HPV & Genital Warts
This webpage is for information purposes only and is not a substitute for professional medical advice.
Genital warts are an STI, caused by the Human Papillomavirus (HPV).
Genital warts also are known as condyloma or venereal warts.
HPV and genital warts are spread through direct skin-to-skin contact and/or oral, vaginal or anal sex.
Of the over-100 strains of HPV, only a few affect the genital area. However, some of these strains are serious and are linked to cancer.
Signs & Symptoms
HPV infection does not always mean that genital warts will appear. You can have HPV without having any symptoms.
HPV strains that cause genital warts can take approximately one to eight months to develop. Most warts appear as small, flat, flesh-coloured or cauliflower-like bumps. While single warts are usually only 1-2 millimetres in diameter, wart clusters can be quite large.
Genital warts can develop anywhere on or near the vagina, cervix, genitals or rectum. They can be asymptomatic (no symptoms), or they can itch or burn.
Possible Outcomes to HPV Exposure
Once you’re exposed to HPV, there are three possible outcomes:
1. Latent Infection
At this stage most people don’t know they have HPV. This means that a person has the virus but there are no warts or other signs of infection. The virus can still be spread to others during genital skin-to-skin contact even if there are no symptoms. The immune system works to clear the virus from the body, and it is believed that this can take one to two years. There is no treatment available at this stage.
In about two-thirds of female cases, the virus eventually ‘shows’ itself in either the growth of warts in the genital area or by the presence of abnormal cervical cells on a Pap test.2. Warts
Warts can grow anywhere in the genital or anal area of both males and females.
For females, warts can appear anywhere on the genitals including inside the vagina and on the cervix (neck of the womb or uterus). For males, warts can appear anywhere on the genitals, including inside the urethra (the tube that carries urine). For both male and females, warts can appear in the anus. Warts can appear fairly soon or months after exposure.
3. Abnormal Cervical Cells
Some types of HPV can cause abnormal changes in the cells of the cervix. These changes are known as CIN (cervical intra-epithelial neoplasia). Not all females with these types of HPV develop CIN. For many, HPV infection is temporary and most will not have any lasting cell changes.
Genital Warts & Pregnancy
Most pregnant women who have had genital warts in the past are not likely to have any complications or problems during a pregnancy or birth.
If you have warts during pregnancy, they can grow in size and number or bleed due to hormonal changes. This could make delivery more difficult.
HPV can cause growths in the throat of an infant exposed to the virus during childbirth, but this is extremely rare.
Diagnosis & Treatment
Diagnosing HPV & Genital Warts
Genital warts or an abnormal Pap test might not emerge for months - even years after exposure to an HPV virus. Often it’s not possible to know from whom or when the virus was spread. Some people never get genital warts even though they have HPV.
To diagnose genital warts your doctor will ask about your medical history, sexual habits and if you’ve had any prior episodes of STIs. He or she will then perform a pelvic exam (for females) and examine your genitals and rectum for evidence of genital warts by placing a vinegar-like solution on the skin. (This solution turns the warts white and makes diagnosis easier.) During the pelvic exam, your doctor will swab the inside of your cervix. A laboratory will test the sample for HPV.
For females and males, tests such as urethroscopy (an instrument to open and magnify the urinary canal) or cystoscopy (an instrument used to look at the bladder) are available to see how far the warts have spread. In addition, males and females may also be tested via a procedure called an anoscopy (examining the anus and lower rectum for some cancers). For females a referral may be made to a specialist for a colposcopy (a test which uses a special magnifying microscope to examine the cervix).
If your doctor diagnoses HPV your sexual partners must be examined. This is especially important for women, as HPV is very contagious and can be spread even when no warts are visible.
Diagnosing Abnormal Cervical Cells
Doctors diagnose abnormal cervical cells as part of a Pap test (also called a Pap smear). Abnormal cervical cells don’t cause symptoms, which is why regular Pap test screening is so important.
An abnormal Pap test indicates that cells on your cervix have changed.
DNA testing is available through some private labs and can be ordered by a family doctor. DNA testing can confirm which type(s) of HPV is present. The cost of DNA testing is not covered by your Ontario health card.
Treatment
Treatment of Genital WartsDoctors treat smaller warts by applying medications (trichloracetic acid, Wartec®, or Condyline®) to the affected skin. In other cases the doctor will apply liquid nitrogen (cryotherapy) to the warts to freeze the tissue and make warts disappear. Some larger warts may require laser treatment or removal by surgery.
In some cases genital warts disappear on their own, as the immune system works to clear the virus.
Left untreated, a very small number of the 100 or so strains of HPV infections can progress to cancer.
Treatment for Abnormal Cervical CellsThe earlier the treatment the better. If caught early the treatment of precancerous changes in the cervix can be highly successful.
Precancerous cells can be treated with topical creams that are effective against the visible warts, lesions and underlying HPV infection.
Left untreated, abnormal cervical cells can progress to cervical cancer.
Prevention
- Getting vaccinated - A vaccine is available for both males & females
- Delaying sex until your late teens & limiting your number of sexual partners.
- Practicing “safer sex” - Always using condoms/dams for all sex acts to help prevent the spread of HPV, HIV & other STIs. Condoms cannot fully prevent the spread of HPV as they do not cover all the areas of the skin that could be affected.
- Avoiding tobacco smoke - smoking & second hand smoke may cause HPV to become cancerous.
- Testing regularly for STIs & getting treatment if you have an infection.
- Having regular Pap tests and checkups.
- Taking care of yourself so the body can fight off infections. Eat well, exercise regularly, manage stress and get enough rest to help keep your immune system healthy.
- Get tested together with your partner for STIs before engaging in sexual activity.
HPV Vaccine
A newly approved vaccine to help prevent HPV is now available for males aged 9-26 years & females aged 9 to 45 years. The HPV vaccine only provides protection against the four most common types of HPV that can cause genital warts and cervical cancer. It is most effective if given before you become sexually active.
If you already have HPV, the vaccine can still provide protection against the other types. People 9 to 14 years old require 2 doses and those 15 years and older need 3 doses of the vaccine.
HPV & Cervical Cancer
“Low Risk” & “High Risk” HPV TypesSome types of HPV are referred to as “low-risk” because they rarely develop into cancer. HPV types that are more likely to cause cancer are referred to as “high-risk.”
Generally, the types of HPV that are most likely to cause cancer are different from those that cause warts. Many people, however, are infected with more than one subtype and people with genital warts are just as likely to be infected with a high-risk virus as well.
Any one of the high-risk strains of HPV can cause anal cancer in both females and males. Cancer caused by an HPV infection usually takes 20 years to detect.
HPV & Cancer in Females
HPV is responsible for almost all cases of cervical cancer. Pre-cancerous changes (abnormal cells) will appear on Pap tests long before cancer cells. These pre-cancerous changes can be treated and cancer can be prevented - this is why it’s so important for all females to have regular Pap tests. For women with on-going abnormal Pap tests, referral may be made to a specialist for a colposcopy. This test uses a special magnifying microscope to examine the cervix. A tissue sample (biopsy) might also be taken at that time. DNA testing is available through some private labs and can be ordered by a family doctor. DNA testing can confirm which strain of HPV is present. DNA testing is NOT covered by your health card.
HPV & Cancer in Males
Males with one of the more serious HPV strains are at greater risk for penile and anal cancers. HPV is not believed to cause prostate cancer. There is no screening test or approved HPV DNA testing for males.
Reducing Your Risk
You can reduce the risk of your HPV infection progressing to cancer by:
- Not smoking (smoking can increase the risk of cancer of the cervix in women with HPV).
- Using condoms to avoid getting other STIs.
- Getting tested regularly for STIs and get treated right away if you have an infection.
- Getting lots of rest, regular exercise and eat a healthy diet to help keep your immune system healthy.
- Females - getting regular Pap tests.
If you have had genital warts, you should be tested for cervical cancer at least once every year.
HPV Vaccine
NEW! HPV immunization program expanded to include men who have sex with men (MSM)
Men who have sex with men are at an increased risk of HPV infection that can lead to penile and anal cancer.
Effective September 2016, Ontario's publicly funded immunization program has been expanded to included men who have sex with men (MSM) who are 26 years of age or younger. The vaccine series must be initiated and completed before the individual turns 27 years of age.
HPV vaccine will be available to MSM meeting the aforementioned eligibility criteria at Peel Public Health Sexual Health clinics.
Overview of the HPV Vaccine
The HPV vaccine provides protection against the four most common types of HPV - types 6, 11, 16 and 18 - that cause genital warts and cervical cancer.
The vaccine does not contain any preservatives, antibiotics or live virus and it won’t cause you to become infected with HPV.
Effectiveness of the HPV Vaccine
The vaccine is almost 100% effective against the four most common types of HPV.
As it’s not known how long the vaccine lasts, females may have to get a booster for protection after 5 years.
Pap Test and the HPV Vaccine
The HPV vaccine only provides protection against the four most common types of HPV. It is recommended that females have regular Pap tests as it is still possible for females who have been vaccinated to be infected with one of the less common types of HPV.
Who Should and Shouldn’t Get the HPV Vaccine?
Who Should Get the HPV Vaccine?
HPV vaccines have been approved for males aged 9-26 years & females aged 9 to 45 years. It is most effective if given before you become sexually active. If you already have HPV, the vaccine can still provide protection against the other types. People 9 to 14 years old require 2 doses and those 15 years and older need 3 doses of the vaccine.
Even if you are already infected with HPV, the vaccine can still protect you against other types of HPV.
Who Shouldn’t Get the HPV Vaccine?
You shouldn’t get the HPV vaccine if you:
- Have already been vaccinated with the HPV vaccine.
- Have a yeast allergy or an allergy to something in the vaccine - speak with your doctor about what is in the vaccine.
- Are pregnant.
- Have a fever or anything more serious than a minor cold.
Side Effects
The HPV vaccine is safe and has similar side effects as other vaccines.
Common side effects include:
- Redness
- Tenderness and swelling at the injection site
- Fever
- Nausea
- Dizziness
- Headache
In rare cases, reactions to the vaccine include:
- Trouble breathing
- Swelling in the face or mouth
- Fever over 39 degrees C
- Hives or rashes
If you experience any of these rare reactions within 15 days of getting the vaccine, please contact your doctor or local health department.
Where to Get the Vaccine
In Ontario, the HPV vaccine is currently only free to all girls in grade 8-12. It is administered in elementary schools by the local health department.
Ask your family physician, local walk-in clinic or the university/college health centre where you attend. You will need to pay for the vaccine, so check with your drug plan as some insurance companies may cover some cost.
More Information About HPV and the HPV Vaccine
To learn more about HPV and the HPV vaccine, visit:
