Genital warts: what to tell your teenager

By Dr. Micaela Wexler
One wouldn’t expect a child psychiatrist to be writing about this, but it turns out a common source of severe anxiety for teenagers is discovery of a sexually transmitted infection. Genital warts is one such infection, which is poorly understood by teenagers. Once they have it, they hear just two things: 1) it’s forever; 2) it’s transmittable. In most cases, no one has ever sat down and had an in depth discussion with them about genital warts.

First, parents always want to know: HOW do you talk to your teenager about GENITAL WARTS?

Here’s a way I know of that has worked for parents. This is the phrase that you can use for just about anything:
“This may not ever happen to you, but I was reading an article about it, and I want you to be prepared if it does happen to you, or if it happens to anyone you know.”

Practice saying that to yourself, and then practice saying that phrase to your teenager. Start by using it for a topic that isn’t so sensitive, like, how to avoid being pick-pocketed. You can then segue to topics about health, like, how to treat a urinary tract infection, how to avoid constipation, all the way to talking about sex.

Once you’ve used it a few times on these less sensitive subjects, don’t waste your currency. Dive in and use it before it “expires.” You can say, “now that we’re on the topic of things I’ve read about, what do you know about genital warts?”

Here’s the skinny on genital warts.

Genital warts are warts that are located near or in the genital areas. In a female, that means on or near the vulva (the outside genital area), vagina, cervix, or anus. In a male, that means near or on the penis, scrotum, or anus. They look like bumps or growths. They can be flat or raised, single or many, small or large. They tend to be whitish or flesh colored. They do not cause pain. They do not drain or ooze.

Genital warts are caused by a type of virus, the Human Papilloma Virus (HPV). There are 100’s of types of HPV warts, and they infect multiple parts of the body. Some types of HPV cause plantar warts, which appear on the bottom of one’s foot. Other types infect the genital area, and a smaller subset of those can cause cancer.

Typically, a wart will show up between three weeks to six months after exposure. Sometimes warts can take even longer, up to years, to appear; the virus can live in the body for a very long time without causing any symptoms. This makes it difficult to know who gave you HPV.

Because warts are caused by a virus, they need to INCUBATE in order to cause a visual wart. In simple terms, what this means is that the virus needs to take over the cell’s genetic machinery, and then change those cells to become cells that look like warts. This takes time; it doesn’t happen in just a few days. And, while the virus is going through all the steps of creating a wart, our body’s immune system is fighting the virus at each step. So, if a person is healthy with a good immune system and living a stress free life, the body could potentially fight off HPV enough to keep a wart from appearing.
To better understand this, think about chicken pox, which is also caused by a virus which causes skin eruptions. The chicken pox virus is much stronger than the HPV virus: no matter how healthy and stress free you are, you’re going to get skin eruptions after being exposed (unless you have been vaccinated). Chicken pox requires at least 10 days to incubate and cause skin eruptions, ie, it takes at least that long after exposure to get the chicken pox rash.

How contagious are warts?

HPV transmission can be complicated. If you have a wart, or a lesion, then you are very contagious. For women, this can be a problem, because they could potentially have an eruption on a part of the body they can not see, like the vaginal canal, and not even know they have HPV. The male sexual partner could then get the virus on his penis, and then give that virus to another female, and SHE could get HPV. All of this could happen without anyone knowing anyone has HPV. This complicated transmission is a strong case for using condoms. However, condoms are not 100 per cent protective, because a male could have a virus on his scrotum and transmit it to a woman’s vulva.

How dangerous are genital warts?

Some types of HPV can cause cancer. In women, they can cause anal or cervical cancer. In men, they can cause penile cancer. For this reason, they should not be ignored. Because of the complicated transmission described above, ALL women are advised to get annual pap smears. (Pap is short for papilloma.) Men should examine their genital area on a regular basis, including the penis, the scrotum and the anal regions. If they see or feel a lesion, they should have it looked at by a doctor. Some physicians provide “anal pap smears” for people who have engaged in receptive anal sex.

How can genital warts be prevented?

The only 100 per cent way to prevent genital warts is to abstain from all sexual activity. For many people, especially married people, this is highly impractical. There are ways to reduce the risk of genital warts: 1) use condoms; 2) get the Gardisil vaccine; 3) know your sexual partner well enough to examine the genital area; 4) get annual pap smears; 4) let your partner know you have “tested positive in the past for HPV.”

The last one is important. Many teenagers will neglect to tell their partners out of fear that they will be ostracized, or accused of intentionally spreading STDs. However, saying “I have tested positive for HPV” is clinically no different than saying “I have genital warts,” but much easier to get out of your month. If teenagers are informed with the knowledge in this article, they can at least have the proper “ammo” to disclose this important information.

Click here for more information on genital warts.

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