How infectious is HPV (genital warts)?

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Dear Dr. Myrtle,

I have recently found bumps on my genital area, which I got checked out. Just by the look of it, the doctor said it’s genital warts. I wasn’t sure if this was correct, but I looked for pictures of genital warts on the Internet and found some that look like my current bumps.

If I do have genital warts, I accept that. But since I have a boyfriend that I care about, I need have some questions.

First, if medication clears up the warts and my partner performs oral sex on me, is he at risk? If I see warts around my boyfriend’s rear, does that mean he has had sex with men? If someone is infected, are they only considered infected when the warts appear, or are they "infected" all the time afterwards?


Your bumps could be HPV (genital warts). Often warts are easily recognizable by healthcare practitioners.

Did your provider do a pap smear? You will need to have monitoring pap smears every six months for the next several years to screen for the presence of early cervical changes that can lead to cervical cancer. Having gental warts doesn’t mean that you will definitely get cervical cancer, but it does increase your risk of cervical cancer. Screening with a pap smear is a very effective way to guide treatment options for you.

Fifty percent of the adult population of the U.S. will have HPV at some point during their adult lives. It’s a really common infection, because it is easy to get and to transfer to someone else.

Yes, you can clear the warts through medication, but not all healthcare providers know this. Some will cut the warts off instead. (I personally suggest the medication route if you have health insurance.)

If you are treated and you have no visible warts, you could still transmit HPV to a partner. Why? Well, it’s really easy to infect the cells next to the treated cells, so even though you cured the first set of cells, you may have an infection that you can’t yet see in the cells next to them. Genital warts/HPV is transferred from one person to another through skin-to-skin contact. Your sexual partner(s) can get HPV/warts in their mouth (especially on the vocal cords/voice box) through unprotected oral sex with someone who has HPV on their genitals. The risk of getting them is less if you have been through treatment and have negative pap smears, but your risk of giving warts to him will not be zero.

"...If I see warts around my boyfriend's rear, does that mean he has had sex with men?"

Great question, and no, it does not mean that he has ever had sex with men. It means that he has had contact with someone who was infected with warts.

So, how did your partner get warts around his anus? He could have touched a partner who had HPV, then touched himself and transferred the infection to a different part of himself; he could have had sex with someone who had warts; or yes, he could have engaged in anal play with a man. I wouldn’t make any assumptions. You’d have to ask, and he’d have to say to know for sure.

"If someone is infected, are they only infected when the warts appear, or are they ’infected’ all the time afterwards?"

Another great question. When researchers use really fancy expensive tools, they can tell whether cells are infected but not expressing (showing) the warts. Those studies show that many (not all) people will get rid of their own wart infection within a year or two. Even when people transfer the infection to themselves, people who have a happy and healthy immune system will have cleared up their infection within three to five years.

Sadly, it’s so easy to be re-infected by your sexual partners, that some couples stay infected for a long time (her turn, his turn, her turn...). The other piece of bad news is that HPV clearly causes cervical and larynx cancer (and is also associated with anal cancer for some people), so it isn’t a good idea to just hope and wait for the infection to go away. It might cause a fatal disease process to start while it’s there.

The best things to do are:

1. Have your current warts treated with a medication called Imiquimod. (Have your health care provider read this article: J Infect 2000 Sep;41(2):148-51 Treatment of external genital warts in men with imiquimod 2% in cream. A placebo-controlled, double-blind study. Syed TA, Hadi SM, Qureshi ZA, Ali SM, Kwah MS. Department of Dermatology, University of California San Francisco Box 0989, San Francisco, CA 94143-0989, USA. Your health care provider will know how to find the actual article him/herself.)

Be aware that Imiquimod damages latex condoms, so you may want to use polyurethane condoms while you’re taking it.

2. Have your partner tested for anal warts and oral warts. His anal warts can also be treated - which is a good idea for both of you, since it will be harder for him to give them back to you.

3. While you are being treated, use barriers when having oral sex. Ideally, you would not have or give unprotected oral pleasure for about six months after treatment, either.

4. Make sure you have a pap smear soon if you have not had one in the last six months. You will need to have them every six months for several years. Don’t let your healthcare provider talk you out of these, either (some will do that to save their practices money). It’s your life, and you’ll have to make this your own personal priority.

5. If you have three consecutive pap smears and have no evidence of change, then you may ask your provider whether you can go back to the once-a-year schedule. Depending on your partner situation, you may choose not to do that. It just depends who you are intimate with.

6. By the way, it’s really easy to have several sexually transmitted infections and have no symptoms. So make sure that you have been screened for chlamydia, gonorrhea, trichomonas, and herpes, too. (If they are being really really thorough, they will also check for syphilis, bacterial vaginosis, hepatitis B, hepatitis C, and HIV, as well.) You do not need all these tests all the time, but please do get a screen now, since the presence of the warts means that you could have also been exposed to other infections.

Best wishes.

Dr. Myrtle