Genital warts are growths of bumps that may be raised or flat, single or multiple, small or large. They range from pink to dark brown in color. Some cluster together forming a cauliflower-like shape. The human papilloma virus (HPV) causes all types of warts. HPV is a group of viruses that includes more than 70 different types. Certain types of HPV cause the common warts on the hands or feet, while others can cause visible genital (or venereal) warts.

Sometimes HPV causes very subtle changes on the skin that can’t be seen with the naked eye. Many if not most, of the people infected by HPV have no visible warts, so many people with genital HPV do not know they have it. Health care providers can find these “microscopic warts” only with the help of special instruments. In other cases, HPV can live in the skin without causing any warts at all. This is called ‘clinically inapparent’ or ‘subclinical’ HPV infection.

HPV infection, including genital warts, occurs commonly in sexually active men and women of all ages, races, and sexual orientations. Infants can be infected by their mothers during birth, but this is rare.

HPV and genital warts are usually spread by direct, skin-to-skin contact during vaginal, anal, or oral sex with someone who has this infection. Different types of HPV cause warts on other parts of the body, such as the hands. Contact with these warts does not cause typical genital warts.

Warts may appear within several weeks after sexual relations with an infected person; or they may take months to appear; or they may never appear. This makes it hard to know exactly when or from whom one got the virus. Very little is known about the transmission of subclinical HPV infection, although some researchers believe it’s less contagious than genital warts.

Warts sometimes can be very difficult to see. Also, sometimes it’s hard to tell the difference between a wart and other bumps or pimples. A Pap smear is a test designed to detect precancerous cervical changes — not HPV. However, an abnormal Pap smear often shows changes that could be caused by HPV infection. Women with abnormal Pap smears should be examined further for cervical problems (usually through a colposcope) or followed closely by a doctor. There are several new tests that can detect the genetic material of HPV (Vira-pap). There is a connection between HPV infection and cancer in both men and women.

There are many different opinions about how to treat genital warts. The goal of treatment should be to remove visible genital warts and get rid of annoying symptoms. While it is not proven, a person should be less contagious after effective treatment. Cryotherapy (freezing off the wart with liquid nitrogen) is a relatively inexpensive and effective treatment in many cases and is excellent if there are only a few warts.

Aldara cream is an immune system stimulant. It helps the body rid itself of the virus. It is expensive, and takes up to three months to work. When effective, results are lasting. It causes only mild irritation.

Condylox is a chemical that can be applied to the surface of the wart at home to “burn” it off. It is relatively inexpensive and effective in a large number of cases. It causes a lot of irritation. Cryotherapy is often needed to supplement Condylox or Aldara if results are not complete on all the warts.

Trichloracetic acid (TCA) is another chemical applied to the surface of the wart, but only by a physician. Electrocautery (destroying the infected tissue with electric current) is another option used by some doctors. Laser therapy (using an intense light to destroy the warts) or surgery (cutting off the warts) can be expensive and are generally is used only in selected cases.

The antiviral drug interferon is sometimes before or after other treatments. The combination increases the chance of success. It is expensive and causes some discomfort.

Gardasil is a new HPV vaccine that is being offered for the prevention of HPV Types 6, 11, 16 and 18. It is not an STD vaccine but can help prevent the risk of cervical cancer which are caused by HPV types 16 and 18. The vaccine is most effective when used prior to exposure to the virus. It is a series of 3 injections over a 6 month period.

Whatever the treatment, be sure one understands the costs and likely benefits, what to do about any discomfort and when to come back to the office. Be patient — treatment often takes several visits and a variety of approaches. Cure is not always possible. If a person is pregnant or thinks they might be, tell the doctor so he or she can choose a treatment that won’t be harmful to the baby. Don’t use drugstore treatments for warts. These are not meant for sensitive genital skin. Some experts suggest avoiding sexual contact with the infected area during treatment. This is partly to protect the treated area of skin from friction and help it heal. Condoms are recommended while healing and with all new or casual sexual partners.