I am concerned about genital warts. Although I have no visible symptoms, I would like to get checked out. Who should I go to and what tests should be performed? Also, I've heard that it is possible to carry the virus and not have any symptoms. How likely is it that this will be found, and does a negative test guarantee I don't have them? Finally, how likely is it that the virus will be transmitted if you have unprotected sex with someone with the warts?
—Wanting to be a Prince
Dear Wanting to be a Prince,
Genital warts are caused by certain strains of the human papillomavirus (HPV). For women, a Pap smear can detect cell changes on the cervix caused by other types of HPV (strains that do not cause warts but are linked to cervical cancer). However, there is no approved test for HPV in men, nor a test used specifically for the strains of HPV that cause genital warts. Instead, warts are usually diagnosed by a health care provider during a visual exam, when warts are actually present. Sometimes, magnification or a vinegar solution is used to identify warts that are otherwise too small to be seen.
You're right that people can carry the types of HPV that cause genital warts without having symptoms. However, you shouldn't need to visit your health care provider unless you or your partner notices warts. It may feel frustrating that there isn't a test that can tell symptom-free people whether they carry the virus. Remember, though, that while people may find genital warts embarrassing and that the growths can sometimes cause discomfort, these particular strains of HPV don't otherwise negatively affect a person's health. The strains of HPV that cause genital warts are not the same high-risk strains that are linked to pre-cancerous growths and cervical cancer. If warts do appear, there are several different treatment options that can remove the growths.
The transmission of HPV is still being investigated, and there are few empirical studies. One study found that 60 percent of people whose partners had genital warts also developed growths, while studies based on simulations and mathematical models have estimated transmission rates to be from 40 to 60 percent per act of intercourse. In general, HPV transmission studies are hard to conduct and interpret: HPV is difficult to test for in men and can be asymptomatic for long periods of time, so it can be hard to tell who has contracted genital warts and who hasn't. Condoms can reduce the risk of transmission but are less effective against HPV than against other STIs, since the virus can be found on skin the condom doesn't cover.
Despite the difficulty of testing for HPV, there is good news. Two vaccines are available to protect against certain strains of HPV that are linked to genital warts and cervical cancer. One of the vaccines, Gardisil, protects against four common strains of HPV and is approved for males and females aged 9 to 26. A second vaccine, Cervarix, is approved only for females aged 10 to 25 and protects against two common strains of HPV. Speaking with your health care provider about whether either of these vaccines is appropriate for you may be a good idea. For more information, you can also check out these sites:
ASHA's National HPV and Cervical Cancer Prevention Resource Center
Information on diagnosis, treatment, prevention, emotional support, and referrals
Centers for Disease Control and Prevention (CDC) HPV Information
National STD Hotline: 1.800.227.8922
If you're asymptomatic but still have questions or concerns about genital warts, you may want to talk with your health care provider. While HPV is extremely common, it's good to know there are precautions you can take to protect yourself from becoming infected.