Genital warts (HPV) testing and treatment in NYC, New York
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• HPV (Human Papillomavirus) types 6 and 11 cause 70% of all visible genital warts
• HPV is one of the most common sexually transmitted infections worldwide. Around 85% of all people get at least one type of HPV in their lifetime
• There are over 100 known HPV viruses
• 90% of those that get exposed to HPV never develop a visible skin lesion
• The first occurrence or a recurrence of genital warts can happen months to years after contracting the Papillomavirus
• Only 10% of those infected can transmit the HPV to other people
• There is a 70% chance of getting HPV from an infected partner even without visible skin lesions
• 90% of HPV infections are cleared by the immune system but some will remain latent (that is, have no visible signs) for the rest of the infected person’s life
• HPV 16 and 18 cause 70% of cervical cancers in females
• Around 90% of anal cancers, and 35% of oropharengeal cancers are associated with HPV
• About 40% of penile and vaginal cancers are associated with HPV

• HPV is transmitted through direct skin-to-skin contact. The infected skin or mucosa comes into contact with healthy skin and enters it through micro abrasions
• The presence of visible warts is not necessary for transmission to occur, but visible warts have the highest concentration of the virus and increase the chance of transmission
• Once acquired, the HPV infection can develop into a visible wart in genital area or enter a latent state with no sign and symptoms
• The average time for the wart’s appearance is 2.9 months

• Sexual activity—simple skin-to-skin contact—is the primary risk factor for genital warts.
• Here are some other factors that can predispose a person to HPV:
  • Weakened immune system due to HIV, diabetes, immunosuppressive medications, etc.
  • Smoking
• Male circumcision, on the other side, may reduce the risk of HPV infection.

The appearance of genital warts varies from person to person.

Shape

Genital warts are single or multiple flat, dome-shaped, or cauliflower-shaped skin growths.

Surface

The surface may be smooth, velvety on a broad base.

Color

The color may vary from pale pink to white to skin-colored to brown.

Size

A wart can be from 1 mm to 1 inch in diameter.

Here we present photographs of HPV lesions on different body parts that we obtained from other educational websites.

Anal warts

This picture shows anal warts that are skin-colored with a typical cauliflower appearance.

Image source: https://www.wirralsurgeon.co.uk/conditions-treated/anal-warts.html

Penile warts

This picture shows slightly discolored penile warts.

Image source: https://www.medicalnewstoday.com/articles/155236

Oral warts

This picture shows oral warts.

Image source: https://www.ncbi.nlm.nih.gov/books/NBK547667/figure/article-19836.image.f2/

What is the best treatment for genital warts?

The “best” treatment for genital warts depends on the number of warts, their location, other health conditions you might have, and your doctor’s experience with different treatment types and preferences. There are many ways to treat genital warts, including topical medications and removing them with a procedure in the doctor’s office.

Self-treatment options

Two prescription medication are commonly used:

Podofilox (Condylox)

How it works

It destroys the wart tissue.

How it’s used

The medication is applied with a cotton swab to visible warts twice a day for three days in a row. Then for four days there is no treatment.

Treatment duration

Treatment should be continued until the warts are gone. This might take up to one month. Side effects include soreness and significant skin irritation.

Imiquimod (Aldara)

How it works

It triggers the immune system to get rid of the warts.

How is it used?

It is applied on the wart three days a week at bedtime and washed off in the morning.

Treatment duration

Treatment might take up to 16 weeks.

Doctor’s office treatment options

In a doctor’s office, genital warts can be destroyed by freezing, burning, or surgically removing them.

Trichloracetic acid (TCA) is an acid that destroys visible warts. It is applied by a doctor weekly for 3–4 weeks until the warts are gone. Side effects involve burning and pain. TCA treatment is not advised on the vagina, vulva, cervix, or urethral opening. TCA is not as effective as cryotherapy treatment.

Cryotherapy refers to the use of liquid nitrogen to destroy the warts. This is the most common method because of its effectiveness and simplicity. Side effects might involve skin irritation, blistering, and sores that heal within a week.

Electrocautery uses electrical energy to destroy the warts. It’s a bit more painful than cryotherapy and is usually done with local anesthesia.

Laser treatment uses light energy to remove the warts. Specialized equipment is necessary and for that reason this treatment is more expensive and not very common. Laser treatment’s most common side effects are pain, scarring, and depigmentation (lightening) of the skin.

Surgical removal (excision) is done mainly for

• Warts that don’t get better with medical therapy
• Large warts when medical therapy is not going to be adequate
• Areas with precancerous changes

Are genital warts curable?

Regardless of the treatment type, warts might come back within a few weeks to months after the treatment. This is because treatment of the visible warts might not get rid of all of the HPV virus. Some of the skin cells of the genitals might look normal but remain infected with HPV, and they could be far from the original area.

Currently, there is no treatment that permanently removes HPV from all infected cells, but in most people the immune system clears the virus within two years (there’s no test to confirm that this has occurred).

Does everybody need to be treated for HPV?

Warts don’t necessarily have to be treated, especially if they’re not bothersome. Most people get treatment to decrease the spread to other parts of their own body and to partners, since visible warts have a higher concentration of the virus than normal skin.

Warts might progress initially, so the number of warts and their size might increase. But it’s estimated that about 30% of genital warts get better within four months.

What causes recurrence of genital warts?

The HPV virus might persist despite the resolution of visible warts. This happens because some of the virus remains latent (inactive) in skin cells without creating any visible skin lesions.

The recurrence rate is not defined.

The most common causes of recurrence are believed to be mechanical irritation, inflammation, or immunosuppression that causes the virus’s reactivation (replication) and the reappearance of warts.

Who should be screened for anal HPV?

Screening for anal HPV is not common. It is reserved for the following categories of people:

• Men who have sex with men
• Woman with a history of high-grade cervical (vulvar, vaginal) cancer
• People with a history of anal warts

How often is an anal Pap smear performed?

Anal screening for high-risk people is advised every two to three years.

How accurate is an anal Pap smear for detecting HPV?

The accuracy and sensitivity of the anal Pap smear is similar to the cervical Pap smear that is regularly performed on females: around 50%.

What is the next step if an anal Pap smear is abnormal?

A Pap smear detects abnormal cells. If abnormal cells are detected on a Pap smear, the next step is to visualize the area and take a biopsy to assess the severity of the disease.

What is the chance of anal HPV being malignant?

Most anal warts (as well as other genital warts) are caused by HPV 6 and 11 and are considered low risk for malignancy, but they may coinfect with other higher-risk strains (16 and 18) that can lead to cancer.

Cancerous transformation of genital warts is very rare. People with a weakened immune system (due to cancer, HIV, or another immunosuppressive condition) may be predisposed to cancerous transformation.

How is oral HPV diagnosed?

There is no test that can find early signs of HPV in the throat. It is most commonly detected during a routine dental exam or when there are symptoms and signs.

To diagnose asymptomatic oral HPV, doctors do a visual physical exam and use a small mirror to check difficult-to-see areas (but this is not commonly done).

Some structures of the throat that cannot be seen with a mirror can be accessed with a flexible laryngoscope by an ear, nose, and threat (ENT) physician.

If an HPV lesion is noticed, it will be treated by removal and can be biopsied to rule out cancer if it is suspicious.

What is the best way to be protected from oral HPV?

The only way to be protected from oral HPV is to not have sex.

The HPV vaccine that was developed to reduce the risk of cervical cancer can reduce the risk of oral and throat HPV as well. Ideally, the vaccine should be given before the beginning of sexual activity, but it can be somewhat helpful at any age.

There is no sure way to prevent getting HPV.

But there are two common ways of decreasing the chance of getting HPV:

• HPV vaccine
• Reducing the number of sexual partners

Let’s talk about them in more detail!

Vaccination

Vaccines are given not to treat but to prevent the condition, and ideally (for the best results) should be given before the beginning of the patient’s sex life.

• Two HPV vaccines are available: Gardasil and Gardasil 9.
  • Gardasil protects against four HPV types: 6, 11, 16, and 18.
  • Gardasil 9 protects against nine virus types: 6, 11, 16, and 18 plus five additional strains: HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58.
  • Note: Types 16 and 18 cause an estimated 70% of cervical cancer. Strains HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58 are responsible for 20% of cervical cancers.
• Both vaccines are safe.
• These vaccines can be given at any age, but ideally between the ages of 9 and 12.
• Here are the current recommendations for the HPV vaccine:
  • Females 9–26 years of age and up to age 45
  • Males 11–12 and up to age 21; from ages 22 to 26, the vaccine is considered optional
  • Note: If the vaccine is not given at the ideal age, the response might be partial since the patient might have already been exposed to some common HPV strains. The vaccine is not harmful, regardless.
• Health insurance covers the cost of the vaccine until the age of 45.

Sexual activity and HPV

Sexual contact—especially penetrative sex—is the primary risk factor for getting HPV. Avoiding people with HPV would be ideal, but from a practical standpoint this is impossible to do since most people positive for HPV don’t have visible skin lesions; rather, their infection is latent, and they can still spread the infection with skin-to-skin contact.

Condoms provide only partial protection since they don’t cover the entire skin area that might come into contact with an infected partner’s skin.

How can I talk with my partner about HPV?

If you have had visible genital warts (that were treated or got better on their own) in the past, have an honest talk with your partner before sexual activity.

Tell your partner these three main points about HPV:

• It is a common condition and most people don’t have visible signs
• There is no test to look for genital warts on the skin
• The test that is routinely performed for females is called a Pap smear; it checks for different wart types

What’s the connection between HPV and infidelity?

There is no clear-cut connection between HPV and cheating while in a relationship. We do not advise people to apologize for having HPV or to blame their partner for having HPV. And here’s why:

• HPV is a very common infection, and 85% of people get it at some point in their lifetime
• It is one of the risks people face by being sexually active
• Unlike other STDs, an HPV infection might remain latent (with no visible signs) for months or even years before showing up as a wart (and only 10% of positive people ever have symptoms)
• This means that if your partner has HPV and didn’t get it from you, they might have gotten it long before they met you
• Since sexual partners can share the same virus, it is always difficult to say where the infection originated, anyway
• Even if both partners are positive, only one may be symptomatic, and it’s not necessarily the one who contracted the virus first

What is the connection between HPV and cancer?

Not all HPV leads to cancer. This is a common misconception. Of more than 100 HPV strains, only a handful are connected to cancer. It is true that HPV (some strains) can cause cancer, but it is a very unusual complication.

According to the CDC, the HPV vaccine significantly decreases the chance of cancer caused by cancerous strains of HPV for cervical cancer (which only people with a vagina can get), penile, oropharyngeal, vulvar, and rectal cancer.

Our walk-in clinic for STD testing and treatment is conveniently located on the east side of Midtown Manhattan near the Grand Central Terminal and the Main branch of the New York City public library.
Despite it being our only STD testing center, we offer health services to New Yorkers from all zip codes across all 5 NYC boroughs: Manhattan, Brooklyn, Queens, Bronx, and Staten Island.
Our certified STD center offers testing services for HPV and other Sexually transmitted diseases (including syphilis, gonorrhea, herpes, chlamydia, HIV, hepatitis B, and hepatitis C), along with quality treatment and follow-up care.