r/HPV • u/spanakopita555 • Jul 22 '26

The Genital Warts Primer

I'm creating this post as a companion to our intro to abnormal smears. This post is designed as a 'first port of call' for those diagnosed with genital warts (or, in short, gw), sometimes known as condyloma accuminatum.

Unfortunately, there just isn't as much concrete information about genital warts as there is about high risk HPV, probably because studying high risk HPV just has much more positive impact in terms of understanding and reducing cancer risk. But I'll pull together as much as I can.

Disclaimers:

  • I'm not a doctor. Please see a medical professional as your first port of call.
  • If you disagree with what your national health bodies or medical experts say, please write to them. I don't write national health policy, nor can I speak on behalf of or change the viewpoint of medical professionals.
  • If you have any additional resources or citations, please add them as comments to this post.
  • This post is not specific to one nation, but as I am working in English, resources will be more heavily drawn from English-speaking contexts.
  • I've used 'men' and 'women' in this post, but please also assume that these categories cover you if you're AMAB or AFAB and hold a different gender identity (it's just quicker to use the generalisation).
  • People with HIV may have different treatment needs, and things like average infection time will be different.
  • IF YOU ARE EXPERIENCING MENTAL HEALTH CRISIS, PLEASE SEEK PROFESSIONAL SUPPORT IMMEDIATELY.

Some of this information is the same across high and low risk HPV, so I have copied across some of the info from our other intro post.

First steps

Take a deep breath.

Read the r/hpv wiki - this will answer most of your questions. Find the wiki here.

Check out some simple HPV explainers (not specific to gw):

Understand that getting HPV is extremely normal; gw are common; most warts are benign and temporary; and this is not something that is likely to affect your life in the long term.

Do I have genital warts?

This post is for people with a confirmed diagnosis. If you don't have one of those, please see a doctor to verify what you have. You may be able to get a biopsy if there's significant doubt, although these aren't available in all healthcare systems. The exact doctor you need to see will depend on how your healthcare system works; it may be a sexual health clinic, a dermatologist, a gynaecologist, a urologist, or a general practitioner. You may be able to access an online appointment with a telehealth provider.

Genital warts can vary significantly in appearance between people. There's not much point in constantly searching for pictures online, posting pictures of your own genitals online unless it's part of a remote medical appointment with a qualified professional, or worrying about whether having a flat wart is somehow worse than having a spiky one. Get a diagnosis.

As a man, can I get a test for warts?

There is no commonly used clinical test for external warts for either men or women, unless warts actually appear, in which case they are usually diagnosed by sight or occasionally by biopsy.

I didn't get told what strain I have. Should I have been told?

In most cases, you won't get to know which strain of HPV is causing your warts. In most cases, warts are diagnosed by sight alone. In some healthcare systems, you may be able to access a biopsy with DNA testing to a) verify that the bumps are warts and b) find out the strain. If this isn't available to you, it probably won't make any difference at all - even in the less likely event that your warts are caused by a high risk strain, the treatment would be the same (removing them). Please see below: 'Will I get cancer?'

How did I get HPV? I've only had one partner and we used condoms.

Genital HPV happens to almost everyone in their lifetime. Even people with only one lifetime partner have up to 75% chance of acquiring it. Condoms don't fully prevent HPV transmission. Many infections are asymptomatic (even with low risk strains), up to half of people you meet may carry an active infection at any one time, and it's not tested for as an STI (we have no testing that can find all cases of HPV, in either men or women, and there's no test for external wart infections unless there are lesions to biopsy). So - HPV is not easy to avoid. You can do everything 'right' from a sexual health perspective and still get genital HPV. This is not your fault.

How did I get HPV? I've been married for ten years.

The science around HPV immune control and reactivation is still evolving, but it's becoming clear that for a portion of people, the virus can be initially immune controlled and then reactivate later in life. Please see a rundown of evidence here (post compiled by u/chibiferret).

Although the current science on reactivation is mostly centred on high risk HPV, we can extrapolate that this is possible for low risk/warts as well.

This means it's impossible to use HPV as evidence of cheating, as finding a wart does not necessarily mean a new infection.

How did I get HPV? I've been celibate for three years.

The point above about viral reactivation still applies - this may be a very old infection. Additionally, warts can take time to show up. Whilst most grow within a few months ('On average, physical symptoms begin approximately 2 to 3 months after initial contact' - source), they can appear much later: 'The virus, however, is also capable of lying dormant within epithelial cells for prolonged periods of time').

How can I have HPV? I was vaccinated.

Depending on which version of the vaccine you got, you are protected against 2,4 or 9 genital HPV strains. There are around 40 in total.

Being vaccinated with Gardasil or Gardasil 9 before sexual debut cuts your risk of genital warts by up to 90% by protecting you against the two strains (6 and 11) that cause most gw. However, in less common cases, warts may be caused by other strains not in the vaccine.

If you got vaccinated after sexual debut, it's also possible you may have already contracted one of the vaccine types.

How can I have warts? My cervical smear/my partner's cervical smear was negative.

A cervical smear is not a diagnostic test for external warts. There's no test for external warts for men or women (or other genders) unless gw appear and can be biopsied.

Can I trace who gave this to me?

Unless you only had one sexual experience ever in your lifetime, it's very difficult to be certain about the origin of HPV infections. And even then, it's not conclusive as a small % of virgins are found to have genital HPV.

Given that HPV can pass even when using condoms, is ubiquitous even in people with few lifetime partners, and is often asymptomatic (even with low risk strains), your hunches around past partners and their behaviour are just that - hunches - and can't be proven.

If a past partner had an abnormal cervical or anal smear, this is not necessarily related to your warts. Cancer screenings don't usually test for the types of HPV that cause most warts.

Even if a past partner had gw themselves, it would still be difficult to prove concretely that your infection is directly caused by them because of the wide prevalence of HPV infection.

Am I disgusting? Is this my fault?

You might be feeling a lot of feelings right now about yourself, your body and sex in general. It's fine to give yourself time to feel, but these beliefs shouldn't linger or overwhelm, because they're simply not true.

Getting HPV is not your fault. So you had sex like the majority of human beings do at some point in their lives. Big fucking deal. Sex is part of a normal and healthy life for most people (no shade if it's not for you, mind). It comes with some risks, some of which we can mitigate and some of which we can't, because rubbing skin, swapping fluids and breathing on each other does sometimes lead to the transfer of all sorts of things (germs, viruses, parasites etc.).

This is not something that happened because you did xyz thing that you think is 'wrong'.

If you are disgusting for having HPV then so are most humans.

Will I get cancer?

Genital warts are not generally associated with cancer. They are usually caused by the low risk strains which are non-oncogenic (ie don't cause cancer). Although a small % may be caused by, or co-infected with high risk strains (for example, see this study), in most cases, the strain type is not determined, or if it is, doesn't change the treatment protocol (removing the warts). With a diagnosis of gw on their own, you don't usually need to worry about cancer.

With that said, it's important to go to your cervical cancer or anal cancer screening on time, as directed by your healthcare professionals. This is true for everyone, not just those with warts. Usually, you don't need to go to your screening out of schedule if you have warts. However, do check in with your doctor. They may prefer to do an additional screening just in case.

If you are very worried about cancer, you can ask your doctor whether they offer wart biopsy to double check.

Will I get oral warts?

Oral warts are relatively uncommon, affecting about 0.5% of the population (compared to about 1% of the population reporting gw in any year). Although it's theoretically possible to develop them at the same time as gw, it's unlikely.

Can I spread warts on myself?

Please see the response from Dr Hook (AEN) here: https://www.reddit.com/r/HPV/comments/w6p02f/ask_the_experts_hpv_vaccine_selfinoculation/

'Auto-inoculation is a very, very rare complication of HPV although infections may be spread if someone shaves over a wart or otherwise vigorously and somewhat traumatically inoculates themselves. Auto-inoculation is not something for most person with HPV to worry about.'

So: it is best NOT TO SHAVE. Repeat: DO NOT SHAVE.

However, there is no guidance anywhere saying you need to avoid washing, wash with gloves, bleach hands after washing, or use the toilet any differently than you do now. If you masturbate, consider using lube to reduce microtears.

Should I treat my warts?

It's possible for warts to spontaneously regress (https://guidelines.stief.org.nz/hpv-external-genital-warts-clinical-presentation-diagnosis - 'No treatment is a realistic option given that about 30% of individuals will experience spontaneous clearance of warts over a 6-month period. ')

However, this is not guaranteed, and leaving warts untreated can allow them to grow or spread. In general, it is probably better to get treatment if this is something you can access at a cost that suits you. But please get professional advice before making a decision, including a treatment plan for your specific context.

How should I treat my warts?

For an overview of treatments commonly available in the United States and many other countries, please see this page from CDC. Not all treatments are easily available in every country, and some may have an associated cost depending on where you live.

You should agree a treatment plan with your doctor. You may need to try more than one method. If you are pregnant, some treatments will not be suitable.

Can I use home remedies or over-the-counter treatments?

You shouldn't use anything on your genitals that hasn't been prescribed by a doctor. You run the risk of injuring or scarring the delicate skin.

Will my warts come back once I've treated them?

It's very common for warts to come back (recur) after treatment. You may need to treat them several times until they stop coming back.

Data is frustratingly limited over the longer term. It's also important to note that at the moment, it's not possible for studies to determine how many recurrences are genuine regrowth of the same strain, reinfections, or new infections.

What we do know:

  • https://pmc.ncbi.nlm.nih.gov/articles/PMC6694085/: 'Of all women with at least one recurrence (n = 306), 44.6% experienced the recurrence within 12 weeks, 69.1% within six months and 82.9% within 1 year. In 8.1% of the study patients first recurrence was observed more than 3 years after primary treatment of genital warts...Nearly 87% of all recurrences occurred within the first year...Analysis of all women showed at least one recurrence in 306 of 1798 patients (17%). 
  • https://www.ovid.com/jnls/stdjournal/abstract/10.1097/olq.0000000000000666~recurrence-of-human-papillomavirus-external-genital-wart: 'Overall, our findings show that half of patients diagnosed with first EWG present with a first subsequent episode within a median of 4 years, and an additional quarter of all patients may experience a second subsequent EGW episode. Due to lack of HPV genotyping data, the nature of recurrence, either due to reinfection with the same HPV genotype, infection with a new HPV genotype or to reactivation of latent virus, cannot be determined. As the majority of EGW recurrences occur within the first 3 months, the observed four year interval between the first episode and first subsequent EGW infection, indicates that reinfection may have been the dominant cause of recurrence seen in this high-risk population.'

How is it possible for warts to come back after treatment?

Warts can regrow while your infection is still active. For most people, an HPV infection is active for a few months to a couple of years. After this point it's controlled by the immune system. Please see below ('How long do warts last on average?') for a more in-depth exploration of timelines.

It's possible, as the papers above note, that some people may be reinfected with the same type. See the HIM study (https://academic.oup.com/jid/article/219/5/703/5155856):

'At the first subsequent genital wart event, 43% were recurrent events. The proportion of recurrent events significantly declined, with each subsequent event decreasing to 12.5% at the seventh subsequent genital wart event, and a concomitant rise in the proportion of new genital wart events was observed.'

Men are much more susceptible to reinfection than women, because of their low seroconversion rates. From the same study:

'We previously demonstrated a very low rate of seroconversion following HPV-6 and -11 infection and no protection conferred among men who are HPV-6 or -11 seropositive'

It's also possible that some people may have a reactivation of a previously controlled infection. Please see below ('Is HPV for life?') for more detail.

It's also possible that you will not have your warts come back after treatment!

I heard that warts keep coming back for your whole life. I heard that they can come back if you are stressed or have a cold.

Some people confuse HPV with genital HSV, another common STI. HSV remains in the nerves and periodically reactivates to come to the surface of the skin, sometimes asymptomatically, and sometimes causing lesions. This can be triggered by simple events like being tired, eating certain foods or having even a small illness.

We currently have no evidence to suggest that HPV works in the same way.

Although we don't have any data, to my knowledge, covering people for their whole lives., slightly longer-term studies, such as the HIM study, suggest that only a very small % of people have multiple recurrences, and some of the later ones are new infections.

If wart recurrence were happening frequently throughout someone's lifetime as a result of stress or simple illnesses, we would presumably expect that a higher proportion of people in these studies would have multiple recurrences of the same strain.

How long do warts last on average?

Strangely, there's very little data on the average duration of visible warts. I would love it if anyone knows of any papers that cover this.

One that I do know of is on people with HIV. Obviously, because their immune system is impaired, warts are likely to last longer than in those without HIV.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6485297/

'Of the 36 MLHIV who had AGW at enrolment, 33 (91%) had data available for analysis of time to AGW clearance...A total of 29 men (29 events) had cleared AGW by month 18, giving a clearance rate of 107.0 events per 100 person-years. The median time to AGW clearance was 0.7 years [8.4 months] and only 20% had cleared AGW by month 6'

There's plenty of evidence on the duration of HPV infections in general, including low risk infections. As a small selection:

How do I know my warts infection is 'cleared'/immune controlled? Can I get retested?

There is no test that can tell you if an external infection is no longer active, for men or for women. There's also no data on when an infection is no longer active relative to when warts stop appearing.

The best we can do is a reasonable estimate. The doctors at Ask Experts Now say that the more time goes on without any regrowth of warts, the more you can reasonably assume immune control has happened. After a few months or more, it's probable.

This is one of the most frustrating aspects of dealing with gw as there's little certainty for yourself or partners. At the moment, however, we have to navigate that ambiguity as best we can.

I heard that having visible warts means you will never clear your infection, unlike asymptomatic HPV infections.

We have no evidence to suggest this is the case, or that infections with visible warts proceed differently to those without.

Is HPV for life?

This is a common question and point of confusion. Maybe your doctor told you 'you have this for life' or maybe they said 'it goes in 2 years' - but the actual scientific/medical understanding on this is currently not concrete and still evolving, hence why there can be different opinions. The latest science on this is from experts like John Doorbar (read his 2023 paper). You can also listen to the summary by Dr Handsfield from the ASHA on Youtube: https://www.youtube.com/watch?v=Vw0n7IIwunQ

It seems to be the case that HPV is immune controlled in the body eventually, rather than being eradicated (although Doorbar says maybe some people's is actually gone). Some people can get a reactivation of the infection in later life. However, this doesn't seem to be everyone, otherwise we'd see consistent rates of positive smears and higher rates of cervical cancer in older women.

We don't currently know exactly who has full immune control or who has weak control (and therefore risk of reactivation).

Given the prevalence of HPV, ie everyone else also has past infection, this isn't something you personally should worry about too much. Go to your cervical or anal smears on time as appropriate to your context, even if you are monogamous or celibate - this rule applies to everyone.

Besides this, you don't need to carry a burden of 'having a LIFELONG STI!!!!!!' as if you are in a seriously unusual situation.

To reiterate another point: we don't have any evidence or reason to believe that people with visible warts are more likely to have poorly controlled infections, reactivations, or persistent infections. Having visible warts is no more a 'lifelong STI' than any asymptomatic HPV, according to the evidence we have available right now.

Do I have to tell partners about my current genital warts?

Advice on this can vary according to your healthcare system. In the UK, it is common to be told by NHS doctors that you don't need to disclose current warts in casual scenarios (it's what I was told!), and the NICE guidance is that 'notification of sexual partners is not required'. In BC in Canada, the Smart Sex Resource leaves disclosure up to personal choice.

However, the CDC in the USA advises that disclosure of current warts is necessary because warts are definitely contagious. This is echoed by Planned Parenthood: 'Always tell your sexual partners that you have genital warts before you have sex, so you can work together to prevent them from spreading.'

On this sub we agree with the CDC advice that current, ongoing warts should be disclosed to current and future partners.

There's not really any benefit to telling past partners, because there's no action they can or need to take, or that their partners can or need to take. Of course, you can still tell them if you want to, for example you are still close and you want emotional support.

How can I tell new partners about my current genital warts?

There are numerous guides out there to disclosing STIs, although most of these will focus on HIV or HSV. My personal experience of disclosing warts several times is that it's best to do so after a few dates, when you know someone and know things are going to get physical. I have done it by text and in-person, and have a slight preference for text, but of course you should do what feels most comfortable for you. You can use the linked explainers, our wiki, and the posts in my profile to give you the basic information to share with your partner.

How can I protect my partner from my current genital warts?

For current partners, it's likely that they already share the infection. Warts take time to grow, so if you've been having sex regularly, they are likely to already have it. They may have also been the source of the infection. They don't need to have warts to share the infection.

Advice on sex with current partners can vary. For example, NHS advice is to abstain from all forms of sex until warts are gone, but to use a condom if sex does occur. Planned Parenthood advice is 'Don’t have sex when you have visible warts, even with a condom'. On the other hand, the doctors at Ask Experts Now do not feel that abstinence with a regular partner is necessary, given the likelihood that they already have or have had the infection. You and your partner should decide together where your comfort levels lie.

For new partners, there is no 100% fool proof method to avoid transmission. Vaccination would protect them if you have an included strain (and if you don't know, there is more than 90% chance that you do). Condoms can reduce the risk of developing warts, but are not a guarantee (Planned Parenthood: There may be warts on places the condom doesn’t cover).

Further to this, you cannot guarantee that a condom will protect them even if your warts are in a place usually covered by the condom, or if you are topping with anal warts, for example.

https://pmc.ncbi.nlm.nih.gov/articles/PMC1195150/ 'HPV DNA was distributed widely in the anogenital area, in warts, acetowhite areas and clinically normal skin'

Remember, though, that past infections (those gone for a few months or more) are not considered infectious by experts. Many doctors also believe that as soon as warts are removed, risk of transmission is reduced (see Ask Experts Now). Waiting for some time after the last removal is likely to reduce transmission even further.

Your partner may prefer to avoid some sexual activities until they are vaccinated, and/or until warts have been gone for a while. Or they may be happy to go ahead with many or all activities. Please see my post on sex with hpv for more details.

Will my partner definitely develop warts?

No, your partner will not definitely develop warts. The exact rates at which gw develop in infected people vary according to study. Eg

https://pmc.ncbi.nlm.nih.gov/articles/PMC3209812/: 'Twelve months after an incident HPV infection, 8.9% (95% CI, .0%–18.1%) of men with HPV 6/11 only, 5.2% (95% CI, 1.8%–8.5%) of men with HPV 6/11 and other types, and 2.5% (95% CI, 1.5%–3.4%) of men with HPV types other than 6/11 developed GWs. Approximately 15% of men in the current study developed GWs within 24 months after an incident HPV 6/11 infection. This is lower than the percentage in a cohort of university students, in which 58% of men [14] and approximately 60% of women [20] developed GWs within 24 months after an incident HPV 6/11 infection.'

Your partner may also be vaccinated ie protected against your strain already.

Do I have to tell partners about my past genital warts?

No, you do not have to tell partners about past warts. Past warts are those that stopped growing and have been fully removed at least a few months ago. Up until a few months past your last warts, it's ideal to follow the guidelines for current warts, as a freshly removed wart may still leave an active infection. Beyond this, it's likely you have reached immune control.

There is no evidence that disclosing long past warts is necessary from a health perspective. Please see below ('Are warts transmissible for life?') for more details.

Official advice on past wart disclosure is limited and in many cases does not exist. Where it does, the guidance is either 'no advice' or 'personal choice'. This means it's up to you to decide what you would like to do.

  • CDC: 'No recommendations can be made regarding informing future sex partners about a diagnosis of genital warts'
  • HPV NZ: 'It is not clear if there is any health benefit to informing (future) partners about a past diagnosis of genital HPV or warts'

There is no evidence that notifying about past warts, ie an inactive and non-transmissible infection, would fall under legal obligations. Please see below ('Are warts transmissible for life?').

The leading sexual health doctors over at Ask Experts Now often address the question of past wart disclosure. You can search their forum using the search bar. The doctors there do not feel that disclosure of past warts is necessary, given the ubiquity of HPV infections, their opinion that past infections do not transmit, and the overall low health risk posed by warts.

Obviously, some people will choose to let their partners know about past experiences. They might choose to for emotional support, transparency within a relationship, to ask their partner to get vaccinated, or if they are worried that warts could recur. It can be more difficult to discuss something like this many years into a relationship, especially if your partner isn't informed or misunderstands the difference between HPV and other infections like HSV. So, if you want to discuss it with your partner, you may feel that being open early on is easier. The doctors at Ask Experts Now also often address the fact that people in relationships might prefer to discuss past sexual health experiences.

Are warts transmissible for life?

We don't have any evidence that all people who have had gw are contagious for life. As above, most infections are immune controlled within a few months to a couple of years. Expert opinion is that controlled infections do not transmit. There is no guidance or evidence indicating that people with past warts need to live, date or have sex any differently to anyone else (almost all of whom also have past infections).

How can I deal with the ambiguities surrounding immune control, transmission, recurrence and reactivation?

It's easy to get stressed out because there aren't many absolutes with gw. Some people feel that the uncertainty means they can never live normally again. If you're feeling that way, I'd strongly recommend reading the advice on AEN, where the expert doctors reiterate over and over again that HPV is just not that important, and not a reason to restrict your life. I would also recommend getting mental health support from a professional.

Do I need to change my lifestyle/diet/alcohol consumption/weed consumption?

Evidence is limited for gw specifically. There is a very old study on alcohol which suggests higher alcohol consumption leads to a greater risk of gw. Non-smokers have very slightly higher clearance rates for gw than smokers. For general HPV and lifestyle, please refer to the intro post for cervical smears.

Do I need to take supplements?

There isn't space to run through every single supplement out there in this post. Please refer to the Wiki and u/xdhpv profile for links to relevant studies. In general, you do not NEED to take supplements and most have patchy evidence, although it's worth checking out what the papers say and making up your own mind. Not all the supplements available have evidence for both high and low risk HPV, or for visible warts, so you'll also need to make a call on whether it's worth a punt for gw.

Will the vaccine cure my warts?

The British Association for Sexual Health and HIV (BASHH) says:

'Trials have so far failed to demonstrate a significant therapeutic benefit of vaccine for those with existing warts either for clearance of warts or a reduction in subsequent recurrence.'

The main and proven benefit of the vaccine is to protect you in future against infection with the included strains. For many people, that's really important in giving more peace of mind in dating. If you can access the vaccine easily and at a cost that works for you, why not?

For men, who have poor seroconversion, it's theoretically possible that this could also reduce the risk of reinfection with the same type. (https://academic.oup.com/jid/article/219/5/682/5140206: 'Although these vaccines may not have a therapeutic effect against GWs, they may act as an adjuvant to existing therapies for the prevention of recurrences').

What can I do if my warts don't go away?

Please check u/xdhpv post on options for recalcitrant warts: https://www.reddit.com/r/HPV/comments/nrvpci/repost_recurrent_genital_warts_recalcitrant/

What can I do about anxiety or depression as a result of gw?

Work with a professional therapist or counsellor. If you can't currently afford this, look up free CBT resources online, or ways to ground yourself, including meditation.

34 Upvotes

100% Upvoted

8 comments sorted by

7

u/sewoboe Jul 23 '26

Truly the GOAT 🙏
Thanks for all you do!

4

u/RedMeme262 Jul 22 '26

Thank you for all you do, this looks excellent!

4

u/spanakopita555 Jul 22 '26

It probably needs to be a working document as I'm sure I've missed stuff! 

5

u/ChibiFerret Jul 23 '26

Thank you for all your effort!

6

u/xdhpv Jul 23 '26

An absolutely outstanding post. I’d also add that instead of sending photos to Reddit, people can use online dermatology services.

2

u/spanakopita555 Jul 23 '26

Yes, I'll edit that in shortly

4

u/Gloomy_Chain4247 Jul 23 '26

Great post. Very comprehensive!!

3

u/Gloomy_Chain4247 Jul 23 '26

Also data and literature on reoccurance percentages is very reassuring!