Genital warts and HPV: treatment, recurrence and vaccine in Taichung

In short

• Having only one sexual partner does not rule out HPV. The infection often causes no symptoms at all.
• You cannot tell who gave it to you, or when. Warts may appear months or years after infection.
• Treatment removes visible warts, not the virus. Warts come back in some people, most often in the first three months. That is not a failed treatment.
• Diagnosis is made by examination, not by an HPV test.
• The 9-valent HPV vaccine is prevention, not treatment.

What HPV is, and what a genital wart is

Human papillomavirus (HPV) is a family of more than 200 types. It infects the skin and the mucous membranes — the moist surfaces of the genitals, anus and mouth. It does not enter the blood.

Low-risk types, mainly 6 and 11, cause about nine out of ten genital warts (condylomata acuminata) and do not cause cancer. High-risk types such as 16, 18, 31 and 33 usually cause no symptoms, but are linked to cancer of the cervix, penis, vagina, vulva, anus and oropharynx (the back of the mouth and throat). Types 16 and 18 alone cause more than seventy per cent of cervical cancer.

Most HPV infections clear by themselves, and only an infection that persists produces a lesion. But having had HPV once does not protect you later. A review in women found that natural infection does not always produce antibodies, and the US CDC notes that HPV can still be present after the warts have gone.

One partner is enough, and the timing tells you nothing

• The incubation period varies a great deal. That is the time between infection and the first visible wart. The 2019 IUSTI guideline records a median of about 2.9 months in women and 11.0 months in men.
• So the date a wart appears tells you nothing about the date of infection. The US CDC 2021 guidelines state that the time of infection cannot be determined, that it is not possible to tell which partner was infected first, and that having HPV does not mean either person had sex outside the relationship.
• HPV can be passed on when nothing is visible, so appearance does not tell you who is infectious.

Was it the hot spring? There is no evidence for that. The routes listed by the US CDC are contact with the anal and genital area, mainly during vaginal and anal sex, and also oral sex and genital contact without penetration. Hot springs, pools and toilet seats are not on that list.

Warts appear where skin is rubbed during sex: the coronal sulcus (the groove behind the head of the penis), the inner foreskin, the shaft, and around the anus. The IUSTI guideline records that warts around the anus are common in both sexes, and can appear in people who have never had anal sex.

Is it a wart? Three lookalikes that need no treatment

• Pearly penile papules: smooth, 1 to 4 mm, in a regular ring around the corona of the glans (the rim of the head of the penis). They stay the same and are not infectious.
• Fordyce spots: white to yellow, slightly raised, 1 to 5 mm. Most common on the lips and inside the mouth; on the genitals, on the penis and vulva. A normal variation.
• Molluscum contagiosum: skin-coloured papules 2 to 5 mm with a dimple in the centre. Infectious until it clears.

Genital warts, by contrast, may grow bigger, increase in number, or appear at new sites. A doctor must also exclude the flat lesions of secondary syphilis, which need a blood test.

Please do not test yourself with vinegar. The US CDC records that routine use of acetic acid is not recommended, and that the result does not change what is done next. The standard is an examination in good light of the external genital area, the skin around the anus, and the opening of the urethra.

Reasons to be assessed sooner

• The lesion bleeds, turns into an ulcer, or feels hard and fixed to the tissue underneath; it grows quickly; or treatment has produced no response. Guidelines list all of these as reasons for a biopsy.
• It is at the opening of the urethra, at or inside the anus, or at the opening of the vagina — sites managed differently, with referral where needed.
• Reduced immunity (HIV infection with a low CD4 count, after a transplant, or medicines that suppress the immune system). Lesions can be more widespread and harder to treat.
• Pregnancy or breastfeeding. The BASHH 2024 guideline records that no self-applied topical medicine is licensed then, while cryotherapy, laser, electrosurgery and excision are.

Treatment: what it can and cannot do

The US CDC 2021 guidelines state the limit in one sentence: available therapies for anogenital warts might reduce, but probably do not eradicate, HPV infectivity. Every option below removes the visible lesion; none clears the virus. This page does not rank them, because the CDC states there is no definitive evidence that one recommended treatment is superior to another.

Neither cream is an acid. Warts around the anus are inside the approved indication; warts inside the anus are not. Both creams may weaken condoms and diaphragms. The BASHH 2024 guideline advises a review at eight weeks, and another method if the wart volume has fallen by less than half.

Pathology comes first when laser treatment is arranged. At this clinic a specimen is taken and sent for pathology before the remaining lesions are treated, and the report takes about seven days. The order cannot be reversed, because laser vaporisation leaves no tissue to examine.

Three things not to do. Do not cut or shave the lesion off yourself. Do not use an over-the-counter wart remover, whose label states it is not for genital warts, or a wart pen or home freezing spray, which have no safety or efficacy data for anogenital warts. And do not simply wait without being examined: guidelines accept waiting for a lesion to clear by itself, but only after the diagnosis is confirmed.

Warts coming back is part of the illness

The 2019 IUSTI guideline states that recurrence occurs after all therapies, that rates commonly fall between 20 and 30 per cent, and that the rate is higher when people are followed for longer. The BASHH 2024 guideline states there is not enough evidence to show which treatment lowers it, and the US CDC records that recurrence is common in the first three months.

Skin that looks normal at the time of treatment may already be infected. That is also why normal-looking skin around a wart is not treated as well: it adds wounds and scarring without preventing later lesions. The BASHH 2024 guideline states that people whose warts have completely resolved do not need routine follow-up.

The warts themselves are benign: the IUSTI 2019 guideline states that anogenital warts by definition do not become malignant. The same guideline cautions that a precancerous or cancerous lesion can sit beside a wart or develop inside one, which is why the warning signs listed above lead to a biopsy.

No medicine "boosts immunity" to clear HPV faster. The US CDC states that subclinical HPV infection usually clears on its own, and that antiviral therapy is not recommended. Three measures do have guideline support.

• Vaccination, where a doctor assesses it as suitable — it acts on the types you have not yet acquired.
• Condoms until the warts have cleared. The IUSTI 2019 guideline gives this as a 1A recommendation, and states that condoms give only partial protection: the scrotum, groin, base of the penis and area around the anus can still make contact.
• Stopping smoking. The same guideline records a dose-related link between smoking and both a higher risk of genital warts and the persistence of HPV infection.

The 9-valent HPV vaccine: what the Taiwan label covers

In Taiwan the 9-valent HPV vaccine is approved for people aged 9 to 45. This follows the product information approved in Taiwan. It is often summed up as "it prevents HPV-related cancers in men and women aged 9 to 45", but the label sets out where prevention has been shown, by age and by sex.

• Men and women aged 9 to 45: genital warts caused by types 6 and 11 — the condition this page is about.
• Men aged 9 to 26: anal cancer caused by types 16 and 18, and grade 2 and 3 anal intraepithelial neoplasia (AIN 2/3, a precancerous change) caused by types 6, 11, 16 and 18.
• Women: cervical, vulval and vaginal precancerous changes and cancer at ages 9 to 26; at ages 27 to 45, only grade 1 cervical intraepithelial neoplasia (CIN 1).

So for a man over 30, the honest statement is this. For genital warts there is a basis in the product information. For anal cancer and AIN, no effect data are listed for his age group. That does not mean it fails to work, but we will not add what the label does not say.

Contraindications. It should not be given after a severe allergic reaction to any component, including yeast, or to an earlier dose of the 9-valent or 4-valent vaccine. It is not advised during pregnancy, and care is needed with a low platelet count or a bleeding disorder. The number of doses depends on your age.

Adverse reactions listed on the label are injection-site reactions, fever, nausea, headache and fainting. Because a faint can cause a fall and injury, the label advises being vaccinated while seated, and staying for 15 minutes of observation afterwards.

Four limits stated on the label: it does not replace cervical cancer screening; people advised to have anal cancer screening should not stop after vaccination; for a type already acquired, protection has not been shown; and it is not for treating existing lesions.

In Taiwan the publicly funded HPV vaccination programme covers junior high school students only; adults and visitors pay for the vaccine themselves.

Should you still have it if you already have warts? The BASHH 2024 guideline advises that eligible people be offered vaccination whether or not they have warts, because it reduces HPV-related anogenital intraepithelial neoplasia and invasive cancer. But it also states that trials show no therapeutic benefit in people who already have warts, and a 2022 meta-analysis found no difference in recurrence (odds ratio 1.04, 95% confidence interval 0.65 to 1.65).

Your visit: what happens, and what to bring

1. Book through the online form, through LINE, or by telephone. LINE covers the visit process only, not diagnosis. Please do not send photographs of the genital area.
2. Registration. Please bring your passport or resident certificate; it is needed to create the medical record. If you are not enrolled in Taiwan’s National Health Insurance, the consultation and tests are self-paid.
3. The diagnosis is settled first, by examining the external genital area, the skin around the anus and the opening of the urethra, in a private consulting room.
4. Then treatment is decided. Same-day treatment is sometimes possible, but not automatic; a first visit can be an assessment only. Costs are explained at the consultation.
5. Other tests. The US CDC notes that testing for other sexually transmitted infections is useful for people who have warts.

Useful to bring: when you first noticed the lesion, any previous treatment, and a list of the medicines you take now.

Common questions

Related pages

• The 9-valent HPV vaccine for men and women
• Sexually transmitted infection screening: what is tested, and when
• HPV self-sampling for women

Appointments and access

Consultations are conducted in Mandarin, and can also be conducted in English.

昭安泌尿科診所 (Morning Urology Clinic)
No. 98, Boguan 2nd St., West District, Taichung City 403, Taiwan（403 臺中市西區博館二街98號）
Consulting hours: Monday to Saturday (closed Sunday). Online booking is open 24 hours.

This page was produced by 昭安泌尿科診所 (Morning Urology Clinic). Medical content last updated: August 2026 (same as the Traditional Chinese version). English version published: 4 September 2026. Medically reviewed by Dr. Chao-An Chen, urologist.

Sources: US CDC, STI Treatment Guidelines, 2021, Anogenital Warts / IUSTI, 2019 European Guideline for Anogenital Warts / BASHH, UK national guideline for anogenital warts (2024) / Taiwan FDA product information database. Indications, contraindications, dosing and adverse reactions follow the Chinese-language product information approved by the Ministry of Health and Welfare.

This page provides general medical information and does not replace an individual diagnosis or treatment plan. Please confirm anything that concerns your own symptoms or test results at a face-to-face consultation.