How do you catch genital warts?
Transmission is usually by direct contact with someone else’s wart or subclinical wart virus infection. Sexual intercourse provides an ideal means of transfer. Some surface cells are always rubbed off as skin surfaces move over each other during sex, and often tiny breaks occur in the membranes. Cells from a wart surface are loaded with HPV and a break in the membrane is just what the virus needs to get into another person.
Virus shed from a wart can also get into secretions, which can contaminate hands or spread around the genital region. For example, people who have never had anal sex can get warts around the anus if fluids containing HPV spread to that region. Babies may be infected from their mothers during birth.
It’s also possible that the virus can be spread by fomites. This means that infected fluids can get onto non-living things such as towels and be transferred without direct contact.
After you pick up HPV, it takes weeks to years for warts to grow big enough to be seen or felt. It may also remain as a subclinical infection. Perhaps some people’s immune defences overcome the virus. We still don’t know whether subclinical infections can be passed on to others.
Should genital warts be treated?
Most genital warts, like skin marks, aren’t harmful and will sometimes disappear without treatment. However, most people want to get rid of them because they can be passed on to sexual partners or from a woman to her baby during birth, or simply because they don’t like the look and feel of them. They can also spread on the infected person; occasionally warts grow very large during pregnancy.
Interestingly, while some subclinical wart virus infections (caused by specific HPV types) have been associated with genital cancer, warts themselves have not been incriminated.
Treatment
Your doctor will advise you about treatment after identifying the warts. Most genital warts can be self-treated by applying podo-phyllotoxin paint, but note that this treatment cannot be used during pregnancy or breast-feeding. If your partner has warts they should be treated at the same time. If he can’t see any, he should be checked by a doctor in case he has hidden warts: a common place for them in men is inside the urethral opening at the tip of the penis. If you can’t see or reach your warts, or if they haven’t disappeared a week after completing treatment, your doctor will freeze or burn them off. Although warts usually disappear with treatment, recurrence is common. After treatment you should have a check every three months for a year in case any new warts or any that were too small to be seen at the time of treatment, have appeared. Recurrences can be treated with podophyllotoxin in the same way.
Can genital HPV infection be prevented?
We can’t answer this as confidently as we can the same question about some other STDs. You’re least likely to be infected if you’re in a monogamous sexual relationship. Condoms seem to offer only limited protection, if any. As mentioned earlier, we don’t know whether subclinical infection is contagious, and most people with subclinical infection don’t know about it. When HPV shows up in the Pap smear of a woman whose only ever sexual partner has no evidence of it, the source of the infection remains one of the many mysteries about HPV infection. With so much research into HPV going on now, let’s hope that most of its mysteries will soon be solved.
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