[Question #7301] Genital Warts, Is no treatment an option? Can I continue to have sex?

6 months ago
Hello, im a 24 year old male and I was diagnosed with genital warts, they are very small and on the base of the penis. I was prescribed Podofilox which I applied for one cycle. Im darker skin and the irritation and effect on my other healthy skin was alarming. Ive heard many things on this site and others from doctors that say genital warts and HPV are no big deal and no treatment is an option, as well as dont change any sexual activity because of it. And ive also heard that you should not have sex while you have visible genital warts. Im NOT in a relationship so I would be talking about new sexual partners. 

Im afraid that Podofilox will make my warts look worse by the end of treatment and may/ may not make them go away. If I simply dont treat my warts and allow time to do its thing, is this an okay choice or do I risk spreading HPV more when I have warts and to other parts of my own body or even risk making them grow? Am I safe to continue having sex even with warts? what about oral sex? or should I get them treated first??  How long should I expect for my body to take to treat them naturally?

Theres a lot of varying opinions on HPV and genital warts just want to clear those things up!

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago

Welcome to the Forum.  Thanks for the question.  Untreated genital warts are infectious for sexual partners.  On one hand, most unvaccinated persons will get HPV infection at some point so we do not feel strongly that abstinence is required.  Consistent condom use will reduce your risk for warts and other HPV infections as well as all STIs, including HIV and we recommend it but do not feel that it is absolutely required for persons with HPV including warts.  It would be optimal to inform future unvaccinated sexual partners of your warts unless they are treated or have gone away -once again, we acknowledge that this is a personal choice but it is the right thing to do.  For warts to resolve without therapy typically takes 1-3 years. 

HPV can be transmitted from your warts to others who perform oral sex on you.  On the other hand, your own infection is a local process and thus the fact that you have genital warts does not mean that you have oral infection.  Your warts will typically not spread to other parts of your body although, on occasion, shaving over warts can spread them- we recommend against shaving over warts. 

All treatments for visible genital warts are destructive and so there is a small risk of discoloration related to the treatment although most people do not experience scarring or discoloration of the skin.  If the skin does become discolored, this typically resolves over time.  Given the concerns that you have expressed, treatment is probably a good idea but this is a personal choice and is not absolutely necessary.  Visible warts can be treated with liquid nitrogen freezing, with excision or cautery, with podofilox, with imiquimod, or with other local therapies.  The success rates of all treatment is about the same.

I hope that this information is helpful.  I would suggest that you read other post on our forum for addition information and for confirmation of what I have just said. There are many other posts and we make them available to others because we feel the information is often helpful.  EWH

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6 months ago
Are the actual warts themselves more infectious and if I was asymptomatic with the virus? Also I have read many studies that claim warts and HPV tend to go away by themselves 64% at 6 months, 80% at 1 year and 90% at 2 years. Is this correct? since you're stating 1-3 years.

Will the act of treating the warts themselves help me get rid of the virus faster? Or am I simply treating something cosmetic and the virus needs to go away by itself anyway? Are the warts likely to grow if left untreated?

Im thinking whether to treat now, or wait for the 6 month mark to see if they resolve themselves and THEN treat, thats only based on the 64% of clearance at 6 month number ive seen in studies 

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
The data on the clearance of HPV infections are not well described for intervals of six months or a year. Most of the data on clearance reflects studies of cervical infections in women. Most genital warts will however go away, most typically in a few (1-3) years.  Treatment will certainly make the warts ( and virus) go away faster and when warts have been treated and have gone away a person should be considered non-infectious. Visible genital warts are primarily a cosmetic problem since they do not cause potentially severe consequences such as cancer. The types of HPV which causes visible warts are different than the pipes which cause cancer.

Hope this clarification helps.  EWH 
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6 months ago
You mention treatment will make the warts AND virus go away faster. How can this be? is it because the immune system is alerted of the damage to the warts, therefore identifies the virus and therefore looks for it in the body in general?

One last unanswered question if if leaving warts untreated cause them to grow in size and/ or numbers? Ive also seen that sex while on treating with Podofilox isnt recommended. How soon after is it okay to have sex if even with a condom?

Lastly, what if I miss one small wart somewhere (I have about 21 small ones), will this somehow defeat the purpose of treatment?

Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
The warts are part of the viral process.  Elimination of warts is consistent with control of the virus. 

Typically warts do not grow and grow.  However, to have more than 20 warts is highly unusual.  I recommend that you see a dermatologist or other health care provide with experience at wart diagnosis and treatment.  This will help to verify that the lesions you have seen are warts and allow you to discuss treatment options with him/her.

“Missing” a wart as part of treatment means that the wart may continue to be present.

As per .forum guidelines, this is my third response and therefore this thread will be closed without further response.  Go see an experienced health care provider.  Take care.  EWH 
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