I had unprotected sex with a girl about seven years ago. I started getting genital warts about three years later. My doctor said I had HPV. I have been treated by a urologist. The first treatment was with a cream. The warts disappeared and came back. The last two treatments have been to burn them off. Since my last treatment about a month ago, the warts have not returned. In the meantime I have met a lady and am considering marrying her. I just told her about the virus and now I don't know if we will ever get married. I want the relationship to work so bad. What can I say to her about it to encourage her? Would she be able to have kids and not get the virus?

A.M.

Genital warts are caused by the human papilloma virus (HPV). Some of the more than 20 serotypes (strains) of HPV cause warts on the hands and palms; some cause respiratory tract warts; and some cause warts on the genitals and around the anus. Certain serotypes of HPV increase a woman's risk of developing cancer of the cervix (the entrance to the uterus), but the strains that are the most common causes of typical genital warts -- serotypes 6 and 11 -- are the not the same ones that are associated with cervical cancer. Therefore, a woman with large external warts does not necessarily have a greater chance of developing invasive cervical cancer.

In most cases, diagnosing genital warts is done by simple examination of the lesions. They look like typical skin warts, although sometimes they can become quite large. Symptoms are minimal, unless the warts become large enough to interfere with urination (or defecation, in the case of anal lesions). Doctors use a variety of techniques to treat genital warts, including freezing them with liquid nitrogen, surgically removing them, or applying toxic chemicals such as podophyllin (Podofin and others) or a newer cream called imiquimod (Aldara).

I frequently counsel patients about what to tell their sexual partners. The first thing to know is that HPV doesn't involve the same level of concern as two other sexually transmitted infections, HIV and hepatitis B. In fact, although some 10-20 percent of all adults have evidence of genital HPV infection, most infections do not even result in warts. Also, if you have been having sexual relations with this woman for a while, there is a good chance that she is already infected with HPV. Doctors generally don't recommend that a woman in her situation be tested for the virus, mainly because there is nothing you can do to decrease the risk of developing warts once infected. She should definitely have regular Pap smears (a screening test for cancer or precancerous changes in the cervix), but she should be doing this anyway, as part of her routine medical care. As far as prevention of infection, condoms have been shown to decrease but not eliminate the risk of transmission of HPV.

Women infected with HPV can definitely have kids safely. Although the virus is sometimes spread to the newborn, only rarely does a baby develop problems, the most serious being recurrent warts in the respiratory tract. There is no proven way to eliminate the risk of transmitting the virus to the baby. Cesarean section (surgical removal of the baby through an incision in the mother's abdomen and womb) may decrease the risk, but experts currently do not recommend performing this procedure on every woman with genital warts. When you discuss this with your partner, remember that HPV is a very common infection and that many couples deal with these very same issues every day.