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HPV Warts: The Misunderstood STD
Fast Facts About the Human PapillomavirusMore than 42 million Americans are thought to have an active HPV infection at any given time, according to the Centers for Disease Control and Prevention (CDC). An additional 13 million people become newly infected with HPV each year.
But not all strains of HPV cause genital warts. Some cause common skin warts, and some can cause cellular changes that can lead to cancer of the cervix, vagina, vulva, anus, penis, and oropharynx — the area at the back of the throat that includes the base of the tongue and tonsils.
For many people, an HPV infection never causes any symptoms or harm because the body is able to clear the virus naturally.
But in some cases, according to one study, the virus may still be present in the body and may become active if a person's immune system is weakened because of illness or age.
"I've had older women show up with the warts for the first time in their lives, and they're widows who haven't had sex for 20 years," says Anita L. Nelson, MD, a professor of obstetrics and gynecology and a staff physician at Harbor-UCLA Medical Center in Torrance, California.
"Suddenly, their bodies can't cope with a virus that they've been walking around with for decades, and it shows itself," Dr. Nelson says.
Your Common HPV Questions AnsweredDiscovering you have a sexually transmitted infection is never a pleasant surprise, but knowing more about it and the treatments available can help to set your mind at ease.
Here, Nelson answers some common questions about HPV.
Q. What causes genital warts?
A. Genital warts are caused by certain types of sexually transmitted HPV. There are more than 40 HPV types that can affect the genital area of women and men. But more than 90 percent of genital warts are caused by just two types: HPV 6 and 11.
Q. How common are HPV 6 and 11?
A. One percent of all sexually active women and men get genital warts every year. We see them in everyone — women who are pregnant, young adults exploring their sexuality, older women and men.
Q. How soon after contact do the warts typically occur?
A. That's one of the most frequently asked questions because a person's really asking, "Who gave it to me?"
Typically, you get warts within one to four months of being infected with HPV. But the virus can be kept in check by the immune system for longer than that.
Q. Does everyone exposed to HPV 6 and 11 get warts?
No. Warts can appear after a person is infected, or you can have none at all, as the body's immune system fights the virus.
Q. Can HPV warts surface at any time in your life — even years after exposure?
A. Yes. Sometimes, we'll see them later in life, when people get sick or their immune system gets compromised by chemotherapy or other drugs.
So they don't just occur when you have a new sex partner.
Q. How can sexually active individuals avoid getting HPV warts?
A. Using condoms — or "finger condoms" for manual stimulation — consistently reduces the risk of acquiring or transmitting the virus that causes the warts.
Also, interestingly, HPV infects rapidly dividing cells. So anywhere there's a little trauma, tear, or abrasion, the body can pick up the virus and bring it inside the cells.
Sometimes, we'll see the warts in younger women because it's the first time they've had sex and the vaginal tissue isn't quite elastic. It's the same with some older women who have vaginal dryness.
Q. Does the number of sex partners a person has over a lifetime increase the risk of HPV warts?
A. Yes, people who have had more than 10 sexual partners over their lifetime are more likely to report a diagnosis of genital warts than those who've had one or two.
The more sex partners you have, the more likely you are to have different types of HPV infection as well.
And there's no limit to how many different HPV types you can have. Limiting the number of partners and using condoms are very important to reducing your risk.
Q. Are HPV warts spread only through genital contact?
A. No, you can spread the virus from any moist source to another. The same type of warts that develop on the genitals can also grow in the mouth and throat and even in the insides of the eyelids.
But there has to be a source, and generally, you're going to be carrying the virus in the genitals.
We have to be quite frank about sexual practices today. There's a lot of oral-genital contact. If one partner has a wart in their mouth, the other partner can wind up with warts on the genitalia if there's oral-genital contact.
Q. Can HPV warts lead to cervical cancer?
A. The two types of HPV that cause most genital warts — types 6 and 11 — do not cause cancer.
However, some types of HPV that are associated with cancer have been found in genital warts.
It's also possible to have or get more than one type of HPV at once, including those that can cause cancers in the genital area, such as cervical, vulvar, or anal cancer, or cancers of the mouth and throat.
Having genital warts caused by noncancer-causing HPV strains doesn't mean you don't also have potentially cancer-causing HPV.
Q. Are genital warts more a psychological issue than a health danger?
A. Genital warts may cause some physical discomfort, such as burning and itching, or even bleeding in an intimate situation.
The various treatments to remove genital warts can also cause pain and irritation and can be expensive, depending on what type of treatment you use and what kind of health insurance coverage you have.
For many people, though, there is significant psychological discomfort in realizing they've been exposed to a virus they're going to live with for the rest of their lives and could transmit to others.
Q. Are women more likely than men to get the warts?
A. No, but we have more statistics on women because doctors tend to see women much more routinely. Gynecologists, for example, do Pap smears and visually inspect a woman's genitals.
Q. Can Pap tests detect HPV warts?
A. No. Pap tests detect abnormalities in cervical cells that may be cancerous or precancerous. A newer HPV test detects the presence of the virus in cervical cells.
RELATED: New Analysis Suggests Cervical Cancer Screenings Should Continue After Age 65
Q. How are genital warts diagnosed?
A. You want to have them professionally diagnosed. Usually, physicians just eyeball them and don't have to do a biopsy. A doctor can often tell it's a wart because warts have a little attachment to the skin and multiple protuberances from the single stalk.
Q. What do the warts look like?
A. They can look soft and fleshy, almost like a skin tag, or they can be rock-hard and large with branches like a cauliflower.
They can be a small little dot or bigger than your fist.
Q. Are they easier to treat if discovered early?
A. Yes. Don't wait if you think you might have genital warts. When you feel a bump, especially around the opening of the vagina, or behind the vagina, see your doctor.
Also, it's important to know that once you get infected, it's a regional infection. For example, you can get a wart inside your anus even if you haven't had anal sex.
Q. How soon should a wart be treated?
A. It's not a medical emergency. But the HPV warts that are really hard to treat have been there for months and have hardened.
If you can't get an appointment for two to three weeks after feeling the bump, don't freak out. But don't wait months.
Most women will get the HPV virus, and their body can handle it. But women with persistent HPV infections are the ones we want to identify.
I want to see a young woman three or four years after her first sexual encounter to see if her body can handle the virus.
Is she having persistent infections, which could be a predictor of cervical cancer? Those are the women we want to find, so we can treat any precancers.
For women over age 30 who got the virus earlier in life, we're testing to see if they show cells that go awry and also to determine if they're still shedding the virus.
Q. When a woman has visible HPV warts, should she stop having sex?
A. When we're treating women for warts, we ask them to be particularly careful and maybe even abstain from sex.
That's because as we're treating it, there are inflammatory changes and maybe even a little ulcer, and those tissues are more vulnerable to acquiring another infection.
So take it easy for a while, or use condoms. Abstain from oral sex, too.
Q. Once you have HPV warts, are you always contagious?
A. You spread more viral particles when you have a concentration of warts. But with treatment, you rev up the body's immune system, and it will help reduce the amount of viruses you have and spread.
You also can avoid spreading it through practicing safer sex.
Q. What's the recommended treatment for HPV warts?
A. Get rid of the warts. We can treat fresh warts with easy topical therapies. There are three creams your doctor can prescribe for external genital warts that can be applied at home.
Q. How do these work?
A. Podofilox works by destroying the skin of the wart. The two imiquimods are really groundbreaking because they don't play with the wart at all but instead turn on the body's immune system, which attacks the virus in the wart so it melts away.
These therapies have really simplified things. When a new wart comes, just put cream on it.
Q. Are there natural remedies?
A. Sinecatechins (Veregen) is a green tea extract, which is applied three times a day for up to 16 weeks. We're not quite sure how it works, but some people really like the idea because it's natural. Green tea is an antioxidant. You use it in ointment form.
Q. How are hardened warts treated?
A. If you've had them for a while and they've hardened, then you're talking doctor-administered destructive therapies.
We can snip them off if they have a tiny base. Or we can freeze them with acids to dehydrate them and kill the cells.
For the ones that are really hard to deal with, we'll surgically excise them or do laser treatments.
Q. Are women more likely to get HPV warts if they're on oral contraceptives?
A. It isn't that the pill causes more problems but that condoms protect against HPV infection, and a woman who's on the pill may be less likely to use condoms.
That said, if someone's warts don't disappear after treatment, it may be that her immune system is teetering on the edge, and the pill pushed it over.
But I would never stop prescribing a woman's birth control pill just because she had a wart.
Q. Are HPV warts a danger during pregnancy?
A. The virus can be passed on before or during birth, but the warts don't pose a major risk to the baby's health.
Symptoms of genital warts can get worse during pregnancy, however, because a woman's immune system gets suppressed.
Warts can grow so large they'll obstruct delivery of the baby. And you have to treat the warts in a way that's not harmful to the baby.
Q. Does the HPV vaccine protect against genital warts?
A. Yes, Gardasil 9, which is the HPV vaccine used in the United States today, as well as the original Gardasil vaccine, protect against the HPV 6 and 11, which cause 90 percent of genital warts.
Cervarix, a vaccine that is no longer available in the United States but is available elsewhere in the world, protects only against HPV type 16 and 18, which significantly raise the risk of cervical, genital, and oropharyngeal cancers. Cervarix does not protect against the strains of HPV that cause warts.
RELATED: What Are HPV 16 and 18?
Q. What are the top things a woman should keep in mind about HPV warts?
A. Use condoms, and be choosy in your partners. People ought to take a good look at what they're being exposed to when they're getting into a relationship where there's going to be sex. But keep in mind that a person can have the virus that causes genital warts without having visible warts.
Also, make sure you're paying as much attention to health in your genital area as you are to other parts of your body. Some women are more in tune with the bottoms of their feet than they are with their genitalia.
Examine your genitalia, and feel if there are any bumps or areas of soreness where there shouldn't be.
And don't hesitate to see your doctor if you do find anything.
What Does The Second Stage Of Labour Really Feel Like?
Labour has been described by some mums as being like pooing a melon!
Now the cervix is completely open it's time for your baby to make his way down the birth canal – with a bit of help from you. This is the second stage of labour and, for most women, it feels completely different from the first. There's nothing to stop the baby being born, but he won't suddenly shoot out – he'll make his way down gradually. Here's how it will feel…
Better out than inThe contractions will change: they'll no longer feel painful or tight across your bump, but will become really expulsive. That means each one will build up like before, but at its peak you'll feel the most overwhelming urge to bear down and push.
It's completely uncontrollable. I've heard mums compare these contractions to everything from sneezing to vomiting or even an orgasm. Ultimately the sensation will be unique to you, so don't expect these extremes, just bear them in mind.
Resistance is futileEven if you suddenly decided you didn't want children and tried to tighten your buttocks for dear life, your body would insist on your baby being born and spontaneously push with each contraction. You don't need to be told to push – your body will know what its doing and you just need to go with the flow. It can feel a bit overwhelming, but as long as you don't fight the urge to push, it gets easier.
You'll want to pooAt this point you're likely to feel as if you need a really big poo! That's because your baby is pushing down on your back passage making you feel you need to go. You'll have no idea if anything comes out because it'll feel like it's happening anyway. At the peak of a contraction you'll probably feel as though you're losing control of your bowels, and that somebody is prising your buttocks apart.
Your baby's closeJust when you're starting to think your baby's never going to make an appearance, your midwife will inevitably say 'I can see some of the head now'. If you pop a finger in your vagina, or look at the baby's head with a small mirror, it can encourage you even more and reassure you that your baby really isn't very far away.
More like this Is he coming or going?
With each expulsive contraction you'll probably feel more of your baby moving forward, and then when the contraction's gone, he'll move backwards a little. Imagine a tortoise poking his head out of his shell and then pulling it back in.
You'll feel the resistance as the head moves forward and back but your vagina is very lubricated so it'll be a smooth, if tight, feeling. This movement is stretching your perineum (the area between your vagina and your back passage) nice and gently.
A bit of a squeezeEventually, your baby won't retreat any more, but will continue to move forward. Now your midwife will be able to see more and more of his head, and the opening of your vagina will be stretching and thinning. This is known as crowning. Picture your head being pushed though a tight-fitting polo neck.
Out he popsYou may feel a burning sensation as your baby crowns, but it will only be for a moment, as any minute now the head will be out. It feels very different to each woman and no one can predict how it'll be for you.
Your midwife will encourage you to use special measured breaths during the contraction to try and slow down the baby's exit and get the head out nice and slowly: this will help to minimise tearing. Once the head is out, you'll wait for a final contraction and with that the baby's body will follow.
He's all yoursSome women experience overwhelming feelings of joy and love when they first hold their slippery little newborn, but for others the truth is that they're exhausted and just want to sleep. You'll be encouraged to cuddle your baby against your skin, to keep him warm, but if you'd rather not then that's also fine.
Assuming there are no problems, he'll be placed straight on to you, unless you state otherwise. He'll be warm and slippy and sometimes have a bit of blood or vernix (white greasy substance that kept him warm and waterproof inside of you!). He will also be wet, so the midwife will dry him and encourage you to cuddle him against your skin, which will keep him warm.
Some women say their baby has a unique subtle smell, which they adore, to the extent where they have refused to have their baby cleaned for days until the smell has gone!
How Do I Know If I Have Herpes Or Another Condition?
Sensitive Content: Medical Images Included
This article contains medical imagery of various skin conditions similar to genital herpes.
Genital herpes is a sexually transmitted infection (STI). At first glance, signs of genital herpes signs are not unique. This makes it difficult to tell the difference between herpes and other sores.
For instance, you may get similar-looking bumps from other STIs, such as syphilis and genital warts, or skin diseases like eczema and folliculitis. Learn more about what herpes looks like and how it differs from other conditions.
The development of a typical genital herpes lesion begins with redness, swelling, and the formation of a papule, a small, solid bump with easily visible edges. Then, a blister develops. Blisters often cluster and may break open and leak fluid, resulting in ulcers (open sores). Eventually, they crust over and heal on their own without leaving scars. Only about 10-25% of people with genital herpes develop typical blisters, sometimes years after infection. The rest may develop lesions that are unusual or go away fast; they may also develop no lesions at all. One difference between herpes and other conditions is that you may experience flu-like symptoms before a herpes outbreak, such as: Fatigue Fever and chills Muscle aches Nausea Tingling or pricking in the area of future lesions Other differences can be due to the absence or appearance of the skin. The conditions may also differ based on skin characteristics. For example: Bacterial vaginosis (BV): Bumps aren't a symptom of BV. Contact dermatitis: Genital contact dermatitis can appear as swelling without distinct boundaries—unlike the pustules in genital herpes—with a loss of skin texture. Jock itch: This condition doesn't spread to the scrotum or penis. Yeast infections: Herpes-like vulvar rashes are not a symptom of yeast infections. Read on to learn more about 13 conditions that may look like herpes. DermNet Contact dermatitis causes skin inflammation and soreness after direct exposure to an irritant or allergen. While herpes lesions can happen anywhere around the genitals, a dermatitis rash develops where the triggering substance touches your skin. Other symptoms of contact dermatitis include burning, itching, soreness, and pain. Also, you may get contact dermatitis from products like toilet paper, menstrual products, or condoms. The first step to resolving and preventing contact dermatitis is avoiding the irritant or allergen. A healthcare provider may prescribe a topical corticosteroid cream to reduce inflammation or an antihistamine medication to reduce itching. DermNet Syphilis is an STI where you may feel swollen lymph nodes about three weeks after infection. You may also notice one or more ulcers on the genitals or other body parts exposed to the virus. Six to eight weeks later, you may experience fever, headache, and a rash on the shoulders, arm, chest, or back, and often on your palms and soles. Syphilis is easily diagnosed and curable when caught early and treated with antibiotics. DermNet A yeast infection, known as candidiasis, happens when Candida—a fungus that usually exists in the body—grows too much. It can affect the vagina, the penis, and the throat. Symptoms may include: Vaginal: genital itching, burning, and white and clumpy discharge Penile: burning, itchiness, and redness on the head of the penis People with a vagina can get a yeast infection as a complication of genital herpes, especially during their first outbreak. Yeast infections can be treated with prescription or over-the-counter antifungal medications. However, if you have herpes-related sores, medication for a yeast infection won't clear them up. DermNet Molluscum contagiosum is a viral infection that presents as lesions that can appear anywhere on the body. Many adult molluscum contagiosum cases are transmitted sexually, but any physical contact with the lesions can pass on the virus. As long as you have bumps, you are infectious. Molluscum contagiosum lesions have the following features: Small raised bumps Usually white, pink, or skin-toned Often appear pearly Have a dimple or pit in the center Occur anywhere on the body, including the genitals Bumps can resolve on their own. Still, if you want to speed up the healing process, talk to a healthcare provider about creams, medications, or physical removal. Genital warts are among the most common STIs in the U.S., caused by the human papillomavirus (HPV). Warts appear between three weeks and eight months after infection. The warts are generally not uncomfortable or painful but can be itchy. They rarely ooze and typically appear as: Clustered in a few small bumps, possibly shaped like a cauliflower, or only appearing as one bump Light and pearly, dark purple, gray, brown, or skin-colored Bumpy or flat Smooth or rough Without treatment, the warts can go away, stay the same, grow, or multiply. You can talk to a healthcare provider about getting prescription medication or physical treatment for the bumps. However, the warts may return since HPV is not curable. DermNet Jock itch is a fungal infection that mostly affects the penis. It can happen because of friction or prolonged wetness in the groin area. Jock itch involves a rash, typically appearing in the upper thigh's creases—possibly spreading to the anus. The rash is red, raised, scaly patches that may blister and ooze, often with visible edges. Jock itch can also cause abnormally light or dark skin. In most cases, jock itch can be cured with antifungal medications. BV happens because of changes in the amounts of certain bacteria in your vagina. About 29% of women in the U.S. May get BV, though only about half experience any symptoms. Symptoms of BV include: The exact causes of BV are unknown, but having sex without condoms or douching can raise your risk of getting the condition. It's generally treatable with antibiotics like metronidazole and clindamycin, but in most cases comes back after treatment. The following causes of skin irritation can mimic genital herpes: Shaving or razor burn Hair removal products Bicycle seat friction Wearing thongs or tight jeans Friction from frequent sexual intercourse Not enough lubrication during sexual intercourse If you experience irritation around your genitals, pay attention to your daily activities and clothing. Avoid tight or wet clothing and use lube during sex. Also, note if the irritation doesn't go away on its own or comes back regularly without a known trigger. You'll want to talk to a healthcare provider about your symptoms and recommended STI testing. DermNet Folliculitis happens when a hair follicle—the tissue around the hair root—becomes inflamed. This inflammation can be caused by friction or shaving and a staphylococci (staph) bacterial infection. Symptoms of folliculitis include rash, itching, and pustules or pimples near a hair follicle that can crust over. You can take care of folliculitis at home by applying a hot, moist compress to the affected area and maintaining good genital hygiene. Talk to a healthcare provider if you experience the condition often or if it worsens or lasts longer than three days. They may prescribe antibiotics or antifungal medicine. Eczema (atopic dermatitis) is a common skin condition that presents as an itchy rash. It may come and go throughout your life, but in many cases gets better over time, especially in children. Besides severe itchiness, symptoms of eczema include skin redness and, occasionally, blisters that easily break and leak liquid. There's not much research on how frequently eczema spreads to the genitals. However, one study of more than 200 participants with eczema found that 45% had experienced genital symptoms. Eczema doesn't have a cure, but over-the-counter and prescription treatments topical corticosteroids, alitretinoin, and immunosuppressant tablets can help reduce symptoms. DermNet Psoriasis is another chronic skin condition that can affect the genitals and is often confused with eczema. About 63% of people with psoriasis develop genital lesions at least once in their lifetime, making the disease one of the most common genital skin conditions. Psoriasis typically causes itchy, raised, and scaly patches known as plaques, but genital psoriasis may appear smooth. There is no cure for psoriasis, but some prescription medications and creams can help reduce and treat flares. Behcet's disease, or Behcet's syndrome, is a rare condition in the U.S. That may look similar to herpes. It is a condition of inflamed blood vessels that can affect several body parts. Behcet's disease can result in sores on the genitals and within the mouth. However, it comes with other symptoms, such as: Eye area swelling Joint pain, stiffness, and swelling Other skin lesions This condition doesn't have a cure, but options are available for treating symptoms. Topical and oral medications may be prescribed. Crohn's disease is a type of inflammatory bowel disease (IBD). However, the disease can affect the vulva, which consists of the outer parts of the vagina, in rare cases. Called vulvar Crohn's disease, it can sometimes occur without the form of Crohn's disease that causes gastrointestinal symptoms. Some signs of vulvar Crohn's disease may include redness, swelling, ulcers, and tissue tears—known as fissures. Though treatment varies individually, steroid treatments can be helpful for short periods. If left untreated, the ulcers can worsen, and the skin may continue to break down. Untreated vulvar Crohn's disease can also result in other conditions like cellulitis, a skin infection, and abscesses, which are pus pockets. Several conditions can present with symptoms similar to those of genital herpes. These may include BV, folliculitis, genital eczema, and skin irritation. If you're worried or your symptoms bother you, there's no need to self-diagnose and wait it out. Talk to a healthcare provider right away, as they can recommend the proper testing and treatment options for the causes of bumps in the genital area.
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