a gel, cream or ointment. Always speak with your medical provider about what is best for you. Commonly used medications include:
- Podofilox is a gel that destroys warts and is typically applied two times a day, for three days. This can be completed up to four times, with a four-day break between cycles. In the UK this is known as Podophyllotoxin.
- Imiquimod is a cream that stimulates the immune system. This is typically applied once at night, three times a week, for up to 16 weeks. This is used both in the US and the UK.
- Sinecatechin ointment is a green tea extract that is applied three times a day for up to 16 weeks. This only seems to be a routine treatment in the US.
Provider-applied methods are conducted in your provider’s medical office. Follow-up visits are usually needed after provider-applied methods of wart treatment:
- Cryotherapy is the application of liquid nitrogen to destroy warts. Health providers must be properly trained on the correct application of this method. This is used both in the US and the UK.
- Podophyllin resin is applied topically and dose applied must be carefully measured. This treatment can be repeated weekly, if needed. This only seems to be a routine treatment in the US.
- Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) are caustic (corrosive) agents used to destroy warts. This treatment can be repeated weekly. This is used both in the US and the UK.
- Surgical therapy is advantageous as it can remove warts in a single visit, but does require a more equipment and time-intensive process. Warts can be removed surgically via electrocautery or excision. Surgery may be beneficial in cases of extensive warts or warts found in difficult locations such as the urethra. This is used both in the US and the UK.
Complications are rare as long as treatment is administered properly by a skilled provider. Changes in pigmentation in the area of the warts is common, and scarring is uncommon but does occur, especially when healing time between treatments is insufficient.
Rarely, treatment can lead to chronic pain in the area of treatment, such as vulvodynia or painful defecation. Finally, a very limited number of severe systemic effects have been noted when treating warts with podophyllin resin and interferon.
Always discuss potential complications and side effects with your provider before beginning treatment.
Certain treatments must not be used during pregnancy. Generally, the removal of warts might be incomplete until the pregnancy is over. There is a low risk of transmitting HPV to children during the birth process if the mother is infected with HPV types 6 or 11, which can become recurrent respiratory papillomatosis in the child. The route of transmission is not completely understood. Pregnant women with genital warts should be counseled by their care team about the risks of transmitting warts to their children, and about how to lower these risks.
Immunosuppressed individuals, such as those living with HIV, are more likely to develop genital warts than immunocompetent individuals. There are no data that suggests the treatment modes should be different for immunosuppressed persons, although having a suppressed immune system may result in larger or more recurrent warts. Biopsy may be needed more frequently in these individuals as squamous cell carcinomas that arise in, or look like, genital warts might occur more often.
Please see our Preventing HPV pages for more information on how to prevent warts and other HPV-related problems.