[Question #3910] Genital Warts that can cause cancer?

35 months ago

I've read that genital warts very rarely cause cancer. The PA who treated my genital warts said something about the really small ones could be cancer causing. So is there a specific way cancer-causing genital warts look?

Also, if I have sex with a girl who is vaccinated. And I have visible genital warts (but they have shrunk due to cryotherapy). It's not putting her at much risk, correct? Especially if we've already had unprotected sex.

If I have genital warts, and have sex with someone who already has hpv but no warts. Am I putting her at risk at all?

Lastly, if I had unprotected sex with a woman who is not vaccinated (25 yrs old). And I have visible warts, she probably already has it? What are my chances of giving her cancer?

35 months ago

I'm male and the women I'm talking about are all 25 years old. Thank you.

H. Hunter Handsfield, MD

35 months ago

Welcome to the forum. Thanks for your question.

It is true that various strains of human papillomavirus (HPV) cause warts and various kinds of cancer. However, warts do not "cause cancer". There are over 100 types of HPV that are sexually transmitted and mostly infect the genital area, and often the anal area or throat. However, only a few of them cause any disease at all. Two types cause 90% of genital warts and rarely lead to cancer. 7 other types cause most cancers and generally do not cause warts. The standard vaccine used in the US and many countries prevent infection with these nine types. However, even with these types of HPV, fewer than 1 in a thousand cases lead to cancer.

Also, your doctor is mistaken (or you misunderstood) that "small warts" are more likely to lead to cancer. That simply is untrue. There are no standard HPV tests in men: diagnosis relies only on examination to observe skin abnormalities that might be warts or, much more rarely, cancer.

If you have visible warts, you are still infectious, i.e. can transmit the virus to partners, even if they have started to improve with treatment. You should not be having sex with new partners until a few weeks or months after your warts are totally gone and the skin appears normal. However, if your partner is already infected with the same HPV strain you have, you will not reinfect her and there is no harm in continuing sex.

Your warts cannot cause cancer in partners. As noted above, the types of HPV that cause warts versus cancer are different. If you have sex with a woman who was vaccinated, and if she received the vaccine before becoming infected with those 9 types, she is immune and you will not catch it; and you also cannot transmit any of those HPV types to her.

If you are under 26 years old, you should be vaccinated against HPV yourself. Even though you apparently have one of the two types that cause warts (HPV6, HPV11), you probably still could catch some of the other 9 types covered by the vaccine, which will largely protect you against future cancer due to HPV. Speak with your doctor about vaccination.

As implied by all that, it is clear you have some basic misunderstandings about HPV, and it is a complex subject -- no way for me to explain it all. To learn more, consider reading the information offered by the American Sexual Health Association (ASHA, the sponsor of this forum) (www.ashasexualhealth.org) and the US Centers for Disease Control and Prevention (www.cdc.gov/std).

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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35 months ago

1) Dr. HHH, thanks for your response! What are the odds she already has it (the strain of hpv that causes genital warts if we already had unprotected sex)? We've had unprotected sex on one occasion, but I ejaculated 4-5 times (so a lot of sex). Also, we had sex on another occasion (with a condom, I ejaculated 5 times). Most of my genital warts are in the same area razor burn would be (so much of it is not covered by condom). Based on this information, what are the odds she already has the genital warts strain of hpv?

She's 25 and I'm a 28 year old male.

2) Also, what if I have sex with a vaccinated new partner if I have visible genital warts? Her odds should be low of catching it, correct?

Thank you.

H. Hunter Handsfield, MD

35 months ago

It is difficult to judge the chance any particular person has been infected with, or still has, any particular HPV type. Since she presumably has had other sex partners in the past, she has undoubtedly experienced HPV, perhaps a few times. Since the main wart-causing types (HPV6 and 11) are quite common, she could have been infected. If not, she could have acquired the HPV causing your warts, although not necessarily. If she did, warts may or may not show up; if they do, probably it is a few months in the future. (The number of ejaculations is irrelevant, by the way.)

And yes, sex with a vaccinated partner would prevent infection with about 90% certainty. (Around 10% of genital warts are caused by types other than HPV6 and 11 and are not protected by the vaccine.)

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35 months ago

Thank you. I had the warts before her.....and don't want to give them to her. I was told by a PA that of the woman in 26 or under she's probably vaccinated, is that true? I think she meant to say they can get vaccinated if 26 or under. But yes I'm very certain she's had other partners before me. I'm thinking if we've already had this much sex, we might as well keep doing it because she's probably infected already? And I know the ejaculations are irrelevant. Giving you that information so that you understand the odds of her having it are increased. More genital to genital contact than just one bout of sex.

H. Hunter Handsfield, MD

34 months ago

Apologies for the long delay in responding to this last comment. Sorry I missed it until now.

You are exactly right that once sexually exposed to a potentially HPV infected person more than a few times, there is little point for that couple to stop or otherwise alter their sexual practices.

Normally threads are closed after 4 weeks without new questions or comments. But given the unintentional delay, I'll leave this open for a few more days in case you have a response or any final questions. Apologies again for the oversight.

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