Dear Doctor Column, March 3, 2003

Question:

My doctor told me I have genital warts, specifically around my anus. They never bothered me and I only happened to discover them when bathing. They don't itch or hurt. My doctor told me that the warts are caused by a virus. If they are treated, will they come back? I have never had intercourse, so how did I get this virus?

Answer:

Genital warts are caused by a human papilloma virus (HPV), which is one of the most common causes of sexually transmitted disease (STD) in the world. STDs are infections that are spread by contact of genital skin (penis, scrotum, anus, vagina, and skin surrounding these areas) with the infected skin of another person. Although sexual intercourse is the most common way of catching a STD, oral sex and occasionally even contact with other infected skin, such as a finger, can sometimes spread infections. Penetration with sexual intercourse does not have to occur for an infection to spread. Using a condom can help decrease the risk of contracting a STD, but skin contact still occurs around the edges of the condom and can spread the disease.

Only certain types of HPV cause genital warts. Other types, not related to genital warts, can cause abnormal cell changes on the genital skin, usually on a female's cervix, which can lead to cervical cancer if not treated. Certain types of HPV infections in the anal area increase the risk of rectal cancer. Warts on other parts of the body, such as the hands or feet, are caused by different types of HPV, as well.

Genital warts appear as growths or bumps and may be raised or flat, single or multiple, small or large. They also are flesh-colored or whitish in appearance and usually do not cause itching or burning. They can occur on the outside skin of the genitals, as well as the inside of the vagina and the anal canal where they are unnoticeable. Genital warts are very contagious — about two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within 3 months of contact.

Currently, there is no cure for HPV or genital warts. However, there are several treatment options available including freezing (cryosurgery), burning (electrocautery), laser therapy, or applying medications that actually destroy the wart. Occasionally, surgery is necessary to remove large warts that have not responded to other treatment. In most cases, warts inside the anal canal need to be treated by electrocautery or surgical removal.

For external genital warts, your doctor may prescribe an at-home prescription cream, either podofilox cream or gel (Condylox) or imiquimod cream (Aldara), which are both safe, effective, and easy to use. However, imiquimod is different than other treatments, which work by destroying the wart tissue. Imiquimod actually boosts the immune system to fight HPV. Over-the-counter wart treatments should not be used in the genital area.

Even after treatment, the virus responsible for the warts continues to live in the skin, so warts often recur, requiring multiple treatments. As a precaution, sexual partners ought to be checked by their physician, even if they have no symptoms.

For more information call the Centers for Disease Control (CDC) National STD Hotline at (800) 227-8922 or (800) 342-2437; in Spanish (800) 344-7432, which provides toll-free information on STDs to the general public. Free educational literature about a wide variety of STDs and prevention methods are available, and Health Communication Specialists are on hand to answer questions about transmission, prevention, and treatment of STDs. Information also is available online at www.cdc.gov.