Genital warts are a common manifestation of a widespread viral infection, but the visible growths themselves are not permanent. While the warts can be physically removed or treated, the underlying virus often remains in the body, sometimes indefinitely. This distinction between the visible symptom and the viral infection is important for understanding the long-term reality of this condition. Treatment focuses on clearing the visible warts, which is highly effective, but it does not eliminate the possibility of recurrence. The body’s immune system plays the primary role in managing the virus over time, determining whether new warts will develop.
Understanding the Viral Origin
Genital warts are caused by the Human Papillomavirus (HPV), the most common sexually transmitted infection globally. HPV is a family of DNA viruses with over 200 different types identified; more than 40 of these can affect the genital area. The warts are almost always linked to specific “low-risk” types, primarily HPV types 6 and 11, which cause about 90% of all genital wart cases.
The virus is transmitted through direct skin-to-skin contact, most often during sexual activity, including vaginal, anal, and oral sex. Although genital warts are a common clinical symptom, most people who contract HPV never develop visible warts or any other symptoms. A majority of new HPV infections are transient and are cleared by the immune system within one to two years without medical intervention.
Treatment Options for Visible Warts
The primary goal of treating genital warts is the clearance of visible lesions, which can cause physical discomfort and emotional distress. Treatment options are divided into those applied by a healthcare provider and those that can be self-applied by the patient at home. No current treatment eliminates the underlying HPV infection itself, but successful removal of warts may reduce the risk of transmission.
Provider-administered treatments include cryotherapy, which uses liquid nitrogen to freeze and destroy the wart tissue. Another common in-office procedure is the application of trichloroacetic acid (TCA), a caustic agent that chemically coagulates the proteins within the wart cells. For larger or more extensive warts, surgical excision, electrosurgery, or laser therapy may be used to physically destroy the lesions. These ablative methods are effective at clearing the immediate symptoms.
Patient-applied topical medications are available and often the first-line choice. Podofilox, available as a solution or gel, is an antimitotic drug that directly kills the wart cells and is applied in cycles. Another option is imiquimod cream, an immune-response modifier that stimulates the body’s immune system to attack the virus. Sinecatechins ointment, a green tea extract, offers an alternative patient-applied therapy.
Managing Recurrence and Viral Status
While visible warts are treatable, the underlying HPV infection can persist in a dormant state within basal epithelial cells, leading to recurrence. The immune system constantly works to suppress the virus; a temporary weakening of this control allows the virus to reactivate. This reactivation causes new warts to appear, which is often mistakenly viewed as a new infection.
Recurrence rates are relatively high across all treatment modalities, with approximately 25% to 30% of patients experiencing a return of warts, most often within the first few months after treatment. This reappearance represents the awakening of a persistent, latent infection that was lying below the level of clinical detection. Over time, the immune system may eventually clear the virus entirely, but it is challenging to know when this true elimination has occurred.
Reducing Risk and Transmission
Preventative measures are the most effective way to address genital warts and the underlying HPV infection. The primary prevention tool is the HPV vaccine, recommended for both males and females, typically starting around age 11 or 12. The vaccine protects against the HPV types that cause most genital warts and HPV-related cancers. Even for adults up to age 45, the vaccine may still be beneficial if they were not vaccinated earlier.
Consistent use of external latex condoms reduces the risk of HPV transmission and other sexually transmitted infections. Condoms do not offer complete protection because HPV can be transmitted through skin-to-skin contact in areas not covered by the condom. Individuals diagnosed with genital warts should inform their partners, allowing for mutual support and consideration of vaccination. Regular check-ups are also important, particularly for women, to monitor for any HPV-related changes.