Genital Warts – How Long They Last if Untreated?

Warts are small growths in the skin and mucous membranes that are caused by Human Papillomavirus (HPV). There are several different subtypes of HPV and each of these types may have a predilection for a certain area of the body. [1]

There are two broad categories of warts, namely: cutaneous warts (or warts that affect the skin in general) and genital warts (warts that affect the skin and mucous membranes of the genitals and anus).[2]

In this article, we will explore genital warts and their progression, and will answer the question: how long do genital warts last.

What causes genital warts?

Genital warts are caused by specific subtypes of HPV, most commonly HPV-6 (which accounts for about 45-90% of cases) [3] and HPV-11. Other types of HPV (including HPV-1 and HPV-2) may cause genital warts but are far less common.

Warts Formation Process

Genital warts are sexually transmitted and may spread to the anus via the same route, or through autoinoculation (which is when persons afflicted with the wart re-infect themselves in other sites).

HPV DNA has been found on patients’ fingers and in their underwear, which supports the theory that transmission is not always sexual. [4] The symptoms may start appearing weeks after sexual contact[5], or may take up to 2 years.[6]

What do warts look like?

Are there many types? What are the symptoms?

The form of wart that occurs in the genitals is called condylomata acuminatum (plural: condyloma acuminata).[7]

Genital Warts on Penis and Vagina

Condyloma acuminata are soft, pink swellings, which may be elongated, and may have a stalk on which they stand. They vary in size and number from single, small, and flat warts to large masses, which may actually be formed of several warts fused together. Their growth can be accelerated during infections and pregnancy.

There usually no symptoms, but the wart itself can cause discomfort, a bad odor, discharge from the genitals or anus, or bleeding.

There are other places besides the genitals where condyloma acuminata can occur.[8]

Oral warts

Transmission to the mouth can occur as a result of oral sex, and is more common in impaired immunity caused by HIV.

Respiratory papillomatosis

Mothers with genital warts may pass on the infection to their babies during labor. This congenital infection of HPV can be found in the larynx, and may stay dormant for years and reactivate, even in adulthood, explaining how respiratory warts are found in adults.

Other sites

Other sites of infection with genital warts are the nose, sinuses, and eyes.

How long do genital warts last?

Will they go away on their own? What happens if I just leave them without treatment?

In approximately 30% of cases, the warts will resolve on their own within 4 months of infection[9], while 40-60% will resolve within 9-12 months. In some cases, the warts may persist for years without resolution.

The other possibility is that untreated warts continue to grow and cluster. [10]

The problem with genital warts is that they can recur after they have resolved, which can happen in about 25% of cases and can occur after a few weeks or a few years. Reports have been made of warts reoccurring after 23 years! [11]

How are genital warts removed?

There are generally 3 lines of treatment for genital warts.

First line treatment:

A cream containing a drug called podophyllotoxin is the most common treatment method. It is applied 3 days a week for 4 weeks and should be avoided during pregnancy.

Another cream used contains imiquimod, which comes in two concentrations: 3.75% or 5%. The 3.75% cream is applied twice a day for 2 weeks and then repeated after 2 weeks. The 5% cream is also applied 3 times a week, but can be used for up to 16 weeks

Skin irritation is a common side effect in both of these treatments

[adinserter block=”4″]

Second line treatment:

Other treatment modalities that will require a visit to the doctor include:

Cryotherapy

[12]Cold-inducing substances (such as liquid nitrogen, or carbon dioxide snow) are applied to the skin, and cause cold thermal damage or eliciting an immune response from the body. Usually, thick layers of keratin on the surface of the warts will be scrubbed away before applying cryotherapy. The freezing takes about 5-30s, and can be applied in pulses or a continuous application. Prolonged periods of over 25s of continuous freezing might leave a scar.

Cryotherapy may be repeated every 3 weeks, and show a cure rate or 30-70% after 3 months.

Electrocautery

[13]This procedure makes use of high-frequency electrical currents or thermal coagulation to destroy warts by burning or desiccation. The dead warts are then removed by a specialized surgical instrument called a curette (which resembles a long spoon). Electrocautery is most effective for smaller warts, but can leave scars if used to treat larger ones.

It is common to experience pain during and after the procedure, and local anaesthetics may be used to prevent that, or even general anaesthesia(though that carries a whole set of problems in, and of itself).

This technique should not be used on patients with any heart devices, implants, or pacemakers.

Photodynamic therapy

[14]A substance called aminolaevulinic acid is given topically or systemically (meaning through the bloodstream) to the patient and then activated with light to damage the wart tissue from the inside.

This treatment can be repeated, but may be painful

Laser

[15]Using lasers to remove warts results in cure rates between 32-75%. Some types of lasers (such as carbon dioxide laser) can cause scarring. Pain following the treatment has been reported, as well as a temporary loss of function of the area exposed to the laser.

Virus particles may become airborne when exposed to laser, and may cause re-infection. Masks and air extraction systems during the procedure can be used to reduce such risks.

Caustic substances (Trichloroacetic acid, 80-90%)

[16]This substance is an irritant that has proven effective, but may cause pain.

Surgery

[17]Though surgical excision is an option, it will almost always leave a scar in which recurrence is a higher risk.

Third line

[18]If the warts are too large – which can occur in patients with impaired immunity – then more aggressive treatment options should be resorted to.

Cytotoxic drugs (drugs that work by killing cells) such as interferon have been used by injection into the warts, or delivered through the bloodstream, often in combination with other treatment modalities.

When used alone, interferon has a 36-63% rate of success for genital warts.

How can I prevent genital warts from occurring in the first place?

There is a vaccine that works against HPV, and is very likely to prevent or at least reduce HPV wart infections. Countries such as Australia have adopted the use of vaccine and have seen improvement in the rates of infection of HPV subtypes 6, 11, 16 and 18, with a subsequent decrease in genital warts.[19]

[thrive_text_block color=”light”]Bottom Line: Genital warts are a sexually –transmitted disease that can affect other areas of the body. They are usually asymptomatic, and can resolve spontaneously within months or years, and may recur within weeks or years.

They can be treated through several modalities like topical creams, freezing, electrocautery, laser, and others. They can be prevented with a vaccine.[/thrive_text_block]

References:
[1] Badaracco G, Venuti A, Di Lonardo A, Scambia G, Mozzetti S, Benedetti Panici P, et al. Concurrent HPV infection in oral and genital mucosa. J Oral Pathol Med 1998;27 (3):130-134.
https://www.ncbi.nlm.nih.gov/pubmed/9563805/
[2] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.
[3] Aubin F, Pretet JL, Jacquard AC, et al. Human papillomavirus genotype distribution in external condylomata: a large French national study (EDiTH IV). Clin Infect Dis 2008;47:610–15. 229
Arima Y, Winer RL, Feng Q, et al. Development of genital warts after incident detection of human papillomavirus infection in young men. J Infect Dis 2010;202:1181–4. 230
Krzyzek RA, Watts SL, Anderson DL, et al. Anogenital warts contain several distinct species of human papillomavirus. J Virol 1980;36:236–44.
[4] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.55.
[5] https://www.healthline.com/health/healthy-sex/how-long-do-genital-warts-last#istreatment-necessary
[6] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.55.
[7] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.55.
[8] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.56, 25.57.
[9] Yanofsky VR, Patel RV, Goldenberg G. Genital Warts: A Comprehensive Review. The Journal of Clinical and Aesthetic Dermatology. 2012;5(6):25-36.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390234/
[10] https://www.healthline.com/health/healthy-sex/how-long-do-genital-warts-last#if-left-untreated
[11] Fairris GM, Statham BN, Waugh MA. The investigation of patients with genital warts. Br J Dermatol 1984;111:736–8.
[12] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.52, 25,58.
[13] https://www.medscape.com/viewarticle/806493_6
[14] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.53, 25.58.
[15] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.52, 25.58.
[16] Ibid
[17] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.53, 25.58.
[18] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.58.
[19] Ibid