What Is It?

Human papilloma virus (HPV) causes common warts, the small, flesh-colored (white, beige or brown) skin growths that can appear almost anywhere on the body and on the moist mucous membranes near the mouth, anus and genitals.

There are more than 70 different types of HPV, each with its own favorite skin surface to invade. Some cause the small, painless, rough-surfaced warts found on the fingers and face, whereas others produce the larger, more painful and flatter plantar warts that grow on the soles of the feet. More than 25 different types of HPV are capable of infecting the skin covering the sex organs and anal opening, producing genital warts.

Certain types of genital HPV infection or warts can increase a woman’s risk of developing cervical cancer. At least five different viruses that cause genital warts have been linked to the development of cervical cancer and (less often) squamous cell cancer of the penis, vagina, anus and vulva (the external genital area in women). Certain types of HPV have been linked to mouth and throat cancers.

Human papilloma viruses are usually spread by direct skin contact, such as shaking the hand of someone who has a wart on their finger or having unprotected sexual intercourse with someone who has genital warts. Less often, the viruses are carried on surfaces touched by someone who has warts, especially inside shoes that have been worn by someone with plantar warts. Once a person has been infected with an HPV, symptoms usually take three to four months to develop. However, in some cases, warts have developed as long as two years after contact with an infected person or contaminated surface.

Health experts estimate that common warts can be found on the hands of about one-fourth of all Americans, especially children. For some unknown reason, plantar warts are most common among teen-agers and young adults.

It is possible to have an HPV skin or genital infection without having symptoms. When an HPV infection does produce a wart, the appearance varies slightly depending on its location:

• Common skin warts — These most often affect the hands, face, skin or scalp, and are especially common on sites of previous skin injury. They are small (about 6 millimeters or one-fourth of an inch), firm, painless, rounded growths that are whitish, pink, beige or brown. The wart surface may be smooth and pearly or rough like a cauliflower.
• Flat warts — These are flat, flesh-colored growths that sometimes itch. They typically occur on the face, neck, chest, forearms, wrists or hands.
• Plantar warts — These are thick, painful overgrowths of skin on the soles of the feet. They are often mistaken for simple calluses.
• Genital warts — These usually appear as one to 10 pink, painless growths with a rough, cauliflower-like surface. In men, genital warts most commonly affect the tip of the penis, the opening of the urethra and the skin around the anus (especially in men who practice anal sex). In women, genital warts usually appear first at the posterior opening of the vagina and on the labia (the liplike folds of skin around the vagina).

Your doctor usually can diagnose warts by examining the affected area of skin. During your physical exam, the doctor will confirm if a appears to be a wart. This helps determine treatment and if a biopsy should be taken to rule out cancer.

People with plantar warts usually complain of pain at the bottom of their feet when walking. If plantar warts are suspected, your doctor will examine your foot for plantar warts and make sure there are no bone, joint or tendon abnormalities that would explain the pain.

If a person has possible genital warts, the doctor will ask about sex habits, including whether you practice safe sex (because condoms may protect against HPV transmission) and engage in anal sex, which increases the risk for warts near the anus. In women with genital warts, the doctor may examine the surface of the cervix and posterior vagina using a colposcope. This tubelike instrument with a light and lenses provides a magnified view of the cervix and nearby vaginal skin. A biopsy of abnormal cervical tissue may be necessary to look for cervical cancer. A Pap smear will be done to look for microscopic precancer or early cancer of the cervix.

Sometimes, HPV infection is detected on a routine Pap smear. Follow up Pap smears or colposcopy will be recommended by your doctor based on your other risk factors for developing cervical cancer.

DNA tests can identify the specific types of HPV infection in cells taken from a woman’s cervix. The test helps to identify women who have the types of HPV infection associated with the development of cervical cancer. Many doctors use this test in women with abnormal Pap smears so that women at higher risk of developing cancer have colposcopy and biopsies earlier, while women who have a lower risk can simply have a follow up Pap smear in a few months.

Many warts disappear on their own, but this may take one or two years. Others persist for longer periods.

There is no definite way to prevent all HPV infections. However, to lower your risk as much as possible, always use condoms and other barrier methods (dental dams for mouth to genital contact) for protection.

If you or someone you know has a wart, avoid skin to skin contact with the wart.

Over-the-counter ointments, lotions and plasters are available to treat common skin warts. Do not use them for warts on the face, genitals or anus. They should not be used by people with diabetes, poor circulation or infected warts. Over-the-counter remedies use strong chemicals to slowly destroy the wart over a period of weeks or months. For faster and more lasting treatment, your doctor may try several procedures: surgical removal of the wart, freezing the wart (cryosurgery), electrical cauterization or application of stronger surface (topical) medications.

A doctor should always examine warts on the face, genitals and anus. In some cases, the doctor will prescribe a medication such as podofilox (Condylox) or imiquimod (Aldara), which you can apply to the wart yourself. In other cases, you doctor will use an office based treatment, such as surgical removal; cryotherapy; application of strong topical medications, such as acids or podophyllum (Podofin, Podocon-25); interferon injections or laser therapy. Several office visits may be necessary to complete your treatment.

Make an appointment with your doctor whenever you suspect that you have a wart on your face, genitals or anus. If you have a wart on another area, you can try nonprescription treatments on your own and see the doctor only if home treatment does not work.

If you are older than 45, talk to your doctor before trying to remove a common wart with an over-the-counter remedy. Your doctor may want to rule out skin cancer.

The prognosis varies. Without treatment, about 50 percent of common warts spontaneously disappear within six to 12 months. Others dissolve when an over-the-counter remedy is used for several weeks or months. Of the office based therapies, surgical removal of a wart gives the best immediate results, because the wart is cut away in one doctor’s visit. Other forms of therapy require several office visits. After a wart has been removed, there is no guarantee that it will not come back, because it is difficult to be certain that HPV infection has been eliminated from the deeper layers of the infected skin. Some stubborn warts require several rounds of treatment before they go away for good.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.