No symptoms, but concerned about genital warts

Dear Alice,

I am concerned about genital warts. Although I have no visible symptoms, I would like to get checked out. Who should I go to and what tests should be performed? Also, I've heard that it is possible to carry the virus and not have any symptoms. How likely is it that this will be found, and does a negative test guarantee I don't have them? Finally, how likely is it that the virus will be transmitted if you have unprotected sex with someone with the warts?

— Wanting to be a Prince

Dear Wanting to be a Prince,

You're certainly right that people can have genital warts without having symptoms. Genital warts are caused by certain strains of the human papillomavirus (HPV), a sexually transmitted infection (STI). While some high-risk strains of HPV are linked to pre-cancerous growths and cervical cancer, these aren't the same as the strains that cause genital warts. In terms of testing, for a person assigned female at birth, a Pap smear can detect cell changes on the cervix caused by other types of HPV, specifically strains that don't cause warts but are linked to cervical cancer. For those assigned male at birth, there is no approved test for HPV, but rather there is a visual examination of the genitals. Read on to learn more!

When diagnosing genital warts for those assigned male at birth, a health care provider will usually perform a visual exam, specifically when warts are actually present. Sometimes, magnification or a vinegar solution is used to identify warts that are otherwise too small to be seen. Given that there needs to be warts present for a medical provider to diagnose genital warts for people assigned male at birth, a visit to a health care provider may be most beneficial when you or a partner notices them. While it may feel frustrating that there isn't a test that can tell symptom-free people whether they carry the virus, remember that, even though people may find genital warts embarrassing and the growths can sometimes cause discomfort, these particular strains of HPV don't otherwise adversely affect a person's health. However, if warts do appear, there are several different treatment options that can assist in removing the growths, such as taking certain medications or undergoing procedures such as cryotherapy and electrocautery.

While transmission is understood to occur through sexual contact, tracing when a person gets it for the first time can be more complicated. One study found that 23 percent of men whose partners had genital warts also tested positive for HPV on their genitals, while 17 percent of women whose partners had genital warts also tested positive. In general, HPV transmission studies are hard to conduct and interpret given that HPV is difficult to test for in men and can be asymptomatic for long periods of time. This can make it hard to tell who has contracted genital warts and who hasn't. Condoms can reduce the risk of transmission, but they're less effective against HPV than other STIs because the virus can be found on the skin that the condom doesn't cover.

Despite the difficulty of testing for HPV, there is good news! There are three vaccines available to protect against certain strains of HPV that are linked to genital warts and cervical cancer: Gardasil, Cervarix, and Gardasil 9. In the United States, Gardasil 9 is the only vaccine available. It protects against nine strains of HPV which cause the majority of cases of genital warts and cervical cancers. The United States Food and Drug Administration has approved the vaccine for those between the ages of 9 and 45 years old. That being said, there are more delineations between these age groups. For those between the ages of 9 and 26, the Centers for Disease Control and Prevention (CDC) recommends the vaccination for everyone. For those aged 27 to 45, the CDC recommends speaking with a health care provider about whether or not the vaccine would be appropriate for them. By an older age, there is a higher likelihood that a person may have already been exposed to HPV, which would limit the benefits the vaccine would have.

If you're asymptomatic but still have questions or concerns about genital warts, you may want to talk with your health care provider. Furthermore, you can also check out the Centers for Disease Control and Prevention (CDC) HPV Information page. While HPV is extremely common, it's good to know there are precautions you can take to protect yourself from becoming infected.

Take care,

Last updated Mar 04, 2022
Originally published Feb 10, 1995

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