The Call-On-Doc Guide to Genital Warts

While there are other causes, genital warts for men and women are primarily caused by the STD HPV. Additionally, the occurrence of many normal warts and genital warts is caused by the virus targeting and then infecting the basal cells of the epithelium, the outermost layer of skin or mucous membranes. Upon being infected, the basal cells multiply rapidly and lead to outgrowths or warts. (3) Depending on the type of HPV, such growths that can be seen include: 

• Common Warts: HPV types 2 and 4 are responsible for causing common warts, which typically appear on the hands and fingers.
• Plantar Warts: HPV types 1, 2, 4, and 63 cause plantar warts, which develop on the soles of the feet.
• Flat Warts: HPV types 3, 10, 28, and 49 cause flat warts, which are small, smooth, and flat-topped warts often found on the face, neck, or hands.
• Genital Warts: Certain HPV types, such as HPV types 6 and 11, are responsible for causing genital warts. These types are considered low-risk HPV, as they are not associated with an increased risk of cancer.

Yes, HPV can be passed on non-sexually in certain circumstances. While sexual contact is the most common mode of transmission for HPV, it is also possible to acquire the virus through non-sexual means, especially in the case of children. Here are some non-sexual routes of HPV transmission:

• Perinatal Transmission: A newborn can acquire HPV during childbirth and in the perinatal period if the mother has an active genital HPV infection. The virus can be present on the mother's genital skin or in the birth canal. Once passing through these parts of the body during birth, the newborn then becomes infected. Additionally, certain types of the virus can make their way to the placenta, umbilical cord, and amniotic fluid. (4)
• Direct Skin Contact: HPV can be transmitted through direct skin-to-skin contact with an infected area. For example, if someone has genital warts, the virus can spread through touching the warts and then touching other parts of their body. (5)
• Fomite Transmission: It is theoretically possible for HPV to be transmitted indirectly through contaminated objects, such as towels or shared personal items. While less common, this mode of transmission still can remain possible due to the virus remaining intact on surfaces for around five days after exposure. (6)
• Autoinoculation: In some cases, a person can spread the virus to other areas of their body through self-inoculation. For instance, if someone has genital warts and touches the affected area and then touches another part of their body, warts can appear in the new location. Less common than normal transmission, this mode of spread depends on many factors like the type of HPV, level of hygiene, and how open wounds are cared for. However, like fomite transmission, this form of HPV transmission is rare. (7)

Poor hygiene itself does not directly cause genital warts. Instead, genital warts are transmitted through skin-to-skin contact, primarily through sexual activities. However, poor hygiene practices may potentially contribute to the spread or persistence of genital warts in certain situations. For example, sharing personal items like unwashed clothes, recently used towels, and sponges with someone who has HPV has a chance to pass the virus along. 

There is a myth that men cannot give women HPV and that only women pass it along. This, however, is untrue, as genital warts are just as common in women as in men. Note that the HPV virus is statistically higher in homosexual men, more specifically, it's estimated that 61% of men that tested negative for human immunodeficiency virus and 93% of men that tested positive for the same STD are infected with human papillomavirus. (8)(9)

In both men and women, most HPV (human papillomavirus) infections are asymptomatic, meaning they do not cause any visible signs or symptoms. However, when symptoms do occur, there are some differences in how HPV can manifest in men and women:

HPV Symptoms in Women: 

• Genital Warts: Women with an HPV infection, particularly low-risk HPV types like types 6 and 11, may develop genital warts. These warts can appear on or around the vulva, vagina, cervix, and anus.
• Abnormal Pap Smear: In cases of high-risk HPV infections affecting the cervix, an abnormal Pap smear result may be the first indication of infection. An abnormal Pap smear may show changes in cervical cells that could be indicative of a persistent HPV infection and potentially precancerous changes.

HPV Symptoms in Men: 

• Genital Warts: Men with HPV infections, particularly low-risk HPV types, may develop genital warts. These warts can appear on or around the penis, scrotum, anus, and groin area.
• Rarely, Urethral or Penile Warts: In rare cases, HPV infections can cause warts inside the urethra or on the shaft of the penis.

Aside from the difference in anatomy, both men and women can develop HPV warts elsewhere on the body like elsewhere on the groin, in the anal area, throat, mouth, hands, and fingers. While not everyone infected with HPV will have warts, the abnormalities that do appear are not isolated to the genitals. 

While there are no tests men can take to determine genital warts or HPV, there does not necessarily need to be a universal test for the disease due to the warts that appear. A healthcare provider typically will just need to have visible confirmation before providing HPV treatment. Additionally, providers like CallonDoc offer labs to test 

There is no cure for HPV or genital herpes once infected, however, there are treatment options for outbreaks as well as suppression therapy. You can get both prescribed online by CallonDoc if you are experiencing symptoms or get tested.

• Condylox: The active ingredient in Condylox is podofilox, which works by interfering with the growth of warts and the HPV virus within the affected cells. When applied to genital warts, Condylox helps to destroy the abnormal tissue, leading to the removal of visible warts. It is considered a self-applied treatment and should be used only as directed by a healthcare provider. Condylox can be an effective option for managing genital warts, but it is not a cure for HPV. Regular follow-up with a healthcare provider is essential to monitor progress and address any new warts or symptoms that may arise. (11)
• Imiquimod: It belongs to a class of drugs known as immune response modifiers. When applied to the affected skin, Imiquimod stimulates the body's immune system to produce interferon and other cytokines, which help target and eliminate the HPV-infected cells and visible warts. The medication enhances the body's natural defense mechanisms, leading to the destruction of the warts over time. Imiquimod is a self-applied treatment and should be used as directed by a healthcare provider. While it can be effective in reducing and removing genital warts, it is not a cure for HPV. Regular follow-up with a healthcare provider is important to monitor progress and address any new warts or symptoms that may appear. (10)

Genital warts should be addressed and treated by a medical provider, not self-treated. While warts on other parts of the body can be treated with over-the-counter measures, solutions applied to the genitals must be specially designed to avoid an excessive reaction that can cause heavy irritation and result in the need for further treatment. 

Warts removed through professional methods lower the risk of spreading the virus, relieve any irritation, and more. Such methods are easily available with telehealth organizations like CallonDoc, which has developed our consultations and treatment delivery with ease of access for the patient in mind!

While HPV treatment will force warts into a dormant state, the condition can flare back up in certain instances. Flare-ups, also known as recurrences or reactivations, are associated with certain factors that can lead to the reactivation of the virus and the development of visible symptoms, such as genital warts or abnormal cervical changes. Some factors that may trigger HPV flare-ups include:

• Lowered Immune System: A weakened immune system due to common illnesses or other reasons can allow the HPV virus to reactivate and cause flare-ups. Immune suppression may result from conditions like HIV/AIDS, organ transplantation, or certain medications that suppress the immune response.
• Stress: Emotional or physical stress can impact the immune system and potentially contribute to the reactivation of the virus.
• Pregnancy: Hormonal changes during pregnancy can influence the immune response and may lead to HPV reactivation.
• Other Infections: Co-infection with other sexually transmitted infections or infections that affect the genital area can increase the likelihood of HPV reactivation.
• Sexual Activity: Engaging in sexual activity can sometimes lead to the reactivation of the virus or transmission of a new HPV strain.
• Trauma or Irritation: Physical trauma or irritation to the genital area may trigger HPV flare-ups or cause the appearance of visible symptoms.

It's important to note that not all individuals with HPV will experience flare-ups, and some HPV infections may remain asymptomatic. The body's immune system plays a crucial role in controlling HPV infections, and maintaining a healthy lifestyle and regular medical check-ups can help manage HPV and reduce the risk of flare-ups. 

Once infected with HPV it cannot be cured, so learning about HPV prevention is important to help you stay on top of your sexual health. Some steps you can take to reduce the infection and transmission of HPV include:

• Vaccination: HPV vaccination is a crucial step in preventing HPV-related health issues. There are several FDA-approved vaccines available that provide protection against specific high-risk HPV types that can cause cervical, anal, and other cancers, as well as low-risk types that cause genital warts. The vaccines are most effective when administered before exposure to the virus, ideally during adolescence before becoming sexually active. Vaccination is recommended for both males and females.
• Safe Sex Practices: Consistent and correct condom use during sexual activity can help reduce the risk of HPV transmission. While condoms provide a barrier against some sexually transmitted infections, including those spread through genital fluids, they may not provide full protection against HPV, as the virus can also be transmitted through skin-to-skin contact in areas not covered by the condom. Nonetheless, condoms can still offer some level of protection and are a valuable addition to a comprehensive prevention strategy.
• Limiting Sexual Partners: Reducing the number of sexual partners and having a mutually monogamous relationship with an uninfected partner can lower the risk of exposure to HPV. The more sexual partners one has, the higher the chance of encountering the virus. However, it is essential to remember that HPV can be present in individuals who have had only one sexual partner in the past.
• Communication: Openly discussing sexual health and history with sexual partners is essential. Honest communication can help make informed decisions about sexual practices, reduce the risk of transmitting or acquiring HPV, and promote a responsible and respectful approach to sexual health.
• Avoiding High-Risk Behaviors: Avoiding high-risk behaviors, such as smoking, is important. Smoking weakens the immune system, making it more difficult for the body to fight off HPV infections. Women who smoke are also at a higher risk of developing persistent HPV infections and cervical cancer.

Staying on top of your sexual wellness requires regular testing and seeking treatment if you think you have been exposed to an STD. At CallonDoc, we offer both testing and treatment options for sexually transmitted infections, all available online for your privacy and convenience. If you or a partner need sexual healthcare visit us today to start a visit.

1. “HPV and Cancer - NCI.” National Cancer Institute, 4 April 2023, https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer.
2. Cates, Joan R., et al. “Human Papillomavirus: A Hidden Epidemic in the United States.” Population Reference Bureau, Population Reference Bureau, 01 May 2001, https://www.prb.org/resources/human-papillomavirus-a-hidden-epidemic-in-the-united-states/.
3. “Quick Facts: HPV-Associated Cancer - MN Dept. of Health.” Minnesota Department of Health, https://www.health.state.mn.us/data/mcrs/data/qfhpv.html.
4. Freitas, A.C., et al. “Human Papillomavirus Vertical Transmission: Review of Current Data.” Clinical Infectious Diseases, Oxford Academic, 15 May 2013, https://academic.oup.com/cid/article/56/10/1451/404432.
5. Petca, Aida et al. “Non-sexual HPV transmission and role of vaccination for a better future (Review).” Experimental and therapeutic medicine vol. 20,6 (2020), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579832/. 
6. Ding, Dah-Ching et al. “Long-term persistence of human papillomavirus in environments.” Gynecologic oncology vol. 121,1 (2011), https://pubmed.ncbi.nlm.nih.gov/21208649/. 
7. Pamnani, Shitaldas J et al. “Sequential Acquisition of Anal Human Papillomavirus (HPV) Infection Following Genital Infection Among Men Who Have Sex With Women: The HPV Infection in Men (HIM) Study.” The Journal of infectious diseases vol. 214,8 (2016), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034951/. 
8. “STD Facts - HPV and Men.” CDC, https://www.cdc.gov/hpv/about/index.html.
9. “National LGBT Cancer Network HPV and Cancer.” National LGBT Cancer Network, https://cancer-network.org/cancer-information/hpv-and-cancer/.
10. Bonnez, W et al. “Efficacy and safety of 0.5% podofilox solution in the treatment and suppression of anogenital warts.” The American journal of medicine vol. 96,5 (1994), https://pubmed.ncbi.nlm.nih.gov/8192173/. 
11. “Podofilox Topical Solution: Uses, Warnings and Side Effects.” Cleveland Clinic, https://my.clevelandclinic.org/health/drugs/19918-podofilox-topical-solution.