Have you ever had genital warts? If so — whether or not you noticed them or knew what they were — there’s a good chance that they will return.

Genital warts are caused by the human papillomavirus (HPV) — primarily by two HPV strains called type 6 and type 11, according to Shobha S. Krishnan, MD, author of The HPV Vaccine Controversy. There are actually more than 100 different strains of HPV, several of which cause cervical cancer — but the strains that cause warts are not the same as those linked to cancer.

The virus is transmitted primarily via sexual contact or skin-to-skin contact… and this can occur even when the infected partner has no sign of warts. Dr. Krishnan explained that risk of contagion is elevated among people who have multiple sex partners, unprotected sex or impaired immunity (for instance, due to stress, cigarette smoking, poor eating habits, lack of sleep or chronic illness). Typically warts appear six weeks to nine months after sexual contact with an infected partner, but it can take much longer — so you may not know exactly when you got infected or by whom.

Recognizing the symptoms. Typically genital warts are small, soft, fleshy bumps or groups of bumps in the genital area. In some cases, they are painless, tiny, few in number and easily overlooked. In other cases, they are quite clearly visible and/or cause noticeable irritation, itching or bleeding. Genital warts can appear on a woman’s vulva (external genitals), vaginal walls and cervix… on a man’s penis and scrotum… and, in either gender, on or near the anus and in the mouth or throat from oral sex.

If you suspect that you have genital warts, see your doctor. Diagnosis is based on a visual examination. Two-thirds of patients diagnosed with genital warts are women.

To treat or not to treat? In up to 30% of cases, genital warts go away on their own without treatment, typically within four months — so talk to your doctor about whether a wait-and-see approach is appropriate for you. According to Dr. Krishnan, the decision about whether or not to treat genital warts is best made on a case-by-case basis after discussion between a patient and her doctor. Note: Even when warts do go away without treatment, there is no test that can reveal whether the immune system has completely gotten rid of the virus or whether the virus is still lying dormant in the body.

Treatment options. Many people choose to treat genital warts, especially if the growths are increasing in size or number and/or causing physical discomfort or emotional distress. But it is important to realize that, while treatment can get rid of the existing warts, it does not get rid of the virus itself — so warts may and often do reappear. It is not known whether treating the warts reduces the risk of passing the virus on to a sex partner.

The choice of treatment depends in part on the number, size and location of the warts. Talk to your doctor about the pros and cons of various therapies. According to Dr. Krishnan, options include a botanical ointment made from green tea extract which has antiviral properties… topical antiviral medication, such as podofilox (Condylox)… or in-office procedures such as cryotherapy (freezing) or laser therapy.

Prevention strategies. Unless you are celibate or in a mutually monogamous relationship with an uninfected person, it is best to use condoms consistently to reduce (but not eliminate) your risk for HPV contagion. Also, Dr. Krishnan recommended talking to your doctor about the benefits and risks of the Gardasil vaccine, which protects against HPV types 6 and 11 (as well as two other HPV strains linked to cervical cancer). Gardasil is FDA-approved for females and males age nine to 26, but it can be given to older women and men.