Do anal warts go away without treatment?

Not reliably, based on the best available trial. Only a small share of untreated participants cleared their warts in six months, while most people who received treatment cleared theirs.

Are anal warts always caused by HPV, and can they go away on their own?

Yes, anal warts are caused by HPV, usually types 6 or 11. A small number of cases clear on their own within months in trial data, though lower-quality studies suggest clearance over longer periods of a few years is more common, those studies are less reliable.

Do anal warts go away naturally over time?

Possibly, over a longer time frame than has been well studied. No well-controlled trial followed people for years, so how often warts clear up on their own after the first few months is genuinely unknown.

Should I just wait instead of getting treatment?

Based on the trial evidence, waiting alone cleared far fewer people (8%) than active treatment (about 70%) over six months. It's reasonable to get warts checked and treated rather than relying on them disappearing by themselves.

Do anal warts go away on their own?

Name: Do anal warts go away on their own?
Published: 2026-10-13
Keywords: do anal warts go away, do anal warts go away on their own, are anal warts always hpv can they go away on their own, do anal warts go away without treatment, do anal warts go away naturally

In patients with anogenital (anal) warts caused by HPV, what proportion experience spontaneous resolution without treatment, and over what time frame, compared with those who receive treatment?

How people search for this, in their own words

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Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

Bottom line

In the best-designed trial, most anal and genital warts did not clear up on their own within six months.

In a randomised trial of 203 people with widespread anogenital warts left untreated as a control group, only 8% cleared their warts within six months, compared with about 70% who received active treatment such as interferon or heat treatment (diathermocoagulation). A second small trial found that none of its untreated control patients cleared warts within six weeks. Lower-quality reviews and small case series report much higher spontaneous clearance, sometimes over several years, but these studies did not have proper untreated comparison groups.

How certain

Moderate

One well-conducted randomised trial addresses this question directly.

What it shows

No meaningful benefit

Most of the evidence found no meaningful difference.

studies found: 75studies found
randomised trials: 4randomised trials
people studied: 85,368people studied
reviews of trials: 3reviews of trials
years covered: 1979–2026years covered

What the research shows

Proportion with spontaneous clearance
In the one randomised trial with an untreated control group, only 8% of people cleared their warts within six months without treatment [68]. Another small trial found none of its untreated controls had natural remission within six weeks [52]. Smaller, lower-quality studies and case series report a wide range, from about 1 in 5 up to more than half, usually over much longer follow-up [44,56,58,18,62].[1,2,3,4,5,6,7]
No improvement shown
Time to spontaneous resolution
No well-controlled study tracked exactly how long it takes untreated anal warts to clear. A review mentions a time frame of two to five years, but gives no original data or patient numbers to back this up [18].[1]
Insufficient evidence
Recurrence rate after spontaneous clearance
One small trial followed 15 people with anal warts left untreated for about a year; none of them had their warts clear on their own, so there is no evidence from these studies on how often warts come back after spontaneous clearance.[1]
Not studied
Progression or persistence of lesions
Case reports describe rare, severe warts (giant Buschke-Löwenstein tumours) that grew instead of resolving and occasionally became cancerous, but these are extreme, atypical cases rather than ordinary anal warts [10].[1]
Insufficient evidence
Rate of clearance with treatment vs no treatment
In the randomised trial, about 70% of people given active treatment (interferon or heat treatment) cleared their warts within six months, compared with 8% of untreated controls [68].[1]
Improvement shown

What it may help with

A minority of anal and genital warts do clear up without any treatment, so spontaneous resolution does happen, just not for most people in the short term studied.[1,2]

Important limitations

The main trial's abstract does not report how long patients were followed after the initial outcome assessment, so it cannot say what happens to warts that are still present afterward, including whether they ever clear later on their own.[1]
Most studies reporting higher rates of spontaneous clearance are small case series or narrative reviews without an untreated comparison group, so they cannot reliably tell true spontaneous resolution apart from treatment effects, misdiagnosis, or recall.[1,2,3,4,5]
Several of the available studies looked at children, pregnant women, or people with HIV, whose immune status or circumstances may differ from most adults with anal warts, limiting how well the findings generalise.[1,2,3,4]

What the studies found

Found a benefit16 · 21%
Found no clear effect2 · 3%
Mixed or unclear55 · 73%
Found possible harm2 · 3%

What kind of studies

Narrative review30 · 40%
Prospective cohort16 · 21%
Case series9 · 12%
Laboratory study8 · 11%
Randomised trial4 · 5%
Retrospective3 · 4%
Meta-analysis2 · 3%
Guideline2 · 3%
Systematic review1 · 1%

The studies that decided it

Schneede et al. 2013
[Proven and new methods in the treatment of genital warts]
Often clear up within years.Narrative reviewLow quality
size not given2-5 years
warts often go away on their own within 2-5 years, but some persist despite treatment
Who was studied
people with anogenital (genital) warts
What they received
no treatment / natural course of infection
Compared with
active treatment options for genital warts
Main outcome
whether warts go away on their own (spontaneous regression)
Quality
this is a narrative review/opinion article without original study data or numbers to check.
Limitations
no study design, sample size, or methodology described; appears to be a general review article citing prior observations.
Taken word for word from the abstract
- population Anogenital warts are the most common clinical manifestation of human papillomavirus (HPV) infections
- primaryOutcome Spontaneous regression of genital warts has been observed mostly within 2-5 years
- result Spontaneous regression of genital warts has been observed mostly within 2-5 years; however, persisting condylomata may prove refractory to all current treatment options.
- intervention Spontaneous regression of genital warts
- comparator treatment of genital warts can often be of long duration, of varying effectiveness and with high recurrence rates
- followUp within 2-5 years
Urologe A · PMID 24026888 · Read it on PubMed ↗
Allen et al. 1998
The natural history of condyloma in children
Warts often go away alone.RetrospectiveLow qualityRelated question
41 people5 years
more than half resolved spontaneously, including most untreated children
Who was studied
children with anal/genital warts (condyloma)
What they received
no treatment (observation)
Compared with
treatment for warts
Main outcome
whether warts went away over time
Quality
this was a small retrospective review of children without a control group or randomization, so results may not be reliable or generalizable.
Limitations
retrospective design, small sample, mix of treated and untreated subjects, and it studied children rather than adults with anal warts.
Taken word for word from the abstract
- n 41 qualified for further retrospective or prospective evaluation
- population children with condyloma
- intervention 6 of 8 (75%) who never received treatment
- comparator 16 of 33 (49%) in whom treatment failed
- primaryOutcome to determine the natural history
- result Spontaneous resolution occurred within 5 years in 22 of 41 subjects (54%)
J Am Acad Dermatol · PMID 9843007 · Read it on PubMed ↗
Handsfield 1997
Clinical presentation and natural course of anogenital warts
Most untreated warts go away eventually.Narrative reviewLow quality
size not given1997
most untreated warts eventually go away on their own, though the virus likely stays latent
Who was studied
people with anogenital warts (HPV infection)
What they received
no treatment (observed natural course)
Compared with
none
Main outcome
whether genital warts resolve over time
Quality
this is a narrative review describing general natural history without specific study data, numbers, or follow-up times.
Limitations
no patient numbers, no study design details, no quantified timeframes given
Taken word for word from the abstract
- population The natural history of human papillomavirus (HPV) genital tract lesions is complex
- intervention Most untreated genital tract lesions eventually resolve spontaneously
- result Most untreated genital tract lesions eventually resolve spontaneously, but it is likely that latent or subclinical infection persists indefinitely.
- primaryOutcome Most untreated genital tract lesions eventually resolve spontaneously
- comparator Most untreated genital tract lesions eventually resolve spontaneously
Am J Med · PMID 9217658 · Read it on PubMed ↗
Usman et al. 1996
Autoimplantation technique in the treatment of anogenital warts: a clinico-immunological study
No natural remission without treatment.Randomised trialLow quality
115 people1 year
70% cured with podophyllin vs 44% cured with autoimplantation after 6 weeks; none of the untreated controls had natural remission; all cured podophyllin cases recurred within a year while none of the autoimplantation cases recurred
Who was studied
patients with anogenital warts, including a group left untreated as controls
What they received
autoimplantation technique for wart removal
Compared with
podophyllin treatment and an untreated control group
Main outcome
rate of clinical cure at 6 weeks and recurrence of warts after 1 year
Quality
Small group sizes, short-term cure assessment, and no clear description of blinding limit confidence in the results.
Limitations
Small sample sizes (50, 50, and 15 per group), unclear blinding, and limited follow-up details reduce reliability.
Taken word for word from the abstract
- n 50 cases of anogenital warts
- n a matched group of 50 patients
- n 15 untreated subjects in a control group
- population 50 cases of anogenital warts
- population 15 untreated subjects in a control group
- intervention An autoimplantation technique was adopted in the treatment of 50 cases of anogenital warts
- comparator compared with the conventionally used podophyllin regimen in a matched group of 50 patients
- comparator 15 untreated subjects in a control group
- primaryOutcome rate of clinical cure after 6 weeks, recurrence after 1 year follow up
- result In the podophyllin group, 70% of patients were cured after 6 weeks while in autoimplantation, only 44% of patients were cured, and none in the control group had natural remission of warts without any treatment.
- result After 1 year all the cured cases (100%) that completed follow up had recurrence of warts with podophyllin treatment, while none had recurrence of lesions in the autoimplantation group.
Int J STD AIDS · PMID 8652714 · Read it on PubMed ↗
Coleman et al. 1994
Immunological events in regressing genital warts
About a fifth cleared on their own.Case seriesLow qualityRelated question
125 people1994
28 of 125 patients had their warts regress on their own, and regressing warts showed stronger immune cell activity than ones that did not regress
Who was studied
people with genital warts
What they received
no treatment described, warts monitored over time
Compared with
nonregressing warts in the same group
Main outcome
whether genital warts went away on their own and immune changes during that process
Quality
This was an observational case series without a control group or randomization, focused mainly on immune cell biology rather than directly testing whether warts clear up.
Limitations
No control group, small subset (14 vs 14) used for detailed immune comparisons, and the population was genital warts in general rather than anal warts specifically.
Taken word for word from the abstract
- n The authors have studied 125 closely monitored patients with genital warts.
- population patients with genital warts
- intervention The authors have studied 125 closely monitored patients with genital warts.
- comparator Regressing warts (n = 14) contained significantly more T lymphocytes (P < .05, Wilcoxon rank sum test) and macrophages (P < .01) than did nonregressing controls (n = 14).
- primaryOutcome wart regression was seen in 28 patients
- result Of these 125 patients, wart regression was seen in 28 patients.
Am J Clin Pathol · PMID 7801889 · Read it on PubMed ↗
Handley et al. 1993
Anogenital warts in prepubertal children; sexual abuse or not?
Some warts cleared on their own.Prospective cohortLow qualityRelated question
42 peoplemean 15.9 months, SD 12.24
about 1 in 5 children had warts clear up on their own without treatment
Who was studied
young children with anal/genital warts
What they received
no treatment (natural course)
Compared with
surgical treatment (excision and electrocautery)
Main outcome
whether warts went away or recurred
Quality
small number of children, not randomized, and mainly focused on how the warts were caught rather than testing treatments.
Limitations
Small sample, not a controlled comparison of treatment vs no treatment, mean follow-up varied widely, and main focus was transmission not natural resolution.
Taken word for word from the abstract
- n Forty-two prepubertal children presenting with anogenital (AG) warts
- population Forty-two prepubertal children presenting with anogenital (AG) warts (15 boys and 27 girls)
- intervention Spontaneous resolution of AG warts was seen in 9 (21.4%) children.
- comparator Thirty-one children had their warts treated with a combination of scissor excision and electrocautery under general anaesthesia.
- primaryOutcome Warts recurred in 10 (31.4%) of these children all within 4 months following treatment.
- result Spontaneous resolution of AG warts was seen in 9 (21.4%) children.
- followUp mean 15.9 months, SD 12.24
Int J STD AIDS · PMID 8218514 · Read it on PubMed ↗
Handley et al. 1992
Ten year follow-up study of women presenting to a genitourinary medicine clinic with anogenital warts
Most warts resolved by 10 yearsRetrospectiveLow qualityRelated question
100 people10 years
At 10 years, 4 of 100 women still had anogenital warts; CIN was found in 36.8% of women who had cervical treatment versus 43.2% of those who had none, a difference that was not statistically significant
Who was studied
women who had anogenital warts in 1979, followed up 10 years later
What they received
cervical treatment for CIN (laser ablation and/or cone biopsy)
Compared with
no cervical treatment for CIN
Main outcome
presence of cervical intraepithelial neoplasia (CIN) at 10-year follow-up, and persistence of anogenital warts
Quality
This was a small, non-randomized retrospective follow-up comparing treated and untreated subgroups, not a controlled trial.
Limitations
Retrospective design, no randomization, small treated subgroup (19 women), and loss-to-follow-up details not given.
Taken word for word from the abstract
- n One hundred heterosexual women presenting at our clinic in 1979 with anogenital warts, were reviewed 10 years later.
- population One hundred heterosexual women presenting at our clinic in 1979 with anogenital warts, were reviewed 10 years later.
- intervention 7 laser ablation, 9 cone biopsy, 2 laser ablation and cone biopsy, and one woman laser ablation, cauterization and cone biopsy
- comparator 35/81 (43.2%) of women having no cervical treatment within this period
- primaryOutcome In 1989 CIN was detected in 7/19 (36.8%) of women who had undergone cervical treatment between 1979 and 1989, and in 35/81 (43.2%) of women having no cervical treatment within this period
- result At 10-year follow-up in 1989 4/100 women had anogenital warts
- result (chi squared P greater than 0.5)
- followUp reviewed 10 years later
Int J STD AIDS · PMID 1543764 · Read it on PubMed ↗
Benedetti Panici et al. 1989
Randomized clinical trial comparing systemic interferon with diathermocoagulation in primary multiple and widespread anogenital condyloma
Rarely clear up untreated.Randomised trialModerate quality
203 people6 months
8% of untreated control patients cleared warts, versus 70% overall response with active treatments
Who was studied
patients with untreated multiple and widespread genital/anal warts
What they received
systemic interferon alpha-2b (two dosing schedules)
Compared with
diathermocoagulation (heat/cautery treatment) or no treatment (control)
Main outcome
complete or partial clearance of warts after 6 months
Quality
it was a randomized trial with a no-treatment control group, but it was not designed primarily to study natural resolution and had small subgroup numbers.
Limitations
abstract text is truncated and focuses mainly on comparing interferon versus cauterization rather than detailing the untreated group's outcomes
Taken word for word from the abstract
- population patients (median age 26 years; range 18-45) with untreated multiple and widespread anogenital condyloma
- intervention recombinant interferon alpha-2b
- comparator diathermocoagulation
- comparator 48 were not treated and were used as a control group
- primaryOutcome the overall response rate (complete and partial responses) was 70%
- result 8% for the control group
- n Two hundred three patients
Obstet Gynecol · PMID 2761917 · Read it on PubMed ↗

All 75 studiesEvery study that answered the question, with its design, size and result.

The other 67 studiesEverything else the search returned, including anything retracted.

Qi et al. 2026
The Natural History of Human Papillomavirus (HPV) Infection in Males: Global Evidence From a Systematic Review and Meta-Analysis
Anal HPV often clears, but warts may return.Meta-analysisModerate qualityRelated question
68,477 people2026
Anal HPV cleared at 65.14 per 1000 person-months, but the recurrence rate of anogenital warts was 50%
Who was studied
males infected with HPV (various ages, including men who have sex with men and people living with HIV)
What they received
no treatment; natural course of HPV infection over time
Compared with
different anatomical sites (oral, anal, genital) and risk groups (e.g., MSM vs heterosexual, HIV-positive vs HIV-negative)
Main outcome
rates of HPV clearance, persistence, recurrence, progression and transmission
Quality
It pools many observational studies with high heterogeneity and no control group, so it shows patterns but can't prove cause and effect.
Limitations
Considerable heterogeneity across behavioural, immunological, anatomical, and virological factors; abstract does not separate warts specifically from overall HPV infection clearance.
Taken word for word from the abstract
- n A total of 89 studies involving 68,477 males were included.
- population A total of 89 studies involving 68,477 males were included.
- intervention A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 statement.
- comparator followed by the anal (65.14 per 1000 person-months, 95% CI: 49.04-83.52) and genital sites (89.40 per 1000 person-months, 95% CI: 66.52-116.99).
- primaryOutcome Meta-analyses were conducted to estimate pooled rates of HPV clearance, persistence, recurrence, progression and transmission.
- result The overall recurrence rate of anogenital warts was 50.00% (95% CI: 39.00%-60.00%).
Rev Med Virol · PMID 42198950 · Read it on PubMed ↗
Hewitt et al. 2024
Risk of developing high-grade squamous intraepithelial lesions or anal cancer after anal condylomata treatment in people living with HIV
Disease can progress even after treatment.RetrospectiveLow qualityRelated question
118 people9.3 years
31% of patients developed advanced anal disease, with risk linked to perianal location, longer time since diagnosis, and lower CD4/CD8 ratio; recurrence and treatment type were not linked to this risk
Who was studied
people living with HIV who had anal warts (condyloma)
What they received
anal condyloma treatment (various treatment modalities)
Compared with
patients who did not progress to advanced anal disease (non-AAD)
Main outcome
developing advanced anal disease (high-grade lesions or anal cancer) after condyloma diagnosis
Quality
This is a single-centre retrospective study without a comparison group of untreated patients, so it cannot show whether warts resolve on their own.
Limitations
Retrospective, single-centre design; no untreated comparison group; studies only HIV-positive patients who received treatment for condyloma.
Taken word for word from the abstract
- population This was a single-centre retrospective cohort study of PLWH and anal condyloma from 2001 to 2021.
- intervention We assessed the potential association between AAD and condyloma location, recurrence, and treatment modality.
- comparator Patients who developed advanced anal disease (AAD; anal high-grade squamous intraepithelial lesions and/or anal cancer) were compared to those who did not progress (non-AAD).
- primaryOutcome To assess the risk and natural history of developing advanced anal disease after diagnosis of anal condyloma in people living with HIV (PLWH).
- result A total of 31% of patients developed AAD (n = 37).
- result Condyloma recurrence and treatment type were not associated with development of AAD.
- n A total of 118 PLWH and anal condyloma were included.
- followUp Mean overall follow-up time was 9.3 years.
Colorectal Dis · PMID 39099077 · Read it on PubMed ↗
Wolf et al. 2024
Human papillomavirus infection: Epidemiology, biology, host interactions, cancer development, prevention, and therapeutics
Doesn't answer this question.Narrative reviewVery low qualityRelated question
size not given2024
the abstract does not state whether anal/genital warts resolve on their own
Who was studied
people with HPV infection, including genital and anal warts
What they received
no specific intervention tested; general review of HPV disease
Compared with
none reported
Main outcome
not a specific measured outcome; review covers epidemiology, biology, cancer risk, prevention and treatment of HPV
Quality
this is a broad narrative literature review that never actually studies or reports on whether warts clear without treatment, so it can't answer the question.
Limitations
abstract does not report any original data, follow-up, or specific findings about natural resolution of warts
Taken word for word from the abstract
- population Low-risk HPV types, such as HPV-6 and HPV-11, are not typically associated with cancer but can cause benign conditions like genital warts.
- intervention This study aimed to carry out a literature review considering several aspects involving HPV infection
- primaryOutcome Global distribution, prevalence, biology, host interactions, cancer development, prevention, therapeutics, coinfection with other viruses, coinfection with bacteria, association with head and neck squamous cell carcinomas, and association with anal cancer.
- result Genital warts are characterised by the growth of small, cauliflower-like bumps on the genital and anal areas. Although not life-threatening, they can cause discomfort and psychological distress.
- comparator Prevention of HPV infection includes vaccination and safe sexual practices.
Rev Med Virol · PMID 38666757 · Read it on PubMed ↗
Tlaker et al. 2024
Prospective Longitudinal Study of Dynamics of Human Papillomavirus 6 and 11 Infection in Anogenital Hairs and Eyebrows of Male Patients with Anogenital Warts and Age-Matched Controls
Warts often recurred despite treatment.Prospective cohortLow qualityRelated question
64 peoplesix follow-up visits (every 2.6 months)
despite treatment, most patients had wart recurrences, and hair HPV positivity tracked with visible warts over time
Who was studied
men newly diagnosed with anogenital warts, compared to age-matched healthy men
What they received
standard treatment for anogenital warts, with tracking of HPV6/11 in anogenital and eyebrow hairs over time
Compared with
age-matched healthy controls without warts
Main outcome
presence/clearance of HPV6/11 in hair samples and recurrence of visible anogenital warts over repeated follow-up visits
Quality
this was a small, observational study of treated patients tracking HPV in hair follicles, not a trial comparing treatment to no treatment, so it cannot show whether warts clear on their own.
Limitations
all patients received standard treatment rather than being left untreated, small sample size (32 patients), and the focus was on HPV DNA dynamics in hair rather than spontaneous wart resolution.
Taken word for word from the abstract
- n 32 newly diagnosed male patients with AGWs and 32 age-matched healthy controls were closely followed
- population 32 newly diagnosed male patients with AGWs and 32 age-matched healthy controls
- intervention Patients were treated according to standards of care.
- comparator 32 age-matched healthy controls
- primaryOutcome The proportion of patients with visible AGWs and HPV6/11-positive hairs declined during follow-up with similar trends.
- result Despite treatment, 78.1% and 62.5% of the AGW patients experienced one and two or more post-initial AGW episodes, respectively.
- followUp six follow-up visits (every 2.6 months)
Microorganisms · PMID 38543517 · Read it on PubMed ↗
Diakite et al. 2023
Public health impact of 2-, 4-, and 9-valent HPV vaccination in females on cervical and noncervical diseases in men and women under different coverage scenarios in China: A simulation study
Not relevant to question asked.Laboratory studyVery low qualityRelated question
size not given2023
this is a simulation model predicting disease reduction from vaccination; it does not address whether anal warts resolve without treatment
Who was studied
men and women in China
What they received
HPV vaccination (2-, 4-, or 9-valent) in females
Compared with
no vaccination
Main outcome
incidence of HPV-related diseases including cervical and noncervical cancers, genital warts, and recurrent respiratory papillomatosis
Quality
this is a mathematical simulation model about vaccination impact, not a clinical study of whether warts resolve untreated
Limitations
abstract does not address natural resolution of anal or genital warts; it is a projection model about vaccination coverage impact over 100 years
Taken word for word from the abstract
- population estimate the public health impact in China
- intervention 2-valent (with and without cross-protection), 4-valent, and 9-valent HPV vaccination strategies
- comparator compared to a scenario with no vaccination
- primaryOutcome The model predicted the incidence and mortality associated with HPV-related diseases, including cervical and noncervical cancers, genital warts, and recurrent respiratory papillomatosis (RRP)
- result all 4 vaccination strategies reduced the incidence of cervical cancer in females and noncervical cancers in both sexes, and the 4-valent and 9-valent vaccines reduced the incidence of genital warts and RRP in both sexes
Hum Vaccin Immunother · PMID 37787054 · Read it on PubMed ↗
Jorge Pereira et al. 2021
[Consensus on HPV of the Portuguese Society of Andrology, Sexual Medicine and Reproduction: Treatment]
Often clear up on their own.GuidelineLow qualityRelated question
size not given2021
not directly studied; abstract states spontaneous resolution rate is high but gives no specific figures or data on natural resolution
Who was studied
people with genital/anal warts (condyloma)
What they received
various wart treatments (patient-applied, provider-applied, experimental)
Compared with
no specific comparator; general treatment landscape discussed
Main outcome
clearance and recurrence of warts
Quality
this is a consensus/expert opinion statement, not original research, and gives no data on natural resolution.
Limitations
This is a consensus statement summarizing treatment options and expert opinion rather than original data on natural history of warts; no numbers or study details are given for spontaneous resolution.
Taken word for word from the abstract
- result Although the spontaneous resolution rate is high, a significant proportion of patients seek treatment
- population treatment of condyloma is generally a challenge in clinical practice
- intervention applied by the patient himself (imiquimod 3.75 or 5%, podophyllotoxin .5%, synecatekines 10% or 15%), applied by the health care provider (bi- and tricloacetic acids 80%-90%, intralesional interferon alpha, cryotherapy, surgical removal, electrofulguration, laser ablation) and experimental or alternative therapies (topical cidofovir, intralesional bleomycin, photodynamic therapy)
- comparator none of the currently available treatments is clearly more effective than the others
- primaryOutcome The overall success rate of the various treatments available ranges from 23% to 94%.
Rev Int Androl · PMID 32684426 · Read it on PubMed ↗
Wei et al. 2020
Sex Differences in the Incidence and Clearance of Anogenital Human Papillomavirus Infection in Liuzhou, China: An Observational Cohort Study
Wart-causing HPV virus often clears within a yearProspective cohortModerate qualityRelated question
4,687 people~1 year
HPV-6/11 infection cleared at a rate of about 112 per 1000 person-months in men and 85 per 1000 person-months in women, with no significant difference between sexes
Who was studied
men and women aged 18 to 55 in China
What they received
no treatment given; natural clearance of HPV infection observed over time
Compared with
men compared with women
Main outcome
incidence and clearance of anogenital HPV infection, including the wart-causing types HPV-6/11
Quality
it is a large, well-designed cohort study, but it tracks HPV virus clearance rather than whether visible anal warts themselves go away, so it only indirectly answers the question.
Limitations
abstract does not report whether participants had visible warts or track resolution of warts specifically, only clearance of HPV genotypes detected by lab testing
Taken word for word from the abstract
- n an observational cohort study including 2309 men and 2378 women aged 18-55 years was conducted in Liuzhou, China
- population 2309 men and 2378 women aged 18-55 years
- intervention Samples from anogenital sites were tested for HPV genotypes by multicolor real-time polymerase chain reaction and melting curve analysis biannually for ~1 year
- comparator men were more likely than women to clear oncogenic infections
- primaryOutcome The incidence of oncogenic HPV infection was similar in men and women
- result no significant difference was found in the clearance of HPV-6/11 by sex (111.7 vs 84.8; P = .266)
- followUp biannually for ~1 year
Clin Infect Dis · PMID 30852604 · Read it on PubMed ↗
Sichero et al. 2019
Human Papillomavirus and Genital Disease in Men: What We Have Learned from the HIM Study
No specific finding reported.Narrative reviewVery low qualityRelated question
size not given2019
the abstract summarizes findings on HPV infection and risk factors but does not report whether anal warts resolve without treatment
Who was studied
men enrolled in a multi-country study on HPV infection
What they received
natural history tracking of HPV infection in men
Main outcome
development of HPV-related genital disease including warts and cancer
Quality
this is a general review summarizing a cohort study without specific data on wart regression or resolution rates.
Limitations
abstract does not describe methodology, statistics, or specific outcomes related to spontaneous wart clearance.
Taken word for word from the abstract
- population men from Brazil, the United States, and Mexico were enrolled
- intervention The design and protocols of this study allowed unraveling crucial information regarding the relationship between HPV infection and clinical consequences in men, and associated risk factors at each of the anatomic sites where HPV is known to cause cancer in men.
- primaryOutcome genital HPV infections may progress to genital warts and penile carcinoma
- result The design and protocols of this study allowed unraveling crucial information regarding the relationship between HPV infection and clinical consequences in men, and associated risk factors at each of the anatomic sites where HPV is known to cause cancer in men.
Acta Cytol · PMID 30799416 · Read it on PubMed ↗
Giuliano et al. 2019
Genital Wart Recurrence Among Men Residing in Brazil, Mexico, and the United States
Warts often recur after the first episode.Prospective cohortLow qualityRelated question
size not givenmedian follow-up of 50.4 months
44% of men had at least one more wart episode after the first, and the rate of new episodes rose with each additional episode
Who was studied
men aged 18-70 in the United States, Mexico, and Brazil who had a prior genital wart episode
What they received
none (observational follow-up of men over time)
Compared with
none (no treatment comparison)
Main outcome
whether and when new genital wart episodes occurred after an initial one
Quality
This is an observational recurrence study, not a test of whether untreated warts resolve on their own, so it only indirectly bears on the question.
Limitations
Abstract does not report total number of participants, does not describe whether warts were treated, and does not directly assess spontaneous resolution without treatment.
Taken word for word from the abstract
- population men aged 18-70 years in the United States, Mexico, and Brazil
- intervention examined every 6 months for a median follow-up of 50.4 months
- comparator unvaccinated men
- primaryOutcome describe the rate of subsequent GWs, associated human papillomavirus (HPV) types, and time to subsequent GW event
- result Forty-four percent of men experienced ≥1 GW following the initial episode.
- result The incidence rate of each subsequent GW increased with increasing events (incidence of first subsequent event was 13.1 vs 36.6/1000 person-months for the fourth event).
- followUp median follow-up of 50.4 months
J Infect Dis · PMID 30388232 · Read it on PubMed ↗
Kim et al. 2018
Giant anorectal condyloma acuminatum of Buschke-Löwenstein presents difficult management decisions
This severe tumor did not go away alone.Case seriesVery low qualityRelated question
1 people2018
BLT differs from normal condyloma acuminata by presenting with locally invasive growth, lack of spontaneous resolution, tendency for recurrence after treatment and potential for malignant transformation
Who was studied
person with a BLT case reaching large dimensions in the anorectal region
What they received
treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions
Main outcome
identify and prevent recurrence or malignant transformation of the tumor
Quality
This is a single patient case report, which cannot show what generally happens to warts.
Limitations
Single case report of a rare, severe tumor variant, not typical anal warts; no comparison group or statistical data.
Taken word for word from the abstract
- n We examine a BLT case reaching large dimensions in the anorectal region treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions.
- population We examine a BLT case reaching large dimensions in the anorectal region treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions.
- intervention treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions.
- primaryOutcome continuous follow-up care can help identify and prevent recurrence or malignant transformation of the tumor.
- result BLT differs from normal condyloma acuminata by presenting with locally invasive growth, lack of spontaneous resolution, tendency for recurrence after treatment and potential for malignant transformation.
J Surg Case Rep · PMID 29644039 · Read it on PubMed ↗
Ventimiglia et al. 2016
Human Papillomavirus Infection and Vaccination in Males
Vaccine lowers new genital lesion risk.Systematic reviewLow qualityRelated question
size not given2016
vaccines showed efficacy of up to 80% against external genital lesions, but data on cancer prevention were limited
Who was studied
sexually active men
What they received
HPV vaccination
Compared with
unvaccinated men (implied)
Main outcome
development of external genital lesions (EGLs) from HPV
Quality
This is a broad review of HPV vaccination and epidemiology in men, not a study designed to measure whether existing anal warts resolve on their own.
Limitations
The abstract does not discuss the natural history or spontaneous resolution of existing anal warts, only vaccine prevention of new lesions.
Taken word for word from the abstract
- population evidence for HPV infection and vaccination in men
- intervention there are two different vaccines approved for men
- comparator efficacy of up to 80% against EGLs
- primaryOutcome a minority of individuals develop external genital lesions (EGLs)
- result efficacy of up to 80% against EGLs; however, efficacy data regarding malignant lesions are still limited
Eur Urol Focus · PMID 28723467 · Read it on PubMed ↗
Mennini et al. 2017
Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy
Vaccine lowers future wart and cancer rates.Narrative reviewLow qualityRelated question
size not given2017
the nine-valent vaccine was linked to a 17% further drop in cervical cancer, 35% and 14% drops in anal cancer for males and females, and over a million fewer cases of genital warts after 100 years, at a cost of 10,463€ per QALY gained
Who was studied
people in Italy eligible for HPV vaccination (girls, and in some scenarios boys)
What they received
nine-valent HPV vaccine (Gardasil 9)
Compared with
quadrivalent HPV vaccine (Gardasil), bivalent vaccine, or screening alone
Main outcome
cost-effectiveness (cost per QALY) and reduction in HPV-related disease including genital warts and cancers
Quality
this is a computer simulation modeling long-term costs and outcomes, not a study of actual patients or whether warts resolve untreated
Limitations
abstract does not state limitations; findings come from a mathematical transmission model rather than direct observation of patients or wart outcomes
Taken word for word from the abstract
- population HPV vaccination with the quadrivalent vaccine (Gardasil®) is offered actively and free of charge to girls aged 12 since 2007
- intervention A nine-valent vaccine (Gardasil 9®) received the European market authorization in 2015
- comparator compared two strategies with the nine-valent vaccine (cervical cancer screening and vaccination in girls only or vaccination in boys and girls) to four alternative strategies (cervical cancer screening and vaccination with quadrialent vaccine in girls only, in both boys and girls, with bivalent vaccine in girls and screening strategy only)
- primaryOutcome used to estimate costs and QALYs associated with vaccination strategies
- result the nine-valent vaccine in a programme including girls and boys shows further reductions of 17% in the incidence of cervical cancer, 35 and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new technology is associated with an ICER of 10,463€ per QALY gained in universal vaccination, decreasing to 4483€ when considering the vaccine switch for girls-only.
Cost Eff Resour Alloc · PMID 28701899 · Read it on PubMed ↗
Roberts et al. 2016
Papillary Immature Metaplasia of the Anal Canal: A Low-grade Lesion That Can Mimic a High-grade Lesion
Does not address if warts resolve.Case seriesVery low qualityRelated question
15 people2016
the abstract describes a histologic pattern that mimics high-grade lesions but is actually low-grade, caused by HPV types 6 or 11; no data on whether warts resolve without treatment
Who was studied
gay men with anal HPV infection
Main outcome
identifying and characterizing a type of anal lesion (papillary immature metaplasia) to avoid misdiagnosis as a more serious lesion
Quality
this is a small descriptive pathology study, not designed to answer whether anal warts resolve without treatment
Limitations
small sample of 15 cases; focused on pathologic classification, not on natural resolution of warts; abstract explicitly states further study of natural history is needed
Taken word for word from the abstract
- population In a natural history study of anal human papillomavirus (HPV) infection and HPV-related lesions among homosexual men in Sydney, Australia, we identified 15 examples of papillary immature metaplasia (PIM) in anal biopsy samples.
- n we identified 15 examples of papillary immature metaplasia (PIM) in anal biopsy samples
- primaryOutcome The clinical significance of recognizing PIM lies in preventing misdiagnosis as high-grade squamous intraepithelial lesion, (the presumed precursor to anal cancer), due to the morphologic immaturity of the cell population.
- result Further study of the natural history of anal canal PIM is needed.
Am J Surg Pathol · PMID 26551619 · Read it on PubMed ↗
Nyitray et al. 2015
The natural history of genital human papillomavirus among HIV-negative men having sex with men and men having sex with women
HPV infections often clear within monthsProspective cohortModerate qualityRelated question
3,593 peopleup to 4 years
HPV infection rates were similar between groups, and typical HPV-16 infections took more than 6 months to clear
Who was studied
HIV-negative men who have sex with men or with women, with no history of genital warts
What they received
no treatment, just observed genital HPV infection over time
Compared with
men who have sex with men versus men who have sex with women
Main outcome
how often new HPV infections occurred and how quickly they cleared
Quality
it is a large multi-year study with regular testing, but it tracks HPV infection clearance in general, not resolution of visible anal warts specifically.
Limitations
study periods of 6 months or less may not be long enough to accurately measure how long infections last, and participants with a history of genital warts were excluded from the study
Taken word for word from the abstract
- n Evaluable specimens were collected from 564 MSM and 3029 men having sex with women (MSW).
- population Eligibility criteria included no history of genital warts or HIV infection.
- intervention provided specimens at 6-month intervals for up to 4 years
- comparator MSM and MSW incidence rates were comparable
- primaryOutcome Incidence and clearance estimates with 95% confidence intervals were calculated.
- result Median times to HPV-16 clearance were also comparable, with point estimates of >6 months for both MSM and MSW.
- limitations Study periods of ≤6 months, however, may not be long enough to accurately measure the persistence of these infections in men.
J Infect Dis · PMID 25649172 · Read it on PubMed ↗
Grillo-Ardila et al. 2014
Imiquimod for anogenital warts in non-immunocompromised adults
More clearing with imiquimod than placebo.Meta-analysisVery low qualityRelated question
1,734 people2014
Imiquimod cleared more warts than placebo, but was similar to other patient-applied or clinic treatments; evidence quality was very low to low throughout
Who was studied
adults with anal/genital warts who are not immunocompromised
What they received
imiquimod cream applied by the patient
Compared with
placebo, other patient-applied creams, or clinic-based treatments like freezing or laser
Main outcome
complete or partial clearing of the warts
Quality
The trials had a high risk of bias and imprecise, inconsistent results, so the findings are very uncertain.
Limitations
High risk of bias in included trials, imprecision, and inconsistency across outcomes; many trials industry-funded.
Taken word for word from the abstract
- n Ten RCTs (1734 participants) met our inclusion criteria
- population the treatment of AGW in non-immunocompromised adults
- intervention comparing the use of imiquimod with placebo
- comparator placebo, any other patient-applied or any other provider-administered treatment
- primaryOutcome achieving complete and partial regression
- result There was very low quality evidence that imiquimod was superior to placebo in achieving complete and partial regression
Cochrane Database Syst Rev · PMID 25362229 · Read it on PubMed ↗
Canepa et al. 2013
HPV related diseases in males: a heavy vaccine-preventable burden
No specific finding reportedNarrative reviewVery low qualityRelated question
size not given2013
The abstract does not report specific findings on whether anal warts resolve without treatment
Who was studied
males with HPV-related disease
What they received
not applicable (natural history review)
Main outcome
burden and natural history of HPV-related disease in men
Quality
This is a narrative review summarizing general HPV disease burden, not a study addressing wart clearance with data or results.
Limitations
No specific methodology, data, or outcomes on wart resolution are reported in the abstract
Taken word for word from the abstract
- population HPV related disease in males
- intervention Purpose of this review is to summarise the main information about the burden and the natural history of the HPV related disease in males.
- primaryOutcome clearance of type-specific HPV infections and transmission dynamics
- result which in some aspects should be clarify, in particular clearance of type-specific HPV infections and transmission dynamics
J Prev Med Hyg · PMID 24396983 · Read it on PubMed ↗
Vender et al. 2013
Therapeutic options for external genital warts
Untreated warts may clear, stay, or grow.Narrative reviewLow qualityRelated question
size not given2013
left untreated, warts may grow, stay the same, or go away on their own via immune clearance
Who was studied
people with external genital warts
What they received
no treatment (natural course)
Compared with
treatment with provider or patient applied therapies
Main outcome
whether warts grow, stay the same, or go away without treatment
Quality
this is a general narrative review of treatment options, not a study specifically measuring how often untreated warts resolve.
Limitations
The abstract is a general review of treatment options and does not provide data, numbers, or a dedicated study on the natural course of untreated warts; it also notes recurrence is common even with treatment.
Taken word for word from the abstract
- population external genital warts (EGWs)
- intervention Left untreated, warts may grow, remain the same, or spontaneously regress as a result of being cleared by the immune system.
- comparator Treatment options fall into two categories: provider or patient applied.
- primaryOutcome Left untreated, warts may grow, remain the same, or spontaneously regress as a result of being cleared by the immune system.
- result Left untreated, warts may grow, remain the same, or spontaneously regress as a result of being cleared by the immune system.
J Cutan Med Surg · PMID 24388560 · Read it on PubMed ↗
Horn et al. 2013
Estimating the long-term effects of HPV vaccination in Germany
Does not address spontaneous wart resolution.Narrative reviewVery low qualityRelated question
size not given2013
Model predicts vaccination will reduce cervical cancer cases and, by implication, anogenital wart rates over decades; the abstract does not describe whether anal warts resolve without treatment
Who was studied
12-17 year old girls in Germany eligible for HPV vaccination
What they received
HPV vaccination against HPV types 16/18
Compared with
No vaccination (modeled natural history without vaccine)
Main outcome
Predicted long-term incidence and mortality of cervical cancer and anogenital warts
Quality
This is a theoretical mathematical modeling study of HPV vaccination impact, not a clinical study observing whether existing anal warts resolve on their own.
Limitations
The abstract describes a simulation model based on epidemiologic calibration data, not direct observation of wart natural history or spontaneous resolution.
Taken word for word from the abstract
- population 12-17 year old girls
- intervention vaccination against the most oncogenic HPV types 16/18
- comparator We developed a dynamic mathematical model for the natural history and transmission of HPV infections to estimate the impact of vaccination
- primaryOutcome estimate the impact of vaccination on incidence and mortality of cervical cancer and its pre-stages, and on anogenital warts
- result HPV vaccination will prevent approximately 37% of cervical cancer cases even if vaccination coverage is only 50%
Vaccine · PMID 23518405 · Read it on PubMed ↗
Videla et al. 2013
Natural history of human papillomavirus infections involving anal, penile, and oral sites among HIV-positive men
Some anal HPV clears, not warts directlyProspective cohortLow qualityRelated question
733 peoplebetween 2005 and 2009
HPV infection cleared in 30% of anal infections, 56% of penile infections, and 44% of oral infections over the study period
Who was studied
HIV-positive men (both men who have sex with men and heterosexual men)
What they received
No treatment; natural observation of HPV infection over time
Compared with
Men who have sex with men versus heterosexual men
Main outcome
Prevalence, clearance, and new occurrence of HPV infection at anal, penile, and oral sites
Quality
This is an observational study of HIV-positive men only, tracking HPV DNA detection rather than visible wart resolution, so it only indirectly addresses whether anal warts themselves go away.
Limitations
Study population was HIV-positive men only, which may not generalize to the general population; the study tracked HPV viral clearance by PCR rather than clinical regression of visible anal warts.
Taken word for word from the abstract
- population HIV-positive men who have sex with men (MSM) and heterosexual individuals
- n In total, 733 patients (538 MSM, 195 heterosexual) were included in the study between 2005 and 2009.
- primaryOutcome The prevalence, clearance, and incidence of HPV infection at anal, penile, and oral sites were studied
- result The prevalence, clearance, and incidence of HPV infection were 73%, 30%, and 36% at anal site; 26%, 56%, and 17% at penile site; and 16%, 44%, and 11% at oral site, respectively.
- intervention This is a single-center, prospective cohort study.
- comparator MSM had a higher HPV prevalence (84% vs. 42%; odds ratio,7.3; 95% confidence interval [CI], 5.2-10.6)
- followUp between 2005 and 2009
Sex Transm Dis · PMID 23250297 · Read it on PubMed ↗
Echenique et al. 2011
Anal warts and anal intradermal neoplasia
No answer given here.Narrative reviewVery low qualityRelated question
size not given2011
the abstract does not report whether anal warts resolve without treatment
Who was studied
people with anal warts caused by HPV infection
Main outcome
natural history, diagnosis, and treatment of anal warts and related dysplasia
Quality
this is a general narrative review summarizing diagnosis and treatment rather than presenting original data or outcomes on spontaneous resolution.
Limitations
the abstract gives no data on natural resolution rates, sample size, or study methodology; it is a broad review of diagnosis and management.
Taken word for word from the abstract
- population Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States
- primaryOutcome the authors detail the diagnosis, management, and treatment of anal condyloma and anal intraepithelial neoplasia with a focus on prevention, early detection, and treatment using current data and technology
- result Knowledge of the natural history of HPV infection, risk factors, diagnostic tools, and therapeutic methods gives us the tools to adequately prevent, evaluate, treat, and counsel our patients.
Clin Colon Rectal Surg · PMID 22379403 · Read it on PubMed ↗
Massad et al. 2011
Genital warts and vulvar intraepithelial neoplasia: natural history and effects of treatment and human immunodeficiency virus infection
Most genital warts resolved naturally.Prospective cohortModerate qualityRelated question
544 peopleup to 13 years
82% of HIV-positive women and 95% of HIV-negative women had their warts regress, mostly within the first year
Who was studied
women with genital warts, some with HIV infection and some without
What they received
no treatment; natural course of genital warts was observed
Compared with
HIV-seropositive women compared with HIV-seronegative women
Main outcome
whether genital warts went away on their own over time (regression)
Quality
it was a large, carefully followed group with regular exams, but it studied vulvar warts in a mostly HIV-focused population rather than anal warts in the general population.
Limitations
Population was selected for an HIV natural-history study, and the lesions were genital/vulvar warts in women rather than anal warts in a general population.
Taken word for word from the abstract
- population A cohort of 2,791 HIV-infected and 953 uninfected women followed for up to 13 years
- intervention natural history of genital warts and vulvar intraepithelial neoplasia (VIN) in women with human immunodeficiency virus (HIV)
- comparator HIV-seropositive and 43 HIV-seronegative women
- primaryOutcome warts regressed in 410 (82%) seropositive and 41 (95%) seronegative women
- result warts regressed in 410 (82%) seropositive and 41 (95%) seronegative women (P=.02), most in the first year after diagnosis
- n Among 501 HIV-seropositive and 43 HIV-seronegative women, warts regressed
- followUp followed for up to 13 years
Obstet Gynecol · PMID 21934446 · Read it on PubMed ↗
Stanley 2010
Pathology and epidemiology of HPV infection in females
Most genital HPV infections clear naturallyNarrative reviewVery low qualityRelated question
size not given2010
most genital HPV infections clear spontaneously, with 10-20% persisting and risking progression to cervical disease
Who was studied
women with genital HPV infection
What they received
no specific intervention described; natural course of HPV infection
Compared with
none reported
Main outcome
spontaneous clearance versus persistence of HPV infection
Quality
this is a general narrative review about HPV biology and cervical disease in women, not a study specifically measuring anal wart outcomes.
Limitations
abstract does not specifically discuss anal warts, does not report a study population or follow-up, and focuses mainly on cervical HPV and cancer.
Taken word for word from the abstract
- population Genital HPV infections are very common, are sexually transmitted, and have a peak prevalence between ages 18 and 30.
- intervention Most of these infections clear spontaneously
- comparator but in 10-20% of women, these infections remain persistent
- primaryOutcome Most of these infections clear spontaneously, but in 10-20% of women, these infections remain persistent and are at risk of progression to grade 2/3 cervical intraepithelial neoplasm (CIN)
- result Most of these infections clear spontaneously, but in 10-20% of women, these infections remain persistent and are at risk of progression to grade 2/3 cervical intraepithelial neoplasm (CIN) and eventually to invasive cancer of the cervix (ICC).
Gynecol Oncol · PMID 20304221 · Read it on PubMed ↗
Giuliano et al. 2011
Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study
Most genital HPV infections cleared within monthsProspective cohortModerate qualityRelated question
1,159 people27·5 months
Genital HPV infections lasted a median of about 7.5 months for any HPV type and about 12 months for HPV type 16 before clearing on their own
Who was studied
Adult men aged 18-70 in Brazil, Mexico, and the USA, HIV negative, no history of cancer
What they received
None - observational natural history study with no treatment given
Main outcome
How often men got new genital HPV infections and how long the infections lasted before clearing
Quality
This is a decent-sized multi-country cohort, but it tracks HPV infection detected in genital skin cells, not visible anal warts, so it does not directly answer whether warts themselves regress.
Limitations
Abstract does not report on anal sites or visible warts specifically, only HPV DNA detected at genital skin sites; no information on clinical wart outcomes.
Taken word for word from the abstract
- population Men (aged 18-70 years), residing in Brazil, Mexico, and the USA, who were HIV negative and reported no history of cancer were recruited from the general population, universities, and organised health-care systems.
- n In 1159 men, the incidence of a new genital HPV infection was 38·4 per 1000 person months
- primaryOutcome The goal in this study was to estimate incidence and clearance of type-specific genital HPV infection in men, and to assess the associated factors.
- intervention They were assessed every 6 months for a median follow-up of 27·5 months
- result Median duration of HPV infection was 7·52 months (6·80-8·61) for any HPV and 12·19 months (7·16-18·17) for HPV 16.
- followUp assessed every 6 months for a median follow-up of 27·5 months (18·0-31·2).
Lancet · PMID 21367446 · Read it on PubMed ↗
Low et al. 2011
Genital warts and infection with human immunodeficiency virus in high-risk women in Burkina Faso: a longitudinal study
Does not address spontaneous clearance.Prospective cohortLow qualityRelated question
765 people27 months
HIV-infected women, especially those with low CD4 counts, got genital warts much more often; antiretroviral treatment did not reduce how often warts occurred or came back
Who was studied
high-risk women in Burkina Faso being followed over time, some HIV-infected and some not
What they received
no treatment given; observation of genital wart occurrence over time
Compared with
HIV-infected versus HIV-uninfected women, and different CD4 count levels
Main outcome
how often genital warts newly appeared or came back, and what risk factors were linked to this
Quality
This study looked at risk factors for getting genital warts in HIV-related research, not at whether existing anal warts resolve without treatment.
Limitations
Studies genital (not anal) warts in a specific high-risk, HIV-focused population in Africa; does not report on spontaneous resolution of warts over time.
Taken word for word from the abstract
- n A prospective study of 765 high-risk women who were followed at 4-monthly intervals for 27 months in Burkina Faso
- population high-risk women who were followed at 4-monthly intervals for 27 months in Burkina Faso
- primaryOutcome Logistic and Cox regression were used to identify factors associated with prevalent, incident and persistent genital warts, including HIV-1 serostatus, CD4+ count, and concurrent sexually transmitted infections.
- intervention Antiretroviral therapy was not protective against incident or persistent genital warts.
- comparator Incidence was 1.1 per 100 person-years among HIV-uninfected women, 7.4 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count >200 cells/μL and 14.6 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count ≤ 200 cells/μL.
- result Genital warts occur much more frequently among HIV-1 infected women in Africa, particularly among those with low CD4+ counts. Antiretroviral therapy did not reduce the incidence or persistence of genital warts in this population.
BMC Infect Dis · PMID 21251265 · Read it on PubMed ↗
Wolf et al. 2010
Treatment of genital warts: facts and controversies
No clear answer given.Narrative reviewVery low qualityRelated question
size not given2010
the abstract says there is no consensus and many unknowns about whether treatment changes the course of the disease
Who was studied
people with genital warts
What they received
treating genital warts to remove lesions
Compared with
leaving genital warts untreated as only a cosmetic issue
Main outcome
whether treatment clears the wart virus, prevents cancer, or reduces spread
Quality
this is an opinion-based discussion of controversies, not a study with data on outcomes.
Limitations
this abstract is a discussion of treatment controversies, not a study designed to test whether warts resolve without treatment, and it covers genital warts generally rather than anal warts specifically.
Taken word for word from the abstract
- population genital warts
- intervention the traditional approach advocates complete elimination of all lesions
- comparator a second approach regards condyloma as merely a cosmetic nuisance
- primaryOutcome the value of treatment of genital warts in terms of clearing and curing the disease (ie, eradicating the viruses, preventing cancer, and reducing infectivity)
- result we have concluded that many unknowns, uncertainties, and controversies concerning the value of treatment of genital warts
Clin Dermatol · PMID 20797516 · Read it on PubMed ↗
Giuliano et al. 2010
Epidemiology and pathology of HPV disease in males
Most HPV infections clear within a yearNarrative reviewLow qualityRelated question
size not given12 months
Median time to clearance of any HPV infection was 5.9 months, with 75% of infections clearing within 12 months
Who was studied
men with genital HPV infection, including asymptomatic males aged 18-70
What they received
no treatment; natural course of HPV infection over time
Compared with
self-comparison over follow-up time (no treatment arm)
Main outcome
time to clearance of HPV infection
Quality
This is a general review of HPV epidemiology in men, not a study designed specifically to track anal warts, and it notes more data are needed on the natural history of infection.
Limitations
The abstract itself states 'More data are needed to better understand the natural history of HPV infection,' and the clearance data refer to HPV infection generally, not specifically to anal or genital warts.
Taken word for word from the abstract
- population estimating a prevalence of 65.2% in asymptomatic males aged 18-70 years
- intervention More data are needed to better understand the natural history of HPV infection.
- comparator the median time to clearance of any HPV infection was 5.9 months, with 75% of infections clearing within 12 months
- primaryOutcome median time to clearance of any HPV infection was 5.9 months
- result the median time to clearance of any HPV infection was 5.9 months, with 75% of infections clearing within 12 months
Gynecol Oncol · PMID 20138345 · Read it on PubMed ↗
Muñoz et al. 2008
[What should be known for the introduction of an HPV vaccine?]
Most HPV infections clear naturally.Narrative reviewVery low qualityRelated question
size not given2008
most HPV infections regress, but persistent infections can progress to cancer
Who was studied
people infected with genital HPV
Main outcome
whether HPV infection regresses or persists
Quality
this is a general narrative review of HPV epidemiology and vaccination, not a study specifically designed to measure whether anal warts resolve on their own.
Limitations
review focuses on cervical cancer and HPV vaccination overall, not specifically on anal warts or their natural resolution; no methods for quantifying regression are given.
Taken word for word from the abstract
- result Fortunately most infections regress, but those infections that persist are the ones leading to cancer.
- population Genital human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide.
- primaryOutcome natural history of HPV infection
Presse Med · PMID 18786806 · Read it on PubMed ↗
Castellsagué 2008
Natural history and epidemiology of HPV infection and cervical cancer
No direct evidence on anal wartsNarrative reviewVery low qualityRelated question
size not given2 years
most women infected with HPV become HPV-negative within 2 years, but persistent high-risk infection raises cervical cancer risk; no data given on anal warts specifically
Who was studied
women infected with HPV
What they received
none (this is a natural history/epidemiology review, not a treatment study)
Main outcome
whether HPV infection persists or clears over time
Quality
this is a general review about HPV and cervical cancer, not a study of anal warts, so it gives no direct data on whether anal warts resolve on their own
Limitations
abstract discusses cervical HPV infection and cancer risk broadly; genital warts are mentioned only in passing as caused by HPV 6/11, with no data on anal warts' natural course
Taken word for word from the abstract
- population women infected with the virus
- result Although most women infected with the virus become negative within 2 years, women with persistent high-risk HPV infections are at greatest risk for developing cervical cancer.
- primaryOutcome Although most women infected with the virus become negative within 2 years, women with persistent high-risk HPV infections are at greatest risk for developing cervical cancer.
- intervention HPV, especially genotypes 6 and 11, can also cause genital warts.
Gynecol Oncol · PMID 18760711 · Read it on PubMed ↗
Tay et al. 2008
Clinical trial experience with prophylactic HPV 6/11/16/18 VLP vaccine in young women from the Asia-Pacific region
Vaccine prevented genital lesions and wartsRandomised trialLow qualityRelated question
814 people2008
vaccine was 100% effective at preventing these HPV-related lesions compared with placebo
Who was studied
young women aged 16 to 26 from the Asia-Pacific region
What they received
quadrivalent HPV 6/11/16/18 vaccination
Compared with
placebo
Main outcome
disease caused by HPV types 6, 11, 16, or 18 (cervical, vulvar, vaginal lesions and genital warts)
Quality
this trial tests whether a vaccine prevents HPV disease, not whether existing anal warts resolve without treatment, so it does not answer the question being asked.
Limitations
abstract does not address natural resolution or untreated course of anal warts; focuses on vaccine prevention outcomes only
Taken word for word from the abstract
- n A total of 814 women from the Asia-Pacific region (aged 16 to 26 years) received vaccine or placebo in 1 of 3 protocols.
- population A total of 814 women from the Asia-Pacific region (aged 16 to 26 years) received vaccine or placebo in 1 of 3 protocols.
- intervention quadrivalent HPV 6/11/16/18 vaccination of young Asia-Pacific women
- comparator received vaccine or placebo in 1 of 3 protocols
- primaryOutcome Vaccine efficacy against disease caused by HPV types 6, 11, 16, or 18 was 100% for cervical intraepithelial neoplasia
- result Vaccine efficacy against disease caused by HPV types 6, 11, 16, or 18 was 100% for cervical intraepithelial neoplasia (0 vs 12 cases; 95% confidence interval [CI], 63.1%-100%) and 100% for vulvar and vaginal intraepithelial neoplasia or condylomata accuminata (0 vs 5 cases; 95% CI, -11.8% to 100%).
Int J Gynaecol Obstet · PMID 18555997 · Read it on PubMed ↗
Meyer-Hoffert et al. 2008
Expression of human beta-defensin-2 and -3 in verrucae vulgares and condylomata acuminata
Does not show if warts resolve.Laboratory studyVery low qualityRelated question
35 people2008
warts showed higher levels of these antiviral proteins than normal skin, with lower levels in anal/genital warts than common warts
Who was studied
people with common warts (verrucae vulgares) and anal/genital warts (condylomata acuminata)
What they received
presence of antiviral skin proteins (human beta-defensin-2 and -3) in wart tissue
Compared with
normal skin tissue
Main outcome
whether these antiviral proteins are expressed in wart lesions
Quality
this is a small lab tissue-staining study that does not test or report whether warts actually went away, so it cannot answer whether anal warts resolve on their own.
Limitations
Retrospective study; immunohistochemistry only; does not follow patients over time or report clinical regression.
Taken word for word from the abstract
- n condylomata acuminata (n = 15)
- n verrucae vulgares (n = 20)
- population Verrucae vulgares and condylomata acuminata are typical cutaneous viral diseases caused by different subtypes of the human papillomavirus.
- intervention we investigated lesions of verrucae vulgares and condylomata acuminata for the presence of hBD-2 and hBD-3 by immunohistochemistry
- comparator Normal skin tissue exhibited no staining of both hBD-2 and hBD-3 with the exception of two cases.
- primaryOutcome Their tendency for spontaneous regression could be caused by antiviral proteins like defensins.
- result The specimens of condylomata acuminata (n = 15) exhibited expression for hBD-2 and hBD-3, with the exception of three and two samples, respectively. The expression levels in condyloma acuminata were lower for both defensins compared with verrucae vulgares.
J Eur Acad Dermatol Venereol · PMID 18355203 · Read it on PubMed ↗
Cox 2006
Epidemiology and natural history of HPV
Does not address this question.Narrative reviewVery low qualityRelated question
size not given2006
The abstract does not report whether anal warts resolve on their own; it discusses HPV types, cancer risk, and vaccination but not natural resolution of warts.
Who was studied
people infected with HPV
Main outcome
HPV infection, cancer risk, and disease epidemiology
Quality
This is a general narrative review of HPV epidemiology and does not study or report on whether anal warts resolve without treatment.
Limitations
The abstract does not address the natural history of genital/anal warts regression or resolution specifically; it focuses on cancer risk, HPV types, and vaccination.
Taken word for word from the abstract
- result low-risk HPV types, the most common of which are HPV 6 and 11, cause genital warts, low-grade cervical lesions, and recurrent respiratory papillomatosis, but they do not cause cervical or other HPV-related cancers
- population an estimated three fourths of adults will be infected with HPV during their lifetime
- primaryOutcome Human papillomavirus (HPV) is a highly prevalent, sexually transmitted infection responsible for significant morbidity and mortality
J Fam Pract · PMID 17366752 · Read it on PubMed ↗
Ault 2006
Epidemiology and natural history of human papillomavirus infections in the female genital tract
Doesn't directly address wart resolution.Narrative reviewLow qualityRelated question
size not given2006
Most HPV infections are cleared by the immune system and do not result in clinical complications, but treatment for genital warts is described as removing the problematic cells and watching for recurrence rather than spontaneous resolution
Who was studied
sexually active women with HPV infection of the female genital tract
What they received
natural course of HPV infection (no treatment, immune clearance)
Compared with
clinical treatment of HPV-related lesions such as genital warts
Main outcome
clearance of HPV infection and development of clinical complications like genital warts or abnormal Pap results
Quality
This is a general narrative review of female genital HPV epidemiology, not a study specifically measuring whether anal or genital warts resolve without treatment.
Limitations
Abstract discusses female genital tract HPV broadly, not anal warts specifically, and provides no study data, follow-up periods, or participant numbers on wart resolution.
Taken word for word from the abstract
- population sexually active women less than 25 years of age who consistently have the highest rates of infection
- intervention Most HPV infections are cleared by the immune system and do not result in clinical complications.
- comparator treatment for clinical sequelae such as genital warts and cytologic abnormalities consists of removing the problematic cells and watching for recurrence
- primaryOutcome Clinical sequelae in cases of low-risk HPV infection consist of genital warts
- result Most HPV infections are cleared by the immune system and do not result in clinical complications
Infect Dis Obstet Gynecol · PMID 16967912 · Read it on PubMed ↗
Dunne et al. 2006
Genital human papillomavirus infection
Does not address this question.Narrative reviewVery low qualityRelated question
size not given2006
The abstract does not report whether anal/genital warts resolve without treatment; it discusses vaccine efficacy and HPV prevalence instead
Who was studied
people with genital HPV infection
What they received
not applicable (general review of HPV)
Compared with
not applicable
Main outcome
understanding of HPV prevalence and prevention, including vaccine efficacy
Quality
This is a general narrative review that does not study or report on natural resolution of warts.
Limitations
Abstract does not address the natural history or spontaneous resolution of anogenital warts; focuses on vaccine and screening recommendations.
Taken word for word from the abstract
- population HPV infection is the cause of anogenital warts and cervical cancer
- intervention an HPV vaccine that prevents cervical cancer precursors, cervical cancer, and anogenital warts caused by HPV types 6, 11, 16, and 18 was licensed for use in girls and women aged 9-26 years by the US Food and Drug Administration (FDA) in June 2006
- comparator Data from clinical trials have resulted in recommendations that support the use of an HPV test in the context of cervical cancer screening and management.
- primaryOutcome with a primary focus on the prevalence of HPV infection in the United States
- result Prophylactic HPV vaccine trials have demonstrated high efficacy
Clin Infect Dis · PMID 16886157 · Read it on PubMed ↗
Weaver 2006
Epidemiology and natural history of genital human papillomavirus infection
Does not say if warts resolveNarrative reviewVery low qualityRelated question
size not given2006
abstract does not state whether warts resolve on their own; it only describes treatment and monitoring for recurrence
Who was studied
sexually active people infected with HPV
What they received
no specific treatment discussed for natural resolution
Compared with
none
Main outcome
whether genital warts or HPV disease resolve or recur
Quality
This is a general narrative review that does not report a study or data on natural resolution of warts.
Limitations
Abstract does not address natural history/resolution of warts specifically, only general epidemiology and future prevention via vaccine.
Taken word for word from the abstract
- population Human papillomavirus infection is most common among young, sexually active individuals
- intervention Treatment of patients with HPV-associated disease such as cervical intraepithelial neoplasia and genital warts consists of counseling, treatment if indicated, and monitoring for recurrence.
- comparator Treatment of patients with HPV-associated disease such as cervical intraepithelial neoplasia and genital warts consists of counseling, treatment if indicated, and monitoring for recurrence.
- primaryOutcome monitoring for recurrence
- result Treatment of patients with HPV-associated disease such as cervical intraepithelial neoplasia and genital warts consists of counseling, treatment if indicated, and monitoring for recurrence.
J Am Osteopath Assoc · PMID 16729554 · Read it on PubMed ↗
Shew et al. 2005
HPV infection in adolescents: natural history, complications, and indicators for viral typing
Doesn't address wart resolution directly.Narrative reviewVery low qualityRelated question
size not given2005
genital warts, dysplasia, and cancer are described as rare outcomes of HPV infection, but no specific data on spontaneous resolution of warts is given
Who was studied
adolescents with HPV infection
What they received
none (review of HPV natural history)
Compared with
none
Main outcome
natural history and complications of HPV infection, including genital warts, dysplasia, and cancer
Quality
this is a general narrative review of HPV in adolescents with no original data or specific findings about anal wart resolution.
Limitations
Abstract does not focus on anal warts specifically, nor does it report whether warts resolve without treatment; it is a broad review of HPV natural history and complications.
Taken word for word from the abstract
- population Prevalence rates are the highest for adolescents.
- primaryOutcome Knowledge about the natural history, virology, and cancerous transformation has lead to improved viral detection
- result Despite the high prevalence rates, sequelae of genital warts, dysplasia, and cancer are rare developments.
- intervention clinical interventions and treatments, including both therapeutic and prophylactic vaccinations
- comparator Human papillomavirus (HPV) is the most common sexually transmitted disease in both men and women.
Semin Pediatr Infect Dis · PMID 16044390 · Read it on PubMed ↗
Azim et al. 2004
Local expression of tumor necrosis factor-alpha and interleukin-4 mRNA in different types of warts
Immune markers studied, not wart clearance.Laboratory studyVery low qualityRelated question
30 people2004
Higher TNF-alpha expression in warts than controls, but no clear link between immune pattern and wart clearance
Who was studied
patients with different types of viral warts (common, plane, plantar, and anogenital)
What they received
measuring TNF-alpha and IL-4 gene expression in wart tissue
Compared with
healthy control tissue
Main outcome
levels of immune signaling molecules (TNF-alpha and IL-4) in wart tissue
Quality
This is a small lab study measuring immune markers in tissue, not a study tracking whether warts actually went away over time.
Limitations
Small sample size of 30 patients covering multiple wart types; only anal/anogenital warts are a subset; no follow-up data on actual wart resolution over time.
Taken word for word from the abstract
- n A total of thirty patients suffering from different types (common, plane, plantar and anogenital) of viral warts were included.
- population thirty patients suffering from different types (common, plane, plantar and anogenital) of viral warts
- intervention Local expression of TNF-alpha (Th1) and IL-4 (Th2) in wart tissue was determined using in-situ hybridization technique.
- comparator Local expression of TNF-alpha mRNA was higher in viral wart patients compared to healthy control
- primaryOutcome to assess tumor necrosis factor-alpha (TNF-alpha) and interleukin-4 (IL-4) expression
- result Local expression of TNF-alpha mRNA was higher in viral wart patients compared to healthy control (P < 0.01), while local expression of IL-4 was not significantly higher in patients compared to control (P > 0.05).
- result it does not appear to be a simple causal relationship between expression of a Th-1 pattern and clearance
Egypt J Immunol · PMID 15724382 · Read it on PubMed ↗
Chu 2003
Therapeutic vaccination for the treatment of mucosotropic human papillomavirus-associated disease
No clear answer givenNarrative reviewVery low qualityRelated question
size not given2003
natural history studies associated with spontaneous regression have provided little guidance to the design of successful interventions
Who was studied
people with HPV-related diseases such as anogenital warts, cervical and anal intraepithelial neoplasia
What they received
therapeutic vaccination approaches for HPV-associated disease
Main outcome
development of immunotherapeutic vaccine strategies for HPV-associated disease
Quality
This is a narrative review about vaccine development, not a study measuring whether warts resolve on their own, so it gives no usable data on that question.
Limitations
The abstract is a review of vaccine research and only mentions spontaneous regression in passing without data or results.
Taken word for word from the abstract
- population anogenital warts and cervical and anal intraepithelial neoplasia
- intervention novel immunotherapeutic strategies
- primaryOutcome clinical studies for a variety of HPV-associated indications
- result natural history studies associated with spontaneous regression have provided little guidance to the design of successful interventions
Expert Opin Biol Ther · PMID 12783616 · Read it on PubMed ↗
Sonnex et al. 2001
The treatment of human papillomavirus lesions of the lower genital tract
No data on natural resolution.Narrative reviewLow qualityRelated question
size not given2001
The abstract does not report whether warts resolve without treatment; it notes a lack of good natural history data with or without treatment
Who was studied
young men and women with anogenital warts caused by HPV 6 and 11
What they received
various treatments for genital warts
Main outcome
clearance and recurrence of genital warts
Quality
This is a narrative review that admits a lack of good natural history or controlled long-term data, so it cannot reliably answer whether warts clear on their own.
Limitations
The abstract states there is a lack of good natural history data either with treatment or without treatment over longer periods of time, and most trials are short-term comparisons of monotherapies.
Taken word for word from the abstract
- population occurring at an incidence rate of 0.5-1.2% in young men and women aged 18-25 years
- intervention Many therapies for genital warts have been described
- primaryOutcome all therapeutic modalities fail to clear the warts in a proportion of patients, and the recurrence of warts after successful treatment is seen with all treatments
- result The current knowledge base of the therapy of genital warts is flawed by a lack of good natural history data either with treatment or without treatment over longer periods of time
- limitations there is a lack of structured trials addressing consecutive therapies over longer durations, as occurs in real-life clinical situations
Best Pract Res Clin Obstet Gynaecol · PMID 11563874 · Read it on PubMed ↗
Arrese et al. 2001
Dermal dendritic cells in anogenital warty lesions unresponsive to an immune-response modifier
Doesn't answer natural resolution question.Case seriesVery low qualityRelated question
47 people2001
imiquimod-resistant warts had far fewer Factor XIIIa-positive dermal dendritic cells than untreated warts, which may explain why the cream failed to work
Who was studied
people with anogenital wart lesions, some unresponsive to imiquimod treatment and some untreated, with normal immune systems
What they received
excised wart tissue examined after imiquimod (immune-response cream) treatment failure
Compared with
untreated wart and bowenoid papulosis tissue samples
Main outcome
density and type of immune cells (dendritic cells, Langerhans cells, T lymphocytes) in the wart tissue
Quality
This is a small laboratory study examining immune cells in removed tissue samples, not a clinical study tracking whether warts resolve without treatment.
Limitations
Very small number of excised specimens, no untreated-and-unmonitored group to assess spontaneous regression, and focus is on why imiquimod failed rather than on natural history of warts.
Taken word for word from the abstract
- population All examined lesions had been excised in otherwise healthy individuals with a normal immune status.
- intervention A total of 14 persistent warty anogenital lesions were excised 4 to 7 weeks after completing a 4-month imiquimod treatment.
- comparator Another series of 25 untreated condylomas and 8 bowenoid papulosis served as controls.
- primaryOutcome Lesions were examined for the presence of Langerhans cells and subpopulations of the monocyte/macrophage/dendrocyte lineage using immunohistochemical detection of L1-protein, CD68, lysozyme and Factor-XIIIa.
- result These dermal dendritic cells were slim and rare in all imiquimod-resistant lesions. In contrast, about two-thirds of the untreated condylomas were enriched in these cells.
- n A total of 14 persistent warty anogenital lesions were excised
- n Another series of 25 untreated condylomas and 8 bowenoid papulosis served as controls.
J Cutan Pathol · PMID 11168764 · Read it on PubMed ↗
van Benthem et al. 2000
Sexually transmitted infections in European HIV-infected women: incidence in relation to time from infection. European Study on the Natural History of HIV Infection in Women
Warts became more common over timeProspective cohortLow qualityRelated question
487 people2000
occurrence of genital warts and other STIs increased the longer women had been infected with HIV, while acute STIs decreased
Who was studied
HIV-infected women with a known time since infection, from 12 European countries
What they received
no treatment given; observational follow-up of sexually transmitted infections over time
Compared with
comparison across different lengths of time since HIV infection
Main outcome
rates of sexually transmitted infections, including genital warts, over time
Quality
this is an observational cohort looking at infection rates over time in HIV-positive women, not a study designed to track whether individual warts clear up on their own.
Limitations
abstract does not track whether individual wart cases resolved, only overall diagnosis rates in a different population (HIV-infected women) than the general question asks about
Taken word for word from the abstract
- population 487 HIV-infected women with a known interval of seroconversion from 12 European countries
- n 487 HIV-infected women with a known interval of seroconversion
- intervention Incidence was measured with person-time methods.
- comparator in relation to time from infection
- primaryOutcome To investigate the prevalence and incidence of sexually transmitted infections (STI) in HIV-infected women in relation to time from infection and sexual behaviour.
- result The occurrence of other STI increased with time from HIV infection, presumably due to reactivation as a result of immunosuppression.
AIDS · PMID 10780721 · Read it on PubMed ↗
Syrjänen 1998
Anogenital human papilloma virus and the problem of persistence
Can resolve, persist, or worsenNarrative reviewVery low qualityRelated question
size not given1998
abstract states lesions can regress, persist, or progress, but gives no specific figures for warts
Who was studied
people with anogenital HPV infection (genital warts and related lesions)
What they received
no specific intervention; natural course of infection observed
Compared with
none
Main outcome
whether lesions go away, stay the same, or get worse over time
Quality
this is a general narrative review with no original data, numbers, or study details on warts specifically
Limitations
abstract does not separate genital warts from cancer-precursor lesions (dysplasia/CIN/SIL) when discussing regression, persistence, or progression, and gives no data specific to warts
Taken word for word from the abstract
- population anogenital HPV infections
- primaryOutcome The natural history of these cancer precursors is characterised by regression, persistence or progression
- result The natural history of these cancer precursors is characterised by regression, persistence or progression
- intervention This review examines the natural history of anogenital HPV infections, especially persistence of the virus.
- comparator Other topics covered include viral transmission, pathogenesis, the natural history of the lesions and treatment strategies.
Eur J Dermatol · PMID 10387956 · Read it on PubMed ↗
Sedlacek 1999
Advances in the diagnosis and treatment of human papillomavirus infections
Most HPV infections clear naturally.Narrative reviewVery low qualityRelated question
size not given1999
the abstract states most HPV infections are cleared by the immune system and never become warts or neoplasia, but does not specifically discuss anal warts or their regression
Who was studied
people infected with human papillomavirus (HPV)
What they received
natural immune clearance of HPV infection
Compared with
no comparator reported
Main outcome
whether HPV infection clears or persists as warts or neoplasia
Quality
this is a general narrative review of HPV biology, not a study specifically on anal warts or their natural resolution.
Limitations
abstract does not specifically address anal warts, does not report study methodology, sample size, or follow-up data
Taken word for word from the abstract
- population Most infections occur early in one's sexual life.
- intervention The overwhelming majority of infections are cleared by the host immune system
- result The overwhelming majority of infections are cleared by the host immune system and never present as warts or neoplasia.
- primaryOutcome never present as warts or neoplasia
- comparator Persistent HPV infection is very strongly related to neoplasia.
Clin Obstet Gynecol · PMID 10370842 · Read it on PubMed ↗
Beutner et al. 1998
External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts
No evidence reported either way.GuidelineVery low qualityRelated question
size not given1998
The abstract does not state whether warts resolve on their own; it only summarizes expert consensus on diagnosis, treatment, and counseling.
Who was studied
people with external genital warts and their sex partners
What they received
not applicable (consensus statement on diagnosis and treatment)
Main outcome
consensus recommendations on diagnosis, treatment, and counseling for genital warts
Quality
This is an expert consensus statement, not a study testing whether warts resolve without treatment, so it provides no direct evidence on natural history.
Limitations
The abstract does not describe study methods, sample size, or data on natural resolution of warts; it is a panel opinion summary.
Taken word for word from the abstract
- population patients with external genital warts (EGWs) and their sex partners
- primaryOutcome to describe and evaluate current information and practice regarding the diagnosis, treatment, and evaluation of patients with external genital warts (EGWs) and their sex partners
- result No one treatment is ideal for all patients or all warts.
- intervention to provide information about the infectivity, diagnosis, treatment, and natural history of EGWs
Clin Infect Dis · PMID 9798036 · Read it on PubMed ↗
Critchlow et al. 1998
Effect of HIV infection on the natural history of anal human papillomavirus infection
Didn't directly study whether warts clear.Prospective cohortLow qualityRelated question
609 people1998
HIV-positive men were less likely to become HPV-negative over follow-up than HIV-negative men, and anal warts were linked to HPV detection but wart clearance itself was not tracked
Who was studied
homosexual men attending a clinic, some with HIV and some without
What they received
no treatment given; natural history observed over time
Compared with
HIV-positive men compared with HIV-negative men
Main outcome
detection, new infection, and clearance of anal HPV virus over time
Quality
This study tracks HPV virus detection in the anal canal over time, not whether visible warts themselves go away, so it only indirectly bears on the question.
Limitations
The abstract reports on HPV DNA detection and persistence, not specifically on resolution of visible anal warts; no information on wart-specific outcomes or duration of follow-up is given.
Taken word for word from the abstract
- population 287 HIV-seronegative and 322 HIV-seropositive men attending a community-based clinic
- n 287 HIV-seronegative and 322 HIV-seropositive men attending a community-based clinic
- intervention Longitudinal study of 287 HIV-seronegative and 322 HIV-seropositive men
- comparator HIV-seropositive and seronegative homosexual men
- primaryOutcome To identify risk factors for the detection of prevalent and incident anal human papillomavirus (HPV) infection, and HPV persistence
- result Becoming HPV negative during follow-up was less common among men with HIV or high HPV levels at study entry.
- result HPV detection was associated with lifetime number of sexual partners and recent receptive anal intercourse (HIV-seronegative men), decreased CD4+ lymphocyte count (HIV-seropositive men), and anal warts (all men).
AIDS · PMID 9677167 · Read it on PubMed ↗
Leiserowitz et al. 1997
Detection of serologic neutralizing antibodies against HPV-11 in patients with condyloma acuminata and cervical dysplasia using an in vitro assay
Does not address whether warts resolve.Laboratory studyVery low qualityRelated question
35 people1997
some wart patients had neutralizing antibodies, none of the cervical dysplasia patients did
Who was studied
patients with genital warts (condyloma acuminata) or cervical cell changes (cervical intraepithelial neoplasia)
What they received
testing patient blood serum for HPV-11 neutralizing antibodies
Compared with
patients with cervical dysplasia (CIN) versus those with genital warts (CA)
Main outcome
presence of neutralizing antibodies against HPV-11 in blood serum
Quality
This is a small laboratory antibody-detection study that does not follow patients over time or report whether their warts resolved.
Limitations
Small number of patients, no clinical follow-up of wart outcomes, lab-based assay only.
Taken word for word from the abstract
- population patients with condyloma acuminata (CA) or cervical intraepithelial neoplasia (CIN)
- n Eleven (of 20) patients with CA
- n None of 15 patients with CIN had detectable neutralizing antibodies against HPV-11.
- intervention Sera previously characterized for reactivity to HPV-11 and HPV-11 VLP (virus-like particles) by ELISA were tested for the ability to prevent HPV-11 in vitro infectivity.
- comparator None of 15 patients with CIN had detectable neutralizing antibodies against HPV-11.
- primaryOutcome This study was designed to investigate if neutralizing antibodies against HPV-11 are detectable in the serum of patients with condyloma acuminata (CA) or cervical intraepithelial neoplasia (CIN)
- result Five of these 11 patients also had detectable levels of neutralizing antibodies in their serum.
Gynecol Oncol · PMID 9264579 · Read it on PubMed ↗
Reid 1996
The management of genital condylomas, intraepithelial neoplasia, and vulvodynia
No clear answer on resolution.Narrative reviewVery low qualityRelated question
size not given1996
unclear whether warts resolve on their own; natural history remains poorly understood
Who was studied
people exposed to HPV who appear healthy
What they received
current management, mainly repeated local destruction of warts
Main outcome
natural history and course of HPV-related disease
Quality
This is a general review article discussing management strategies without presenting original study data or outcome measurements on wart resolution.
Limitations
The abstract states the natural history of HPV disease is poorly understood and that no effective medical therapy or vaccine exists; it discusses genital condylomas broadly rather than anal warts specifically.
Taken word for word from the abstract
- population Screening of apparently healthy populations suggests that most HPV exposure results only in latent infection
- intervention the management of HPV-induced disease remains rooted to the strategy of repeated local destruction
- primaryOutcome The natural history of HPV-related disease still is poorly understood.
- result The natural history of HPV-related disease still is poorly understood.
Obstet Gynecol Clin North Am · PMID 8989781 · Read it on PubMed ↗
Arany et al. 1996
Status of local cellular immunity in interferon-responsive and -nonresponsive human papillomavirus-associated lesions
Does not address spontaneous wart clearance.Laboratory studyVery low qualityRelated question
size not given1996
Nonresponders to interferon had depleted Langerhans cells, reduced MHC and cytokine expression, while responders showed strong immune cell recruitment against HPV-infected cells
Who was studied
patients with anogenital warts (condyloma acuminatum) who later received interferon treatment
What they received
pretreatment local cellular immune response measured in wart biopsies
Compared with
patients who responded well to interferon therapy versus those who responded poorly
Main outcome
local cell-mediated immune markers (Langerhans cells, MHC expression, cytokine mRNA, T-cell recruitment) in wart tissue
Quality
This is a small mechanistic lab study of immune markers, not a clinical trial measuring whether warts actually clear, and it does not report participant numbers.
Limitations
No participant numbers given, no clinical wart clearance outcomes reported, focuses on molecular/immune markers rather than wart resolution.
Taken word for word from the abstract
- population patients with condyloma acuminatum, who later received IFN treatment and responded well or poorly to that therapy
- intervention the authors determined the pretreatment status of local cell-mediated immune response to HPV infection by reverse transcription-polymerase chain reaction
- comparator patients with condyloma acuminatum, who later received IFN treatment and responded well or poorly to that therapy
- primaryOutcome biopsies from nonresponders were depleted markedly in Langerhans cells, leading to decreases in major histocompatibility complex class II expression
- result responders demonstrated high macrophage-natural killer cell (CD16-positive) and activated CD4 (IL-2, interferon gamma-positive, TH1 cells) T-cell recruitment against HPV-infected keratinocytes
Sex Transm Dis · PMID 8946632 · Read it on PubMed ↗
Vargas-Hernández 1996
[Human Papilloma virus. Epidemiologic, carcinogenic, diagnostic and therapeutic aspects]
Sometimes clears on its ownNarrative reviewVery low qualityRelated question
size not given1996
clinical picture is variable, with some spontaneous remission, but infection sometimes cannot be eradicated from the genital tract
Who was studied
women with HPV infection
What they received
clinical treatment of HPV based on experience
Main outcome
natural course and treatment outcome of HPV infection
Quality
this is a general narrative review of HPV with no study data, numbers, or specific methodology given
Limitations
abstract gives no study design details, no patient numbers, and discusses HPV infection generally rather than anal warts specifically
Taken word for word from the abstract
- population Human Papillomavirus (HPV) is the most common infection among women.
- result Clinical picture is variable even with spontaneous remission.
- result Sometimes can not eradicated since just it is impossible make to disappear it from genital tract.
- primaryOutcome Natural History of HPV infection has changed as well as diagnosis and treatment.
- intervention The disease can be treated according to clinical experience.
Ginecol Obstet Mex · PMID 8964543 · Read it on PubMed ↗
Stone 1995
Human papillomavirus infection and genital warts: update on epidemiology and treatment
Treatment effectiveness unclear; natural course not studied hereNarrative reviewLow qualityRelated question
size not given1995
no single treatment worked better than another, and warts often came back after any treatment
Who was studied
people with exophytic genital warts
What they received
various treatments: podofilox, podophyllin, cryotherapy, 5-fluorouracil, interferon, laser surgery
Compared with
treatments compared against each other
Main outcome
treatment efficacy and recurrence after treatment
Quality
this is a narrative literature review of treatments, not a study of spontaneous resolution, and it explicitly states the natural history of genital warts is not well understood.
Limitations
the abstract states little is known about the natural history of genital warts and subclinical HPV infection, and the review covers genital warts generally rather than anal warts specifically or spontaneous resolution without treatment
Taken word for word from the abstract
- population genital warts
- intervention podofilox (which was recently approved by the Food and Drug Administration), podophyllin, cryotherapy, topical 5-fluorouracil, intralesional interferon, systemic interferon, and laser surgery
- comparator No single treatment modality was superior to another
- primaryOutcome recurrence rates associated with all modalities were high
- result No single treatment modality was superior to another, and recurrence rates associated with all modalities were high.
- limitations little is known about the infectivity and natural history of exophytic genital warts or subclinical genital infection with human papillomavirus
Clin Infect Dis · PMID 7540876 · Read it on PubMed ↗
Li et al. 1995
Detection with the polymerase chain reaction of human papillomavirus DNA in condylomata acuminata treated with CO2 laser and microwave
Microwave destroyed wart virus DNA more than laser.Laboratory studyVery low qualityRelated question
12 people1995
Virus DNA was found in all untreated samples, fewer laser-treated samples, and even fewer microwave-treated samples
Who was studied
women with genital wart tissue (vulvar condylomata) surgically removed
What they received
wart tissue treated with CO2 laser or microwave in the lab
Compared with
untreated wart tissue from the same patients
Main outcome
whether wart virus (HPV) DNA could still be detected in the tissue after treatment
Quality
This is a small lab experiment on excised tissue, not a study of whether warts clear up in real patients over time.
Limitations
Only 12 specimens, tissue was tested once right after removal rather than following patients over time, and it does not address whether warts resolve without any treatment.
Taken word for word from the abstract
- population Twelve specimens of condylomata acuminata of the vulva were excised from 12 patients
- n excised from 12 patients
- intervention the second and the third parts were treated with CO2 laser and microwave, respectively
- comparator One part was untreated
- primaryOutcome DNA was then extracted from tissue by proteolytic digestion and amplified by the polymerase chain reaction
- result HPV DNA was amplified in 100% of untreated specimens (6-HPV 6; 6-HPV 11), and in 83.3% and 50% of specimens treated with CO2 laser and microwave, respectively.
Int J Dermatol · PMID 7751101 · Read it on PubMed ↗
Breese et al. 1995
Anal human papillomavirus infection among homosexual and bisexual men: prevalence of type-specific infection and association with human immunodeficiency virus
HPV infection often persisted, not cleared.Prospective cohortLow qualityRelated question
209 people6 months
HPV infection persisted in most men, more often in those with more severe HIV-related immune suppression
Who was studied
homosexual and bisexual men, some HIV-positive and some HIV-negative
What they received
no treatment given; anal HPV infection followed over time
Compared with
HIV-negative men compared to HIV-positive men with different CD4 counts
Main outcome
persistence of anal HPV infection detected by anal swab testing over 6 months
Quality
This is an observational study in a specific high-risk population (HIV-positive and negative gay/bisexual men) that tracked HPV DNA persistence, not specifically whether visible anal warts resolved, so it only indirectly addresses the question.
Limitations
Small subgroup numbers (especially for men with AIDS/ARC), focus on HPV DNA detection rather than clinical wart resolution, and a selected population not representative of all people with anal warts.
Taken word for word from the abstract
- population 93 HIV-seropositive (HIV+) and 116 HIV-seronegative (HIV-) homo-sexual/bisexual men
- n 93 HIV-seropositive (HIV+) and 116 HIV-seronegative (HIV-) homo-sexual/bisexual men
- intervention with testing of anal swabs for HPV DNA by Virapap/Viratype assay
- comparator HPV prevalence increased with declining CD4 cell count: 33% with counts of more than 750, 56% with counts of 200 to 750, and 86% with counts less than 200
- primaryOutcome Persistence of anal HPV for 6 months was more common among men with AIDS/ARC (95%) than among asymptomatic HIV+ men (62%) or HIV- men (61%)
- result Persistence of anal HPV for 6 months was more common among men with AIDS/ARC (95%) than among asymptomatic HIV+ men (62%) or HIV- men (61%) (P < .05).
Sex Transm Dis · PMID 7709329 · Read it on PubMed ↗
Rusconi et al. 1994
Serum 2'-5'-oligoadenylate synthetase levels and clinical response to interferon-beta therapy in women with genital human papillomavirus infection
Not relevant to warts clearing alone.Randomised trialVery low qualityRelated question
size not given3 months
higher baseline enzyme levels predicted failure to respond to interferon-beta treatment
Who was studied
women with genital HPV infection
What they received
interferon-beta injections
Compared with
untreated controls
Main outcome
blood marker (2'-5'OAS enzyme) levels and treatment response
Quality
This study is about a lab blood marker predicting drug response, not about whether warts resolve without treatment, and does not report participant numbers.
Limitations
No participant numbers reported; focuses on a biochemical marker rather than wart outcomes; no untreated natural history data on wart resolution.
Taken word for word from the abstract
- population women with genital human papillomavirus (HPV) infection
- intervention parenterally administered interferon-beta (IFN-beta)
- comparator untreated controls
- primaryOutcome serum 2'-5'-oligoadenylate synthetase (2'-5'OAS), an enzyme induced by IFNs, was measured before, during, and after therapy
- result women with genital HPV infection and elevated baseline levels of 2'-5'OAS are unlikely to respond to therapy with IFN-beta
- followUp not responding to treatment at 3 months of follow-up
J Infect Dis · PMID 8169403 · Read it on PubMed ↗
Nahhas et al. 1993
'Abnormal' Papanicolaou smears and colposcopy in pregnancy: ante- and post-partum findings
Most abnormal findings persisted after birthProspective cohortLow qualityRelated question
73 people4 months
only a few patients showed partial regression; most still had abnormal findings 4 months after delivery despite normal cytology
Who was studied
pregnant women with genital warts or abnormal Pap smears
What they received
no treatment during pregnancy, observed after delivery
Compared with
same patients' findings before versus after delivery
Main outcome
whether abnormal cervical/genital HPV findings resolved after delivery
Quality
small, uncontrolled group of pregnant women followed only briefly, and it looks at cervical/genital HPV findings generally rather than anal warts specifically.
Limitations
No control group, short follow-up, focuses on cervical/colposcopic findings in pregnancy rather than anal warts, and relies on cytology which was shown to be unreliable for predicting true status.
Taken word for word from the abstract
- n Seventy-three pregnant patients were examined by colposcopy because of genital warts and/or abnormal Papanicolaou smears.
- population Seventy-three pregnant patients were examined by colposcopy because of genital warts and/or abnormal Papanicolaou smears.
- intervention the post-partum outcome of the untreated ante-partum abnormal cytologic smear and colposcopy has not been defined clearly
- comparator Cytologic, colposcopic and histologic re-evaluation was conducted after delivery.
- primaryOutcome It is concluded that a few pregnant patients may have partial regression of clinical HPV infection and abnormal cytology and colposcopy after delivery.
- result However, the majority will continue to have abnormal findings 4 months following delivery in spite of normal post-partum cytology and even colposcopy.
Int J Gynecol Cancer · PMID 11578352 · Read it on PubMed ↗
Kesner 1993
Extensive condylomata acuminata of male urethra: management by ventral urethrotomy
One case resolved untreated; others recurred or worsened.Case seriesVery low qualityRelated question
4 people1 year
most needed repeat surgery for recurrence; one case resolved on its own after a year without treatment, another progressed to cancer
Who was studied
men with severe wart infections inside the urethra
What they received
surgical cutting open of the urethra to remove warts
Compared with
no comparator, case series of surgical treatment
Main outcome
whether warts cleared up and complications after treatment
Quality
This is just 4 patients followed with no comparison group, so it cannot reliably show what usually happens to warts.
Limitations
Very small number of patients, two lost to follow-up, and this is about urethral warts treated surgically rather than untreated anal warts in general.
Taken word for word from the abstract
- n 4 males with extensive intraurethral warts
- population 4 males with extensive intraurethral warts presented with marked inflammation of the external genitalia
- intervention all patients underwent ventral urethrotomy, in which the urethra was divided median as far back as was necessary to expose all of the warts
- comparator Surgical and electro-excision were the preferred methods of removal
- primaryOutcome Of 3 patients who developed recurrences 2 were lost to follow-up
- result A third remained without treatment for 1 year and when next seen the warts had spontaneously resolved and his urethra was closed
- followUp remained without treatment for 1 year
Br J Urol · PMID 8461956 · Read it on PubMed ↗
Tosi et al. 1993
Use of antibodies against a synthetic peptide of the E6 protein of human papillomavirus (HPV) type 16 for the diagnosis of genital HPV lesions
Not about anal wart regression.Laboratory studyVery low qualityRelated question
41 people1993
staining patterns differed by HPV type, and among HPV16 lesions, intense staining was more common in lesions that progressed than in those that spontaneously regressed
Who was studied
patients with genital lesions caused by HPV (cervical lesions and genital warts from HPV types 16, 6, 11, 18)
What they received
antibody staining test to detect an HPV16 E6 protein marker in tissue biopsies
Compared with
different HPV types and lesion types (HPV6, HPV11, HPV18 vs HPV16; CIN vs non-CIN)
Main outcome
whether lesions stained positive for the HPV16 E6 antibody and how this related to lesion behavior
Quality
This is a small laboratory staining study not designed to test whether anal warts resolve on their own, and it barely touches on regression in a different context (cervical lesions, not anal warts).
Limitations
Small numbers in subgroups, focuses on cervical and mixed genital lesions rather than anal warts specifically, and is a diagnostic/laboratory study rather than a clinical outcome study of wart regression.
Taken word for word from the abstract
- population a series of 41 paraffin-embedded biopsies including 29 cases of HPV 16-associated cervical lesions, five HPV 6, four HPV 11, and three HPV 18-associated genital warts
- intervention The antibodies obtained were used for the immunohistochemical analysis
- comparator 2/5 (40%) of the HPV 6, in 2/4 (50%) of the HPV 11, and in 3/3 of HPV 18 lesions
- primaryOutcome Expression of a reacting molecule (both intranuclear and cytoplasmic) could be demonstrated
- result In the HPV 16 group, intense reactivity was more frequent in lesions shown to make clinical progression (8/9, 89%) as compared with those which underwent spontaneous regression (10/15, 66.7%)
- n a series of 41 paraffin-embedded biopsies
Cytopathology · PMID 8384016 · Read it on PubMed ↗
Campion 1991
Clinical manifestations and natural history of genital human papillomavirus infection
No specific finding reported.Narrative reviewVery low qualityRelated question
size not given1991
not stated; the abstract only discusses the broader scope of research into HPV biology and clinical spectrum, with no specific findings on wart resolution
Who was studied
people with genital HPV types
Main outcome
the clinical profile of disease associated with genital HPV types
Quality
This is a general narrative review that only discusses the scope of HPV research without reporting any study data or outcomes.
Limitations
The abstract provides no methods, no patient outcomes, and no information about whether anal warts resolve without treatment.
Taken word for word from the abstract
- population disease associated with genital HPV types
- primaryOutcome the clinical profile of disease associated with genital HPV types is much broader than previously recognized
- result It is not surprising, therefore, that the clinical profile of disease associated with genital HPV types is much broader than previously recognized.
Dermatol Clin · PMID 1647903 · Read it on PubMed ↗
Jenson et al. 1991
Tissue effects of and host response to human papillomavirus infection
Immune response may clear warts.Narrative reviewVery low qualityRelated question
size not given1991
regression of warts depends on the body's immune response to HPV
Who was studied
people with HPV infections causing warts or condylomata
What they received
no specific treatment (natural course of infection)
Compared with
treated lesions or immune response variation
Main outcome
whether warts/condylomata go away on their own
Quality
this is a general review of virology and immunology, not a study measuring how often warts clear on their own
Limitations
abstract does not report a specific study, patient numbers, or follow-up time; discusses general immunologic mechanisms rather than clinical outcomes
Taken word for word from the abstract
- population benign lesions
- intervention Spontaneous regression or successful treatment of the benign lesions appears to depend on either naturally acquired or iatrogenically related stimulation of HPV type-specific immunity.
- comparator successful treatment of the benign lesions
- primaryOutcome Spontaneous regression or successful treatment of the benign lesions
- result Spontaneous regression or successful treatment of the benign lesions appears to depend on either naturally acquired or iatrogenically related stimulation of HPV type-specific immunity.
Dermatol Clin · PMID 1647900 · Read it on PubMed ↗
Courtial et al. 1991
[Spontaneous regression of flat condylomata of the cervix]
Most cervical HPV changes cleared untreated.Prospective cohortLow qualityRelated question
146 people18 months
among women with CIN 1, 65.2% had a negative smear within 18 months without treatment
Who was studied
women with HPV infection of the cervix found on a smear test, mostly with mild cervical cell changes (CIN 1)
What they received
no treatment, just advice to use condoms
Compared with
no comparator, natural course observed over time
Main outcome
whether the smear test became negative (infection cleared) over time
Quality
this is an uncontrolled observational study of cervical HPV changes, not anal warts, with no comparison group and no randomization.
Limitations
no control group, patients came from outpatient clinics and may differ from hospital-referred patients, and findings concern cervical not anal lesions
Taken word for word from the abstract
- n 146 patients with a human papilloma virus infection of the cervix detected on cervical smear
- population 146 patients with a human papilloma virus infection of the cervix detected on cervical smear
- intervention No treatment was carried out on these patients except for advising the use of condoms.
- comparator No treatment was carried out on these patients except for advising the use of condoms.
- primaryOutcome 65.2% of them had a negative smear within 18 months
- result Among the 123 women whose diagnosis was CIN 1, 65.2% of them had a negative smear within 18 months.
J Gynecol Obstet Biol Reprod (Paris) · PMID 1885888 · Read it on PubMed ↗
Mohanty et al. 1990
Cryotherapy in the management of histologically diagnosed subclinical human papilloma virus (HPV) infection of the cervix
Cryotherapy reduced wart recurrence.Prospective cohortLow qualityRelated question
63 people18 months
cryotherapy reduced the rate of developing visible cervical warts compared to no treatment
Who was studied
women with genital warts who had subclinical HPV infection of the cervix
What they received
cryotherapy treatment of subclinical cervical HPV
Compared with
untreated patients with subclinical cervical HPV infection
Main outcome
development of clinical cervical warts after treatment
Quality
This was a non-randomized comparison of treated versus untreated patients with small subgroup numbers, not a controlled trial of natural resolution.
Limitations
Not randomized; compares cryotherapy treatment to an untreated group rather than studying natural resolution of anal warts specifically.
Taken word for word from the abstract
- population Women with genital warts who had subclinical HPV infection of the cervix and no other sexually transmitted diseases
- intervention treatment with cryotherapy
- comparator In the untreated group development of clinical warts was noticed in five patients (20%) after 18 months.
- primaryOutcome Twelve weeks after treatment only one patient developed clinical warts on the cervix, which increased to three patients (4.8%) after 12 months.
- result The failure rate for the histologically diagnosed subclinical HPV infection was 38% in the treated group, whereas it persisted in 76% of the untreated group.
- n Sixty-three of them had subclinical HPV infection of the cervix only, and were considered suitable for cryosurgery.
Br J Clin Pract · PMID 1966312 · Read it on PubMed ↗
Laval et al. 1990
[Human papillomavirus infections of the cervix uteri. Clinical implications, indications of typing]
Cervical HPV lesions often cleared on their ownProspective cohortLow qualityRelated question
224 people1990
HPV infection and even some abnormal cervical cell changes disappeared on their own without treatment in many patients
Who was studied
women with HPV infection of the cervix
What they received
no treatment, just follow-up observation of HPV infection/lesions
Compared with
treatment of cervical lesions when needed
Main outcome
whether HPV infection and cervical lesions went away over time
Quality
This is an observational study of a different body site (cervix, not anus) with no control group formally comparing treatment versus no treatment.
Limitations
Observational cohort without a formal untreated control group; abstract is truncated and gives no clear follow-up duration per patient.
Taken word for word from the abstract
- n We carried out a prospective anatomo-clinical study on 224 HPV positive women followed in the Rene Huguenin Centre, from April 1984 to December 1988.
- population 224 HPV positive women followed in the Rene Huguenin Centre
- intervention In some cases, a simple follow-up showed a spontaneous resolution of the lesion and of the virus.
- comparator These patients were followed up and treated when necessary for cervical intra-epithelial neoplasia (CIN) or carcinoma
- primaryOutcome This virus disappeared spontaneously during follow-up; therefore, HPV infection even oncogene, did not necessarily carry onto CIN.
- result In some cases, a simple follow-up showed a spontaneous resolution of the lesion and of the virus.
J Gynecol Obstet Biol Reprod (Paris) · PMID 2177486 · Read it on PubMed ↗
Lehnen 1988
[Condylomata acuminata and mode of delivery]
Warts went away after delivery.Case seriesVery low qualityRelated question
3 people8 weeks
all three patients had spontaneous regression of warts eight weeks after delivery
Who was studied
pregnant women with severe genital condylomata acuminata (anal/genital warts)
What they received
cesarean section delivery (no treatment of warts)
Compared with
none (natural course after delivery)
Main outcome
regression of genital warts after delivery
Quality
This is a tiny case series of only three patients with no control group, so it cannot reliably show what happens generally.
Limitations
Only three cases, no comparison group, and delivery was by cesarean section rather than observing untreated natural progression.
Taken word for word from the abstract
- n The present paper describes three caes in which cesarean section was performed because of severe genital invasion by condylomata acuminata.
- population three caes in which cesarean section was performed because of severe genital invasion by condylomata acuminata
- intervention cesarean section was performed because of severe genital invasion by condylomata acuminata
- comparator Eight weeks after delivery, there was a spontaneous regression of the condition in all three patients.
- primaryOutcome there was a spontaneous regression of the condition in all three patients
- result Eight weeks after delivery, there was a spontaneous regression of the condition in all three patients.
Z Geburtshilfe Perinatol · PMID 3400301 · Read it on PubMed ↗
Krebs 1987
The use of topical 5-fluorouracil in the treatment of genital condylomas
Addresses 5-FU treatment, not spontaneous resolution.Narrative reviewVery low qualityRelated question
size not given1987
once/twice weekly 5-FU for 10 weeks was as effective as continued regimens but better tolerated, and periodic use helped prevent recurrence after surgical removal
Who was studied
people with genital warts (vulvar and vaginal condylomas), including cases resistant to other treatments
What they received
topical 5-fluorouracil (5-FU) applied to vagina or vulva
Compared with
continued (more frequent) 5-FU application regimens
Main outcome
effectiveness of treating condylomas and preventing recurrence after removal
Quality
this is a narrative review discussing treatment opinions without reporting patient numbers or study data, so it carries little evidential weight.
Limitations
No sample size, no study design details, no data on untreated or spontaneous resolution of warts are reported.
Taken word for word from the abstract
- population extensive untreated vulvar condylomas
- population therapy-resistant condylomas
- intervention Topical 5-FU is indicated for therapy-resistant condylomas
- intervention Applications of 5-FU once weekly to the vagina and twice weekly to the vulva for 10 weeks
- comparator appear to be as effective as continued regimens but are better tolerated
- primaryOutcome periodic application for prevention of recurrences of condylomas removed by surgical methods
- result Applications of 5-FU once weekly to the vagina and twice weekly to the vulva for 10 weeks appear to be as effective as continued regimens but are better tolerated.
- result Perhaps the greatest value of 5-FU lies in the periodic application for prevention of recurrences of condylomas removed by surgical methods.
Obstet Gynecol Clin North Am · PMID 3323965 · Read it on PubMed ↗
Weck et al. 1986
Interferons in the treatment of human papillomavirus diseases
Doesn't address spontaneous clearance.Narrative reviewVery low qualityRelated question
size not given1986
Interferons caused objective regression of warts but had side effects; no data on natural resolution without treatment
Who was studied
people with HPV-related warty diseases, including genital warts
What they received
interferon treatment
Main outcome
regression of warts
Quality
This is a narrative review discussing interferon treatment, not a study of untreated warts, so it gives no evidence on spontaneous resolution.
Limitations
Abstract is a general review of interferon therapy, not a controlled study, and does not address whether warts resolve without treatment.
Taken word for word from the abstract
- population epithelioproliferative benign neoplasms, both trivial and life-threatening, are caused by subtypes of human papillomaviruses
- intervention Interferons objectively regress HPV-induced warty disease
- primaryOutcome Interferons objectively regress HPV-induced warty disease and affect the regrowth of the transformed epithelium
- result Interferons effectively control the most serious and potentially life-threatening papillomavirus associated diseases, respiratory papillomatosis and genital warts, but not without the anticipated side effects associated with this potent biological weapon.
Cancer Metastasis Rev · PMID 2435427 · Read it on PubMed ↗
Stein et al. 1985
The use of the Nd:YAG laser in urology
Laser cleared warts; no untreated comparison.Case seriesVery low qualityRelated question
7 people1985
all patients had excellent results without complication
Who was studied
patients with genital warts (condylomata acuminata) treated urologically
What they received
Nd:YAG laser therapy
Compared with
none reported
Main outcome
treatment success and complications
Quality
This is a tiny, uncontrolled case series of only seven wart patients with no comparison group and no mention of spontaneous resolution.
Limitations
No control group, very small number of wart patients, no follow-up duration given, and the study does not address whether warts resolve without treatment.
Taken word for word from the abstract
- n Seven patients with condylomata acuminata were treated with laser therapy.
- population Seven patients with condylomata acuminata were treated with laser therapy.
- intervention Seven patients with condylomata acuminata were treated with laser therapy.
- comparator Seven patients with condylomata acuminata were treated with laser therapy.
- primaryOutcome All had excellent results without complication.
- result All had excellent results without complication.
Lasers Surg Med · PMID 3838788 · Read it on PubMed ↗
Wilkinson et al. 1984
Association of Fanconi's anemia and squamous-cell carcinoma of the lower female genital tract with condyloma acuminatum. A report of two cases
Warts linked to cancer, not resolutionCase seriesVery low qualityRelated question
2 people1984
both women developed multicentric genital cancer after having condyloma acuminatum, and one died of vaginal cancer
Who was studied
two young women with Fanconi's anemia and genital HPV infection
What they received
no treatment intervention studied — natural history observation
Compared with
none reported
Main outcome
development of genital squamous-cell carcinoma following condyloma acuminatum
Quality
Only two case reports in women with a rare genetic disorder, so it says nothing reliable about whether warts resolve on their own in typical patients.
Limitations
Only two cases, both with Fanconi's anemia, a rare condition that may not reflect typical patients with anal/genital warts; abstract does not address spontaneous resolution at all.
Taken word for word from the abstract
- n Two young women had Fanconi's anemia and genital human papillomavirus infection associated with multicentric genital neoplasia.
- population Two young women had Fanconi's anemia and genital human papillomavirus infection associated with multicentric genital neoplasia.
- primaryOutcome The finding of condyloma acuminatum in both of them prior to the onset of carcinoma suggests a partial causal association.
- result One of these women represented the first documented case of death from vaginal squamous carcinoma associated with Fanconi's anemia.
- intervention The finding of condyloma acuminatum in both of them prior to the onset of carcinoma suggests a partial causal association.
- comparator Involvement of the cervix, vagina, vulva and perianal epithelium by the oncogenic process implies that a field effect occurred in those areas.
J Reprod Med · PMID 6481701 · Read it on PubMed ↗
Mambo 1983
Isoantigen status in condyloma acuminata of the uterine cervix: an immunoperoxidase study
Did not actually study wart regression.Laboratory studyVery low qualityRelated question
size not given1983
Most warts showed some or complete loss of isoantigens, which the authors link to cancer risk, not regression
Who was studied
women with genital warts (condyloma acuminata) of the cervix
What they received
testing cervical wart tissue for blood isoantigen status using immunoperoxidase technique
Compared with
no comparator group; different degrees of isoantigen loss within same sample
Main outcome
whether wart cells showed loss of blood group isoantigens
Quality
This is a small lab study on cervical tissue that speculates about regression rather than actually measuring whether warts went away.
Limitations
Studies cervical warts, not anal warts; does not actually follow patients to see if warts regressed; number of specimens not stated; conclusions about regression are speculative.
Taken word for word from the abstract
- population blood isoantigen status in condyloma acuminata
- intervention The immunoperoxidase technic was used to investigate the blood isoantigen status in condyloma acuminata
- comparator Complete isoantigen loss was seen in 33% of cases, partial loss in 47%, and retention in 20%.
- primaryOutcome the purpose of the study was to determine if koilocytotic atypias are associated with isoantigen loss
- result Complete isoantigen loss was seen in 33% of cases, partial loss in 47%, and retention in 20%.
- result Isoantigen retention may identify those epithelial atypias that undergo spontaneous regression.
Am J Clin Pathol · PMID 6297292 · Read it on PubMed ↗
Scott et al. 1979
Effect of injections of small doses of human fibroblast interferon into genital warts. A pilot study
Interferon slightly slowed wart growth versus placebo.Case seriesVery low qualityRelated question
11 peopletwo weeks
interferon-treated warts grew less than placebo-treated ones, and in one patient a treated wart disappeared while an untreated wart grew
Who was studied
male patients with genital warts
What they received
interferon injected into the base of a wart
Compared with
placebo injected into the base of another wart
Main outcome
change in size of the treated warts compared with controls
Quality
Only 11 patients, no clear randomization, and warts still received an injection rather than being left completely untreated, so it can't show what happens with no treatment at all.
Limitations
The dose given was probably insufficient for a dramatic effect, and this is a small pilot study using genital (not specifically anal) warts with injections in both arms rather than a true untreated comparison.
Taken word for word from the abstract
- population Eleven male patients with genital warts
- intervention were given injections of fibroblast interferon (300 u) and placebo into the bases of two similar warts
- comparator placebo into the bases of two similar warts
- primaryOutcome The changes in size of the treated warts compared with that of the controls
- result suggested that interferon did inhibit the growth of the warts
- result a wart on the penile shaft was injected with interferon and did disappear within two weeks whereas an untreated meatal wart increased in size
- n Eleven male patients
- followUp did disappear within two weeks
Br J Vener Dis · PMID 526848 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-13
The exact search — paste this into PubMed to repeat it: ("Condylomata Acuminata"[Mesh] OR "anal warts"[tiab] OR "anogenital warts"[tiab] OR "genital warts"[tiab]) AND ("spontaneous regression"[tiab] OR "spontaneous resolution"[tiab] OR "natural history"[tiab] OR "untreated"[tiab] OR "watchful waiting"[tiab] OR "remission, spontaneous"[Mesh]); PubMed expanded that to: ("Condylomata Acuminata"[MeSH Terms] OR "anal warts"[Title/Abstract] OR "anogenital warts"[Title/Abstract] OR "genital warts"[Title/Abstract]) AND ("spontaneous regression"[Title/Abstract] OR "spontaneous resolution"[Title/Abstract] OR "natural history"[Title/Abstract] OR "untreated"[Title/Abstract] OR "watchful waiting"[Title/Abstract] OR "remission, spontaneous"[MeSH Terms])
What came back: 208 records found · 200 read · 75 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

208records came back from the search
200were read
75actually answered the question

Risks and safetyReported side effects and who should be careful.

Choosing to wait means living with visible warts that may grow or stay the same while you wait to see if they clear on their own, since reviewing the evidence shows untreated warts can grow, stay unchanged, or spontaneously regress, with no way to know in advance which will happen.
Very rarely, warts that are left untreated or do not respond to treatment can grow into large, locally invasive masses (Buschke-Löwenstein tumours) that are hard to treat and can become cancerous; this is not typical for ordinary anal warts.
In people living with HIV, anal warts have been linked to a higher chance of developing more advanced anal disease, including precancerous changes, though this study could not prove the warts themselves caused this.

Why people try thisThe reasoning behind the question — not a claim that it works.

Anal warts are an embarrassing place to have an exam, so many people hope the problem will simply disappear on its own.
Wart treatments like freezing, creams, or minor surgery can be uncomfortable or costly, making 'just waiting' feel like the easier option.
People know that HPV infections and some skin growths elsewhere on the body often clear on their own, and assume anal warts behave the same way.
Online information repeats the idea that 'the immune system clears HPV naturally', which gets applied to visible warts even though that's a different thing.

Common questionsShort answers, drawn from the same studies.

Do anal warts go away?: Sometimes, but in the one randomised trial that tracked an untreated group, only 8% cleared within six months. Most people in that study still had warts without treatment.
Do anal warts go away without treatment?: Not reliably, based on the best available trial. Only a small share of untreated participants cleared their warts in six months, while most people who received treatment cleared theirs.
Are anal warts always caused by HPV, and can they go away on their own?: Yes, anal warts are caused by HPV, usually types 6 or 11. A small number of cases clear on their own within months in trial data, though lower-quality studies suggest clearance over longer periods of a few years is more common, those studies are less reliable.
Do anal warts go away naturally over time?: Possibly, over a longer time frame than has been well studied. No well-controlled trial followed people for years, so how often warts clear up on their own after the first few months is genuinely unknown.
Should I just wait instead of getting treatment?: Based on the trial evidence, waiting alone cleared far fewer people (8%) than active treatment (about 70%) over six months. It's reasonable to get warts checked and treated rather than relying on them disappearing by themselves.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.