HPV Type 31 and Warts
HPV type 31 can occasionally cause visible genital warts, but it is primarily and more importantly associated with cervical dysplasia and cancer rather than typical wart formation.
Primary Association: Dysplasia and Cancer, Not Warts
The evidence consistently demonstrates that HPV 31 is classified as a high-risk oncogenic type rather than a wart-causing type. According to CDC guidelines, visible genital warts are usually caused by HPV types 6 or 11, while HPV types 16,18,31,33, and 35 are strongly associated with cervical dysplasia and neoplasia 1, 2.
When HPV 31 Does Cause Warts
HPV type 31 is found occasionally in visible genital warts and has been associated with external genital squamous intraepithelial neoplasia (vulvar, penile, and anal), including conditions like bowenoid papulosis and squamous cell carcinoma in situ 1, 2. Research confirms this pattern, with one Egyptian study finding HPV 31 in common warts (though at low frequency) 3, and another recent study identifying HPV 31 in anogenital lesions 4.
Critical Clinical Implications
The most important concern with HPV 31 is not wart formation but cancer risk. Recent data shows that among women with HPV 31 infection:
- 10.2% developed CIN2+ lesions overall
- 22.7% of those who underwent biopsy had CIN2+
- Notably, 13.9% of cytology-negative women were diagnosed with CIN2+ on histopathology
- Two invasive cancers occurred in women with isolated HPV 31 and negative cytology 5
Management Approach
When HPV 31 is detected:
Do not treat it as a simple wart case. The priority is cancer screening and surveillance, not wart removal:
If visible warts are present with HPV 31 detection: Treat the warts using standard protocols (cryotherapy, topical agents), but recognize these patients may be co-infected with multiple HPV types 1, 2
Primary focus should be on dysplasia screening: Women require appropriate cervical cancer screening with cytology and colposcopy as indicated, particularly given the high rate of CIN2+ even with negative cytology 5
HPV 31 co-infection with HPV 16/18 significantly increases risk: CIN2+ detection rate jumps to 44.4% versus 6.0% in isolated HPV 31 5
Common Pitfall to Avoid
Do not dismiss HPV 31 as merely a "wart virus." This is a high-risk oncogenic type that warrants cancer surveillance regardless of whether visible warts are present. The presence of warts with HPV 31 detection should prompt evaluation for dysplasia, not just cosmetic wart treatment.