Please Stop Believing These 10 Genital Warts Inaccuracies
Some, but not all, genital warts are caused by the human papillomavirus (HPV), the most common sexually transmitted infection (STI) in the United States, one that affects nearly everyone at some point in their lives, according to the Centers for Disease Control and Prevention (CDC).
"It's simply unavoidable. All sexually active people, anybody with two or three partners ever in their lifetime, can expect that they've been infected with HPV," said H. Hunter Handsfield, M.D., professor emeritus of medicine at the University of Washington Center for AIDS and STD who directed the STD control program for Seattle and King County Public Health for 27 years. "Having genital HPV is a normal aspect of human sexuality that cannot be avoided."
Of the virus's 100-plus strains, most produce no noticeable effects, and just a handful can lead to cancer. About 40 strains, however, can cause genital warts or small growths that appear on or near the penis, vulvovaginal area or anus.
Warts, like HPV, are extremely common, but myths and misconceptions about them are about as pervasive as they are. Understanding genital warts and HPV is essential to protect yourself and your sexual partners. We spoke to five experts to separate fact from fiction.
Not all genital warts are caused by HPV
All genital warts are caused by HPV, explained Monte Swarup, M.D., an OB-GYN in the Phoenix area and the founder of HPV Hub, and Steven Klemow, M.D., a specialist in HIV treatment and prevention and the medical director at Texas Health Action in Dallas.
However, not all strains of HPV cause warts. Of the 40 strains of HPV known to be sexually transmitted, Klemow said two types—6 and 11—are most likely to cause warts.
It is possible to mistake other growths or skin tags for genital warts, according to Klemow and Mina Kalantari, Ph.D., the scientific director of molecular testing at Innovative Health Diagnostics, based in Santa Ana, California. Some of these growths, such as benign moles and pearly penile papules, are harmless and just normal parts of our bodies, Klemow said. Different conditions cause others.
"For example, molluscum contagiosum is a viral skin infection that can cause small, raised bumps on the skin, including in the genital area. Some skin conditions, such as seborrheic keratosis or skin tags, can also be mistaken for genital warts," Kalantari said.
Occasionally, mpox lesions can be mistaken for genital warts, or vice versa, Klemow added. However, genital warts appear quite different and aren't typically associated with the flu-like symptoms, pain or discomfort characteristic of mpox.
Unlike mpox lesions, warts rarely resolve without treatment within three to four weeks.
"It's important to consult with a healthcare provider to determine the cause of any unusual growths in the genital area," Kalantari said.
This is especially important because HPV can infect body parts that aren't visible and can be associated with an increased risk of cancers, such as cervical, anal and penile carcinomas, Klemow said.
As a result, experts highly recommend preventive measures such as cervical and anal Pap smears and routine external examinations for sexually active people at risk.
You can get warts from stress, toilet seats or poor hygiene
No, really, it's all HPV.
Some people mistakenly think genital warts are caused by poor hygiene, genes, stress, sitting on public toilets, sharing clothing or towels, or a poor diet, said Mayra Hernandez Schulte, M.D., a family medicine physician in California and a fellow with Physicians for Reproductive Health.
Wearing tight clothing is also frequently implicated, Kalantari said.
In truth, genital warts are caused by skin-to-skin contact with a person who has the virus, experts reiterated. A weakened immune system might make you more susceptible, but it is not a cause, Hernandez Schulte said, and HPV doesn't fare well outside the human body.
You should generally exercise caution in public restrooms, yes, but a toilet seat won't give you warts.
You can only get genital warts through unprotected sex
Unprotected sex increases your risk of getting HPV and possibly its accompanying warts, but it isn't the only way to become infected. The infection can reside in skin or mucosal linings anywhere in the anogenital region, including inside the urethra, beneath pubic hair or on the external parts of the vagina or scrotum, Klemow said.
"As such, barrier protections such as condoms—effective in preventing infections like HIV, which lives in seminal or vaginal fluids—may not prevent tissues shedding the HPV virus when coming in contact with a sexual partner's skin," Klemow said. "All that is required for the transmission of HPV between partners is skin-to-skin contact, and condoms do not cover all the many regions where viral shedding can occur.
"Also, HPV can infect the mucus membranes inside the mouth, so oral sex is another means by which HPV can be transmitted to another partner's anogenital areas, causing warts to occur," he added.
Generally, warts appear two to three months after exposure, Klemow added, though it can take anywhere between one and 20 months for them to appear.
If you can't see genital warts, you don't have HPV
Most people with HPV don't have warts, said Swarup and Handsfield.
"The large majority of HPV infections cause no symptoms and no visible abnormality," Handsfield said. "In individuals with warts, think of them like an iceberg: Visible warts are the tip, plus a more widespread invisible skin or mucosal infection with HPV."
Most strains of HPV don't cause genital warts, and those that do occur might be inconspicuous or undetectable, Swarup and Klemow said.
"Only a small subset of the 40-plus strains of HPV known to be sexually transmitted are responsible for causing visible warts, and the strains that are asymptomatic are at higher risk for progressing to cancerous lesions," Klemow explained. "Additionally, there are many areas of our bodies that are susceptible to developing warts that are inside our genital tracts or anus and are, therefore, invisible to us by design."
This is why sexually active individuals should undergo one of the screening modalities, such as cervical or anal Pap smears. They have been shown to be effective and justifiable from a cost perspective as a universal healthcare recommendation, Klemow added.
Women are more likely to get HPV
Warts and HPV have no gender preference.
"HPV and genital warts can affect anyone with genital skin, regardless of gender," Kalantari said. "While women are more likely to develop cervical cancer as a result of HPV infection, men can also develop genital warts, anal cancer or other HPV-related cancers. It's important for all individuals to get vaccinated against HPV and to practice safe sex to prevent transmission."
This misconception may exist since women may be more susceptible to warts because of the vulva's and vagina's moist environment, which is conducive to their development, Swarup explained.
Additionally, Klemow and Hernandez Schulte said people assigned female at birth (AFAB) are more likely to be diagnosed with HPV because healthcare providers often perform routine vaginal Pap smears. Usually, when a Pap smear produces an abnormal result, a provider follows up with an HPV test.
By contrast, there is no clinically approved way to specifically test for HPV in men, according to the American Sexual Health Association. However, anal Pap smears can detect anal cancer caused by HPV.
Genital warts are curable
There's no cure for warts or HPV. Wart outbreaks can go away independently after several months, but most people need professional help to remove them.
Removal methods include freezing, laser therapy, chemical cauterization and surgery, Swarup and Kalantari said. Antiviral medications can also help clear up warts and diminish the risk of future outbreaks, Kalantari added.
"It is estimated that up to one-third of anogenital warts will spontaneously resolve after four months without treatment, and most sexually transmitted HPV strains that can be carcinogenic may resolve by 12 months," Klemow said. "Those carcinogenic strains that progress beyond 12 months, whether they cause visible warts or not, are the infections that justify our current preventative screening recommendations."
Over-the-counter ointments, gels and creams can treat genital warts
Some over-the-counter anti-wart products with an active ingredient of salicylic acid are modestly effective against nongenital warts, Handsfield said. There's little evidence they're safe and effective to use on the genitals, though, and the potential benefits may not be worth the risk.
"The use of over-the-counter preparations to treat anogenital warts is not recommended. These agents were not designed for use in the sensitive tissues present in our genital or anal areas," Klemow said. "And they can cause significant discomfort, burns or damage if applied without the supervision of a trained provider."
Medical professionals have more effective topical therapies available—Klemow named imiquimod cream—that are far less irritating or painful. Plus, he added, the doctor may determine, based on a physical assessment, that topical therapies will not be sufficient to resolve warts at all.
"Either way, the likelihood of a rapid and complete resolution of the warts is far more likely if performed under medical supervision and guidance with the use of well-studied and proven therapies," Klemow said.
Warts won't return after treatment
Even if treatment removes warts, that doesn't necessarily mean they're gone for good, Handsfield and Swarup said.
"Some experts believe that HPV DNA continues to reside in the infected tissues for life. Others say not for life, but a long time," Handsfield explained.
Within one to two years, the immune system contains most HPV infections to the degree they don't recur, aren't transmissible to partners and don't cause visible abnormalities, he continued.
However, the HPV DNA may persist and reactivate years or decades later.
"So a woman with a cervical infection who acquired HPV at a certain point might have an abnormal Pap 20 years later due to reactivation of an HPV acquired all those years ago," Handsfield said. "The exact frequency of reactivation isn't all that clear. There probably are innumerable reactivations that don't cause any symptoms and are not detected by routine testing or Pap smears."
No firm data indicates the incidence rate, but Handsfield estimated that recurrence occurs in about 10 percent of people with genital warts.
Genital warts are a sign of cancer
HPV causes most skin cancers, and cancerous growths can initially resemble genital warts, Handsfield said. Warts are not cancerous, however.
Additionally, the primary HPV strains responsible for genital warts—types 6 and 11—are usually relatively unlikely to progress into cancer, Klemow said.
"Alternatively, strains such as 16 or 18 significantly increase the risk for causing cancer but are not commonly known to cause visible warts," Klemow explained. "During sexual contact, it is relatively common for more than one strain to be transmitted at a time. When we see visible warts in our patients, we recommend screening for precancerous lesions because one strain suggests the risk of having acquired others."
Warts aren't contagious
HPV is highly contagious, and people with genital warts may have a higher viral load than those without them, Handsfield said. As a result, they may be more likely to transmit the virus.
However, people with HPV can pass the virus along regardless of whether they have visible symptoms or not.
Practicing safer sex, including using condoms, can reduce the risk of transmission and infection. Experts reiterated, though, it doesn't protect against HPV completely, which is why vaccination is recommended.
When the HPV vaccine was first approved, the Food and Drug Administration and other experts recommended it for young girls only, Klemow and Handsfield noted. However, subsequent studies have demonstrated the value of vaccinating a much broader demographic, including anyone from ages 9 to 45.
Initially, Klemow said, the perception was that cervical cancer prevention was the only priority. Now, there's proven value in vaccinating to prevent transmission and protect against other cancers, including mouth and throat, penis and anus cancers.
Ideally, Handsfield said, everyone should receive a vaccination before they become sexually active, shielding them from all virus strains. By the time a sexually active person is in their 30s or 40s, there's a high likelihood they have, or have had, HPV.
However, if they are with new partners, there's a possibility they could be reinfected, potentially with a different or more dangerous strain. For this reason, anyone who is at risk and eligible should consider getting vaccinated, Handsfield stressed.
If you'd like to discuss potentially getting the HPV vaccine or being screened, be sure to talk with your doctor. If for whatever reason you're looking for a new doctor, Giddy Telehealth takes the difficulty out of the search. The easy-to-use online portal provides access to hundreds of healthcare professionals who have expertise across the full scope of medical care.