Warts Do Not Become More Prevalent in Adults Over 45
Warts actually become less prevalent with increasing age, not more common, even with age-related immune decline. The epidemiological data clearly demonstrates that HPV exposure and new infection rates decrease substantially in older adults, which is the opposite pattern you would expect if age-related immunosenescence were driving increased wart prevalence 1.
Epidemiological Evidence Against Increased Prevalence
The data on HPV infection patterns by age directly contradicts the hypothesis that warts become more common after 45:
In women, the prevalence of anogenital HPV infections declines sharply with age: 17 cases per 100 person-years in ages 15-19, dropping to 10 in ages 20-24,7 in ages 25-29,5 in ages 30-54, and only 1.5 per 100 person-years in those over 55 1
In men, rates remain relatively constant but do not increase: 39 cases per 100 person-years in ages 18-30,41 in ages 31-44, and 33 in ages 45-70 1
Overall prevalence of disease-associated HPV (including wart-causing types 6 and 11) was 24.2% in men and 19.9% in women aged 15-59, with no evidence of increased rates in older age groups 2
Why Exposure Matters More Than Immune Function
The primary driver of wart prevalence is exposure to HPV, not immune competence 1:
HPV acquisition generally occurs soon after first sexual activity, with the highest rates in adolescents and young adults 1
Approximately 39% of college-aged women acquire HPV within 24 months of sexual activity onset 3
Exposure to HPV decreases among older age groups because most adults over 45 are in long-term, mutually monogamous relationships with lower rates of new partner acquisition 1
The Immune Function Paradox
While it's true that immune function declines with age, this does not translate to increased wart prevalence because:
Most adults have developed natural immunity to common HPV types through prior exposure 1
The decline in new infections with age far outweighs any theoretical increase from immunosenescence 1
Adults over 45 who do acquire new HPV infections are typically those with new sexual partners or specific risk factors, not simply due to aging 1
Clinical Implications for Vaccination
The CDC's vaccination recommendations reflect this epidemiological reality:
Routine vaccination is recommended through age 26 when exposure risk remains substantial 1, 4
For ages 27-45, only shared clinical decision-making is recommended (not routine vaccination) because population benefit is minimal 1
The number needed to vaccinate to prevent one case of anogenital warts increases from 9 in the routine program to 120 when extending to ages through 45 1
HPV vaccines are not licensed for use in adults over 45 precisely because the risk-benefit ratio becomes unfavorable 1, 5
Common Pitfall to Avoid
Do not conflate general immunosenescence with increased susceptibility to new HPV infections in adults over 45. The critical factor is exposure opportunity, not immune competence 1. Adults over 45 who present with new warts should prompt evaluation for new sexual partners or immunocompromising conditions (HIV, transplant, immunosuppressive medications) rather than attributing it to normal aging 6.
Special Populations at Higher Risk
The exceptions where warts may be more problematic in older adults include:
Immunocompromised individuals (HIV, organ transplant recipients, those on immunosuppressive therapy) who may have reactivation of latent HPV or difficulty clearing infections 4, 6
Adults with new sexual partners at any age, who face renewed exposure risk 1, 4
Men who have sex with men (MSM) who may have ongoing exposure risk regardless of age 4