HPV Warts and How to Treat Them

For the vast majority of people, an infection of human papillomavirus (HPV) resolves on its own, with no medical intervention necessary. Most people with HPV are asymptomatic, and their immune system will eventually fight off the infection within two years, resulting in no medical costs. But others may experience physical symptoms, such as warts.

If an HPV infection leads to symptoms, they typically appear in the form of cutaneous or anogenital warts. Keep in mind, though, the HPV variants that cause warts are generally considered low risk. Warts may appear somewhere along the surface of the skin, most commonly on the hands or feet for cutaneous outbreaks. Anogenital warts, as the name suggests, appear on the genitals or anus. Although less common, warts can also appear on the throat and mouth, and this is referred to as oral HPV.

Warts can be awkward for social occasions, especially if the outbreak appears in an area of your body that isn't easy to hide, such as the face or hands. However, warts indicate a low-risk infection that will likely go away on its own as long as the patient is not immunocompromised. According to researchers, 30 percent of all HPV-related warts regress within four months but may recur after treatment.

Low-risk HPV treatment options

There is no cure for human papillomavirus. However, the immune system is capable of clearing the virus within a span of two years as long as it is functioning normally.

"Like many infections, your body can clear HPV itself and cure it," said Babak Ashrafi, M.B.B.S., from Superdrug Online Doctor, based in the United Kingdom. "But if you develop any warts, you can use treatments like podophyllotoxin [brand names: Condyline and Warticon] or imiquimod [Aldara] for genital warts, salicylic acid products for common warts or you can get them frozen with cryotherapy. All treatments aim to irritate and damage the warty skin, which means if you get any on normal skin, you can develop irritation or inflammation around the wart. This can sometimes develop into ulcers, but it normally settles within a few days of stopping treatment."

Judith A. Smith, Pharm.D., professor and director of the Women's Health Integrative Medicine (WHIM) Research Program at UTHealth Houston McGovern Medical School in Texas, also shared low-risk HPV treatment options.

"Low-risk HPV is associated with visible lesions that are treated with either imiquimod topical medication or frozen off with liquid nitrogen or burned off with topical salicylic acid," she said.

"Imiquimod works by mediating a local immune response and is associated with irritation, swelling, burning and pain at sites wherever applied," she added. "The cost of imiquimod can vary but typically costs about $40 per six-week treatment. Local topical treatment with liquid nitrogen to freeze off or burn off requires an office visit with a healthcare provider and is associated with stinging/burning, itching and pain at the sites treated. These options are local treatments to remove the lesions but do not eliminate the low-risk HPV, so patients often experience recurrent outbreaks of low-risk HPV lesions."

A research letter published in 2022 in JAMA Dermatology reviewed the healthcare utilization and costs associated with cutaneous and anogenital warts. The researchers studied an insured section of the U.S. population, discovering the annual treatment costs of cutaneous and anogenital warts were approximately $973 million in 2019. The study also revealed that the average per-patient cost of a cutaneous wart outbreak was $288, and for anogenital warts, the cost ballooned to $431.

As mentioned previously, wart outbreaks are associated with low-risk HPV variants. For example, 90 percent of genital warts are caused by HPV types 6 and 11. High-risk HPV variants (most commonly types 16 and 18) do not show any symptoms. However, they are known to be oncogenic (causing tumor development).

HPV is also linked to a variety of cancers, with the most common form by far being cervical cancer in women. However, high-risk HPV infections have also been associated with other forms of cancer such as:

• Anal cancer
• Oropharyngeal cancer
• Penile cancer
• Vaginal cancer
• Vulvar cancer

Not all high-risk HPV infections lead to cancer though, because the majority of people clear the virus on their own without ever knowing they are carriers. However, although prolonged high-risk HPV infections that lead to cancer are less numerous than those that cause warts, they still result in billions of dollars in treatment costs every year.

Treatment options for high-risk HPV infections

According to Smith, high-risk HPV is not associated with any symptoms that can be detected. However, this can change after several years, when an active infection causes cell damage in the surface layers of the skin, which if left untreated, can lead to cancer. In line with that, she recommended routine screening at least once a year to look for cellular changes in patients with persistent high-risk HPV (cervical, vaginal, vulvar and even anal areas). But screening will need to continue every six months if the infection persists after treatment.

"The primary treatment for a precancerous condition called cervical intraepithelial neoplasia [most often caused by HPV and may lead to cancer if not treated] is removal by either in-office loop electrical excision procedure [LEEP] or outpatient surgery to remove the involved portion of the cervix, called a cone biopsy," Smith explained. "There are currently no FDA-approved systemic treatments for high-risk HPV infections. However, there are still options to try to help the immune system clear the HPV infection."

Smith was involved in a 2022 double-blind, placebo-controlled phase II study that looked at women with a history of persistent, high-risk HPV infection for greater than two years. Supplementation with the mushroom root extract AHCC—3,000 milligrams daily for at least six months—supported the immune system to eliminate the HPV infection in 58.8 percent of the women (19 of 34) on active AHCC compared with 10 percent (2 of 19) who received the placebo only, Smith said.

Ashrafi said cervical cancer and other HPV-related cancers should be treated by specialists depending on the severity and stage.

There's no cure, but vaccination is highly encouraged

Gardasil was a vaccine developed by Merck & Co. and approved for medical use in 2006 in the United States. The initial use was for females ages 9 to 26, and a year later, it was recommended for routine vaccinations for girls ages 11 to 12. In 2009, the vaccine was recommended for all females and males before adolescence.

The U.S. Food and Drug Administration (FDA) approved a nine-valent version of the vaccine in 2014 called Gardasil 9 to protect against new strains of HPV. In 2019, the FDA approved the use of Gardasil 9 for anyone ages 27 to 45 years old.

"There is no cure for HPV," said Monte Swarup, M.D., a board-certified OB-GYN in Arizona and the founder of HPD Rx. "Gardasil 9's list price is $268.02 per dose or shot. Depending on your insurance and other factors, you may pay less for this. Gardasil 9 requires two or three shots. It's important to note that Gardasil does not include a live virus so will not cause an HPV infection."

Gardasil does not treat an existing infection but it's still recommended for anyone who is HPV-positive as it may protect against the new and different strains of the disease.

Studies have estimated that routine vaccination of adolescents could potentially avert $13.1 billion in HPV-associated cancer costs. It's also been estimated that if programs included catch-up vaccination for people younger than 26, it's possible an additional $3.8 billion in cancer costs could be averted.

HPV vaccines have been shown to work but are only effective prior to exposure to the virus.

"Vaccines work—it is recommended for boys and girls [ages] 11 to 26 and those at risk up to 45," said Robyn Faye, M.D., a physician in Pennsylvania and a member of the HealthyWomen Women's Health Advisory Council. "The cost of prevention outweighs treatment costs of HPV medical complications."

Your sexual and reproductive health

HPV can affect a person's sexual health because of its several physical manifestations.

"Genital warts are unsightly and are not pleasant for potential partners to see," said Laurence Gerlis, D.P.M., chief executive officer and lead clinician at SameDayDoctor in the U.K.

People with HPV can also feel insecure. Luckily, the most common symptoms can be treated.

"HPV can affect your confidence or willingness to have sex if you know you might be passing on the virus to a partner or if you have visible warts," Ashrafi explained. "Unless you develop cancer, which might need surgical intervention, things like warts are very common, easily treated and shouldn't affect your sexual health long term."

When it comes to reproductive health, Ashrafi noted there are no long-term or direct effects.

On the other hand, Swarup explained that although most people recover from HPV with no reproductive health problems, if HPV causes cervical dysplasia or cervical cancer during pregnancy, this can cause issues with delivery. However, this is incredibly rare and should not be a deterrent to anyone's reproductive plans.

If you're concerned about your reproductive health, it's important to reach out to your doctor to ensure there are no problems.

"Generally speaking, HPV should not affect your ability to conceive, carry or deliver a pregnancy, as most strains are not high risk and clear themselves within a couple of years with no need for treatment," said Melanie Bone, M.D., an OB-GYN in Florida and a member of the medical board for Daye, a gynecological health company. "However, if you have high-risk HPV and it causes abnormal changes to your cervical cells, your cervix may be compromised, which can lead to difficulty with conception and/or a high risk of premature birth. As long as you share your medical history with your practitioner, they can monitor and intervene as necessary to ensure a healthy pregnancy."

"In general, the concerns come if there is a low-risk HPV lesion outbreak near the time of delivery of an infant. It could be recommended to do a C-section to avoid direct exposure to the newborn," Smith added. "Depending on how many LEEP or surgical cone biopsies a patient has done, it may decrease the integrity of the cervix and ability to carry a pregnancy to term without intervention, such as cervical cerclage."

A cervical cerclage is a series of surgical stitches made to close the cervix, usually carried out in the second trimester of pregnancy to prevent preterm birth.

Other possible complications

HPV has become very common in society. However, it is still largely harmless for the vast majority of people with normal and healthy immune systems. Most cases are asymptomatic, and if warts appear, then it is most likely a low-risk variant. However, complications can vary widely depending on treatment interventions and management.

"Low-risk HPV interventions over time can lead to scarring, and the stress and worry about if/when outbreaks may occur can impact mental health," Smith explained. "The potential for complications from high-risk HPV infections is more concerning. Left untreated, active HPV infections may cause cell damage, then lead to cancer conditions in the infected areas. The complications of cancer and its treatments are extensive and even life-threatening, so it's worth the time and effort to prevent it with regular screening as recommended by your healthcare provider; and getting vaccinated against HPV, too."

Swarup also shared that some HPV patients experience sexual dysfunction and depression. He also highly recommended regular cervical cancer screenings to detect changes so they can be treated early.

Prevention and early detection matters

Here's the bottom line: It's better to protect yourself and detect HPV symptoms early rather than fix the damage after it's happened.

"When HPV advances undetected, it can cause cervical cancer. This is particularly concerning because HPV infections do not always show symptoms. That's why it's critical for women to prioritize their well-woman exams and regular screenings, even if they don't feel sick," said Jessica Shepherd, M.D., a board-certified OB-GYN, the chief medical officer for Verywell Health and a member of the HealthyWomen Women's Health Advisory Council.

"If HPV goes undetected and leads to cervical cancer, there can be negative effects on a woman's fertility or reproductive health," she added. "That's why I talk to all my patients about the importance of detecting this disease early. Cervical cancer is highly treatable when we catch it in the early stages, and it helps us preserve a woman's future fertility."