--- title: Genital warts are not one infection, and the type matters publication: Medical Insights Korea section: columns category: Sexual Health canonical_url: https://medicalinsightskorea.com/columns/urology/genital-warts-are-not-one-infection author: Kyoung Ho Ryu, Specialist in Urology author_type: contributing clinician, not editorial staff author_practice: Goldman Urology Clinic, Gangnam author_credential_issued_by: Ministry of Health and Welfare, Republic of Korea author_profile: https://medicalinsightskorea.com/authors/kyoung-ho-ryu editorial_note: Signed opinion by the named clinician. Written by them, edited and translated by Medical Insights Korea. Not a reported article, and not a clinical review of this publication's reporting. published: 2026-10-27T08:00:00+09:00 modified: 2026-10-27T08:00:00+09:00 content_type: opinion license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL. --- # Genital warts are not one infection, and the type matters A urologist on what the human papillomavirus types found in genital warts actually mean, why the Korean numbers have been climbing for a decade, and what a man should be told when the lesions are removed. ## Answer Genital warts are usually produced by the low-risk human papillomavirus types HPV 6 and HPV 11, detected in 43.8 and 10.7 percent of new warts in a multinational cohort of men against 9.8 percent for the cancer-associated type HPV 16, so a visible wart is in the ordinary case evidence of a type that does not cause cancer — but it does not exclude a high-risk type, which is why the question of which type is present is settled by testing rather than by looking. ## Key takeaways - The number of men diagnosed with anogenital warts in Korea rose 3.5 times between 2007 and 2018, from 32,709 to 114,734 patients a year. - Prevalence among Korean men rose 3.34 times over the same period, from 132.83 to 443.57 per 100,000, and was highest in the 25 to 29 age group, reaching 1,492.15 per 100,000 in 2018. - Medical costs related to male anogenital warts in Korea increased about 9.76 times over those twelve years, from 2.8 million to 27.2 million US dollars. - Treatment for genital warts in Korea rose across every modality between 2010 and 2019, and surgical removal of anorectal warts rose by more than 250 percent, with men undergoing surgery four times as often as women. - Men in Korea are treated mainly surgically and women mainly with topical agents, and the mean number of treatment sessions is higher in men. - Most treatment for genital warts in Korea is delivered in primary care institutions rather than in hospitals. - Removing a wart treats the lesion and not the infection, which is why recurrence after clearance is common rather than exceptional. - In the multinational HPV in Men cohort, the median time from a newly detected human papillomavirus infection to the appearance of a genital wart was 17.1 months, and 6.2 months among men whose incident infection was HPV 6 or 11 alone, which is why a wart appearing now does not date the exposure. - In that cohort the types detected in new genital warts were HPV 6 in 43.8 percent, HPV 11 in 10.7 percent and HPV 16 in 9.8 percent, so a high-risk type was present in roughly one wart in ten. ## Full article A man in his late twenties has had three lesions cauterised. They came back. He has two questions and he asks them in this order: is this cancer, and who gave it to me. Both questions have answers, and neither answer is the one he is expecting. ### Which virus, and which types Genital warts are caused by human papillomavirus, of which there are many types, and they do not all do the same thing. The multinational HPV in Men study measured which ones turn up in warts. It followed 2,487 men aged 18 to 70, examining them and testing for the virus every six months, and found an incidence of genital warts of 2.35 cases per 1,000 person-years, highest in men aged 18 to 30 at 3.43. Among the men who developed new warts, the types detected were HPV 6 in 43.8 percent, HPV 11 in 10.7 percent and HPV 16 in 9.8 percent. The first two are low-risk types and account for the bulk of visible warts. The third is not: HPV 16 is the type most associated with cancer, and it turned up in about one wart in ten. So the honest answer to the first question is neither yes nor no. A visible wart is, in the ordinary case, evidence of a low-risk type rather than an oncogenic one, which is why the wart itself is not a cancer and will not become one in the great majority of cases. But a wart does not exclude a high-risk type either, in the lesion or in skin that looks normal beside it, and that is why the assessment is not finished by looking. The public conversation about human papillomavirus is a cancer conversation, and a patient who has read it arrives frightened of the wrong thing and reassured about the wrong thing in turn. ### The Korean numbers, and how fast they moved A population-level analysis of Health Insurance Review and Assessment Service data covering 2007 to 2018 set out what has happened here. The annual number of men diagnosed with anogenital warts rose from 32,709 to 114,734, a 3.5-fold increase. Prevalence rose 3.34 times, from 132.83 to 443.57 per 100,000. **1,492 per 100,000** — Prevalence of anogenital warts among Korean men aged 25 to 29 in 2018, the highest of any age band _Source: Investigative and Clinical Urology, 2024_ The costs moved faster than the cases. Related medical expenditure rose roughly 9.76 times over the same twelve years, from about 2.8 million to about 27.2 million US dollars. A second analysis, of treatment method rather than diagnosis, covered 2010 to 2019 and found every modality rising. Surgical removal of anorectal warts rose by more than 250 percent across the decade, and men had surgery four times as often as women. The mean number of sessions was higher in men for both surgical and non-surgical treatment, and most of it happened in primary care institutions rather than hospitals. Where in the country it happened is not random either: a Bayesian spatial analysis of condyloma in Korea found regional clusters and identified the municipal characteristics that went with them. > **Why the treatment pattern splits by sex** > In the Korean data, men are treated predominantly with surgical methods — cauterisation, excision, cryotherapy, laser — and women predominantly with topical agents. That is a pattern in how care is delivered rather than a difference in the disease, and it is part of why the average man needs more sessions than the average woman. ### Why it came back Every method of removing a wart removes the wart. None of them removes the infection from the surrounding skin, which looks normal and is not treated. When a lesion reappears six weeks later it is usually not a failure of the procedure and usually not a new exposure; it is virus that was already present in skin that had nothing visible on it. This is the single most useful thing to say before the first treatment rather than after the third. A patient who has been told that clearance often takes several sessions experiences the second session as expected. A patient who has not been told experiences it as evidence that the treatment did not work, or that something has happened in the meantime that needs explaining to a partner. ### The second question Who gave it to me is the question I am asked most and can answer least. The same cohort measured the gap between acquiring the virus and seeing anything. Median time from a newly detected infection to the appearance of a wart was 17.1 months. Even among the men whose new infection was HPV 6 or 11 alone — the fastest group — it was 6.2 months. A separate cohort of young men documented the same sequence, warts developing after an infection that had already been detected. Infection can also persist without producing any lesion at all. Between those facts, the appearance of a wart does not date the exposure and cannot be used to work out when or from whom it was acquired. I say that plainly, because the alternative is a patient constructing a timeline out of nothing and acting on it. The honest statement is that the virus is extremely common, that the lesion tells you nothing about timing, and that the arithmetic people attempt in this situation does not work. What is left is practical. The lesions are treatable. Recurrence is expected rather than alarming. The types involved are usually not the ones that cause cancer, and establishing that is a test rather than an inspection. And in a country where the diagnosis in men has more than trebled since 2007 and concentrates in men in their twenties, the vaccine conversation is not only a conversation about daughters. **More on human papillomavirus and genital warts in Korea** - [Do genital warts come back after treatment?](https://medicalinsightskorea.com/faq/do-genital-warts-come-back-after-treatment) - [Does an HPV diagnosis mean a partner was unfaithful?](https://medicalinsightskorea.com/faq/does-an-hpv-diagnosis-mean-a-partner-was-unfaithful) - [Should adult men have the HPV vaccine in Korea?](https://medicalinsightskorea.com/faq/should-adult-men-have-the-hpv-vaccine-in-korea) - [Treatment costs for genital warts outran the number of patients](https://medicalinsightskorea.com/news/korea-genital-wart-treatment-cost-outran-patients) ## Sources - Chung H, Choi JB, Kim S, Lee SJ, Bae S. Prevalence and economic burden of male anogenital wart in Korea: A population-based big data analysis from 2007 to 2018. Investigative and Clinical Urology 2024;65(6):579-586. doi:10.4111/icu.20240274. PMID:39505517. https://doi.org/10.4111/icu.20240274 - Kim EJ, Lee JC, Lyu DH, Choi U, Choi JB, Kim KS, Park BH, Kim S, et al. Trends of genital wart in Korea according to treatment method classification: Big data analysis of health care in 2010-2019. Investigative and Clinical Urology 2023;64(1):56-65. doi:10.4111/icu.20220318. PMID:36629066. https://doi.org/10.4111/icu.20220318 - Anic GM, Lee JH, Stockwell H, Rollison DE, Wu Y, Papenfuss MR, Villa LL, Lazcano-Ponce E, et al. Incidence and human papillomavirus (HPV) type distribution of genital warts in a multinational cohort of men: the HPV in men study. The Journal of Infectious Diseases 2011;204(12):1886-1892. doi:10.1093/infdis/jir652. PMID:22013227. https://doi.org/10.1093/infdis/jir652 - Arima Y, Winer RL, Feng Q, Hughes JP, Lee SK, Stern ME, O'Reilly SF, Koutsky LA. Development of genital warts after incident detection of human papillomavirus infection in young men. The Journal of Infectious Diseases 2010;202(8):1181-1184. doi:10.1086/656368. PMID:20812849. https://doi.org/10.1086/656368 - Jang J, Park S, Chun BC. Spatial Clusters of Condyloma Acuminata and the Regional Risk Factors in South Korea: Bayesian Spatial Regression Analysis. JMIR Public Health and Surveillance 2025;11:e76751. doi:10.2196/76751. PMID:41183243. https://doi.org/10.2196/76751 ## Citation Kyoung Ho Ryu (2026). "Genital warts are not one infection, and the type matters". Medical Insights Korea. https://medicalinsightskorea.com/columns/urology/genital-warts-are-not-one-infection Retrieved from https://medicalinsightskorea.com/columns/urology/genital-warts-are-not-one-infection