Genital warts

sexual health pages

What is it?

Genital wart virus infection (also known as Human Papilloma Virus or HPV) commonly infects the genital skin. In most people, it never causes any symptoms, but in a proportion of people it will cause the development of visible warts, similar in appearance to those on other parts of the body.

How is the genital wart virus transmitted?

There are at least 50 different types of HPV, each with its own number for identification purposes. However, only about five strains commonly occur in the genital area. The virus is passed from one person to another by direct skin-to-skin contact, including nonpenetrative sexual activities. As most people carrying HPV have no symptoms, this means that it can be very easily transmitted without either partner realising it.

How common is genital wart viral infection?

Using extremely sensitive, specialised research techniques, HPV has been detected in up to 80% of young, healthy and sexually active people. Studies in gay men are limited, but prevalence figures of 50% have been reported. So, the general message is - this is an extremely common viral infection, but the vast majority of people will show no symptoms.

Which parts of the body are affected?

HPV infects the surfaces of the entire genital and anal area, including the urethra ("water passage") and anal canal. The virus remains on the surface and does not penetrate to the deeper tissues or bloodstream. If warts appear, they generally do so in warm, moist areas or at sites of friction - under the foreskin or around the anal area. Warts are common inside the anal canal - but rarely cause any symptoms.

How can I tell if I have genital wart virus infection?

The answer is that you usually can't tell, because the virus is so often present without causing any identifiable warts. At the moment, there is no easy, routine way to detect the virus, although a number of specialised and painstaking techniques have been developed for research purposes.
If warts appear, they area usually easy to feel and appear as small, soft, fleshly lumps which are often multiple. They are totally painless. The diagnosis can easily be confirmed by a doctor on examination.

What treatment is available?

Visible warts are treated with a range of therapies. Sexual health specialists are able to offer treatment best suited to the type, size and location of the warts. This includes the application of topical solutions, freezing and various other (painless!) methods. It is often necessary to repeat the treatment on one or more occasions. This is partly because the virus is active in the initial stages of infection and new warts may continue to appear, until your body's immune system begins to suppress the virus. Unfortunately, there is as yet no treatment which will kill HPV outright.

Will my partner be affected?

As up to 50% of gay men may be carrying HPV, this virus seems to be easily transmitted. It is reassuring for partners to attend a sexual health clinic together, for a careful check-up, accurate information and to exclude other problems. As mentioned above, there is no test in routine use for reliable detection of HPV. Condoms help, but do not guarantee complete protection as the virus affects the entire anal and genital skin surface. The average length of time between acquiring HPV and developing warts is three months, but this can be as long as several years.

Are there any long term effects of genital wart virus infection?

With time, your body's immune system will suppress the virus, but probably never eliminates it completely. The vast majority of people never have any problems at all, but there is some research which shows that infection with some HPV strains (16/18/33) may be one of several factors involved in anal cancer. This is in fact quite a rare disease, and only 10% of anal/genital warts are actually caused by these "higher risk" strains of HPV. It is also becoming clear that HIV positive men with wart virus infection may be at higher risk of developing abnormal cells in the anal canal; however it is very important to emphasise that this is very early research and its overall implications for gay men are as yet unclear.

For further information on this and a range of other important sexual health issues, contact the GUM Clinic or Gay Men’s Health.

GUM Clinic, Level 4, Lauriston Building, Royal Infirmary of Edinburgh. Phone (0131) 536 2103
Gay Men’s Health, 10a Union Street, Edinburgh. Phone (0131) 558 9444

Images courtesy of the Steve Retson Project

Last updated 20th May 2004

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