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Factsheet

HPV - Wart Virus

Date 18 January 2008

Genital warts is a sexually transmitted infection (STI) caused by the human papilloma virus (HPV). Genital warts are most common in people from 20-24 years of age. There are more than 200 types of wart virus that can infect human skin. About 20 of these infect the skin of the genital area, e.g. the penis or vagina.

Wart virus infection can occur in three ways:

Visible warts (warts which are easy to see): these may have either a hard, smooth surface, or a 'cauliflower-like' appearance.
Sub-clinical infection: where you cannot see warts on your skin, but the wart virus can be found inside the skin cell using a microscope, and it may still be able to infect other people.
Latent infection: where the wart virus can only be found with special tests that look for wart virus DNA.

HOW COMMON IS THE WART VIRUS?

Wart virus is very common - 75% of people from 15 to 49 years of age who are sexually active, have wart virus, or have had it in the past. Only 25% of sexually active people in that age group show no signs of ever having HPV. Most people who have HPV have no idea that they carry the infection.

Only 1% have visible warts
4% have HPV found on a Pap test
10% have sub-clinical HPV that can be found with special pathology tests.
60% have had HPV in the past but have no signs of it at present

Warts that you can see are very infectious. Around 30-60% of the partners of people who have visible warts will also have HPV infection. So your partner should have a check-up as well. You should also discuss with your health practitioner whether you need to have a full STI check-up. At least 50% of people who are infected with HPV are found to have other STIs as well.

Sub-clinical infections are also likely to be infectious to others even though you cannot see anything on the skin. Because there are no visible warts, a person may not even know they have the infection until some time later when it is found on a Pap test or HPV test. The virus is transmitted to another person by skin to skin contact, so when it is found in the genital area, it is likely that it was passed on by a sexual partner.

The incubation time varies a great deal, so it may be very difficult to work out how long someone has carried the infection, or who gave it to them. Condoms do not give complete protection from HPV infection, as they do not cover all areas on the genitals where you can have skin contact. However, you should use condoms with all casual or new partners to reduce the risk of other STIs and HIV/AIDS. It may be best not to have sex until the visible warts have disappeared.

HOW ARE WARTS TREATED?

In 10-30% of people with visible warts, the warts will disappear without any treatment at all within three months. In almost all others they will go away within a couple of years. But because most people do not like the appearance of genital warts, many prefer to have their warts treated. Treatment may also reduce the risk of spreading the infection to others. Visible warts can be treated in various ways - with chemical solutions, by freezing, electric current or laser, or by using a special cream that improves the immune system's response to the virus. All of these options are painless.

However, no method is completely effective. Treatment can remove physical signs of the virus, but it may take up to two years before the virus is completely removed from the skin cells. For this reason, warts can come back at any time during the first two years after treatment, especially in the first three months. This is even more likely to happen if the skin is irritated or damaged. It is important to keep the area clean and dry during treatment. You can also infect a sexual partner during this time, even if no warts can be seen on the skin. At present, there is no successful treatment for sub-clinical HPV infection.

WHAT HAPPENS WHEN HPV IS FOUND ON A PAP TEST?

In women, HPV can also infect the cervix (the lower part of the uterus). Certain types of HPV in the cervix may be one of the things that leads to pre-cancerous or even cancerous changes in these cells. Only a small number of women with HPV showing on their Pap tests will ever develop these cancerous changes, and there may be a number of other factors that need to be present before that happens. We know for example, that smoking is one of the factors that increases the risk of cervical cancer. It is thought that using hormonal contraception for long periods of time may be another factor - but this is not quite so clear.

When HPV is found on a Pap test, the woman usually just needs more regular Pap tests to make sure that the virus goes away. The presence of HPV in the cells of the cervix is common. About 80% of women having regular Pap tests will have at least one Pap test that shows HPV infection, during their life. If HPV is still seen on the Pap test after a year, then the woman has a colposcopy examination, which gives the doctor a magnified look at the cervix, to check on the extent of the infection.

Treatment is usually only recommended when there are pre-cancerous cells found along with the HPV. We do not, as yet, have any good treatments for cervical HPV where no warts can be seen, so we depend on the body's ability to clear the infection itself. This usually takes two to five years. It is very important for a woman who has ever had an abnormal Pap test result, to have regular follow-up Pap tests at the times recommended by her health practitioner. Sometimes special HPV tests will be recommended to find out whether the virus is one that is more likely to cause pre-cancerous changes.

Remember, wart virus is a common infection that is not serious in itself, but may be embarrassing, and can be difficult to treat. Although HPV on the cervix can be associated with cell changes in some women, most infections of the cervix get better without treatment and only require regular follow-up Pap tests to check that the cervix is healthy.

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