Genital warts – treatment, symptoms and how they’re spread

What are genital warts?

Genital warts are caused by certain types of a virus called the human papillomavirus (HPV). They’re a sexually transmitted disease (STD) – also known as a sexually transmitted infection (STI) – because the virus is usually spread through skin-to-skin contact during sex.

They’re small, fleshy bumps or growths that can appear around or inside your vagina, penis and/or bottom (anus).

You might sometimes hear them called ‘anogenital warts’ or ‘condylomata acuminata’ – these are medical names

Ditch the shame – and get treatment

Genital warts don’t cause serious health problems. But they can be distressing or uncomfortable, and make you feel self-conscious, embarrassed or ashamed.

“Unfortunately, there can still be a stigma attached to STDs, perhaps especially for women,” says Dr Ann Nainan, family doctor and Healthily expert. “This can mean you might not want to accept there’s a problem, or get help for it. But remember, having an STD doesn’t mean you’ve been ‘sleeping around’ – it only takes 1 infected partner.”

Find out more about women and STDs in our eye-opening article.

If you’re worried you might have genital warts, know that:

• they’re really common – the Centers for Disease Control and Prevention (CDC) says about 1 in 100 sexually active US adults has genital warts at any given time
• they’re only caused by certain types of HPV – there are more than 150 types of the virus, and genital warts are mostly caused by only 2 types. So having an HPV infection doesn’t mean you’ll get genital warts (read more about HPV below)
• it’s important to get the right diagnosis – so you can talk to your doctor about your options, and avoid spreading genital warts to other people
• if you do have them, there are good treatments available. You also need to work out if you need to tell a partner. Read more about talking to your partner about an STD

HPV: what you need to know

HPV is thought to be the most common STI in the world. “It’s estimated that about 80% of women will be infected by HPV at least once,” says Dr Ann.

But often, you can have an HPV infection – and pass it on – without knowing it. This can be because:

• you don’t have any symptoms – HPV mostly doesn’t cause any symptoms, such as genital warts
• you have genital warts, but you don’t notice them – because they’re very small, or inside your vagina

In 9 out of 10 cases, HPV goes away on its own without causing any problems – your body can usually fight it off within about 2 years.

But when it doesn’t go away, it can sometimes lead to more serious conditions, including cervical cancer.

Read more about HPV, including how to protect yourself with a shot and regular cervical screening.

Are genital warts contagious?

Yes – genital warts can be spread from person to person through:

• sexual contact – including vaginal, anal and (less commonly) oral sex. This is the most common way they spread
• hand warts – this is rare, and usually in children
• childbirth – if you’re pregnant, it’s possible to pass on genital warts to your baby during the birth, but this is also rare

Preventing genital warts

You can reduce your risk of getting genital warts by:

• getting the HPV shot (vaccine) if you’re under 26 – this targets the viruses that cause genital warts, so helps with prevention (but won’t treat an existing infection). In the US, the CDC recommends the first vaccine dose at 11-12 years old, but you can have it up until the age of 26 (or 45 in some cases – speak to your doctor). Read more about HPV vaccination
• using a condom for vaginal, anal and oral sex – but bear in mind that this doesn’t totally protect you, because genital warts can be on skin that’s not covered by a condom, such as around your vagina or anus
• not sharing sex toys – or if you do, washing them and covering them with a condom before anyone else uses them

Who gets genital warts?

Research suggests that genital warts are most common among sexually active women aged 20-24, and men aged 25-29.

Certain risk factors may mean you’re more likely to get them, including:

• being sexually active from a young age
• having multiple sexual partners over your lifetime
• having sex with someone when you don’t know about their sexual history
• having had another STI
• having a weakened immune system – such as if you have HIV or an organ transplant

What are the symptoms of genital warts?

Here’s what to look out for:

• they usually start off as bumps about 1-2mm in size
• you may have only one genital wart, or multiple warts
• they can be flesh-colored, darker than your skin color, or white or red
• they can feel smooth or rough
• they can look a bit like mini cauliflowers
• they can change size, shape and color over time
• in rare cases, they can bleed, especially if they keep getting rubbed
• you can get them around your genital area, but also on your vagina, the neck of your womb (cervix), around the hole you pee from (urethra) and your anus
• rarely, they can keep growing and affect the surrounding tissue. If you have genital warts in or around your urethra, they can affect your normal flow of pee – so it flows sideways, for example

Do genital warts itch?

In most cases, no. But they can sometimes feel itchy or painful, and they might bleed – especially if they get irritated by friction from your underwear, for example.

What do genital warts feel like?

Here’s how women online have described genital warts symptoms:

“I was peeing in the bathroom at work, and as the pee dripped down, it felt like there was ... something extra down there… I brought my mirror close, and saw, along the curves of my vulva, a few tiny, pale, almost translucent nubby growths, speckled all over like mushrooms in a forest after it rained. I counted maybe 5 of them as I squatted in all sorts of positions in the tiny office bathroom.”

Another woman says:

“I wasn’t itchy. I wasn’t hurting. It was just bumps. I thought it was just irritation from my tampons.”

Read more about what it feels like to have an STI.

Pictures of genital warts

This picture shows genital warts on the labia [Warning: graphic content]
This picture shows genital warts on the penis [Warning: graphic content]

How long do genital warts last?

It depends. In about a third of cases, they disappear without treatment within 6 months.

If you have treatment, it can take weeks or months to work. And genital warts can also come back after treatment – this is thought to happen in between a quarter and two-thirds of people.

This is because the HPV infection can stay in your skin (the treatment doesn’t get rid of the virus) and cause warts again. How long it stays for depends on various things, including your health, age and type of HPV you’re infected with.

So you don’t necessarily need to have sex with someone with genital warts to get them again.

When to see a doctor

Make an appointment to see your doctor if:

• you have symptoms of genital warts
• you don’t have symptoms, but you’ve had sex with someone who may have HPV or genital warts – this is important, because you can still pass on the infection if you don’t have symptoms
• you’re worried about genital warts, or they’re affecting your mental health

How are genital warts diagnosed?

Your doctor or nurse can usually make a diagnosis by:

• asking you about your symptoms and sexual partners
• looking at the affected area – they might need to use a magnifying lens to do this

If they don't think you have genital warts, you might need to be tested for other STIs, such as genital herpes or syphilis.

Genital warts treatment

There’s no treatment for the wart-causing virus, HPV. Although your body usually clears the infection itself within 2 years (read more about HPV testing).

But you can have treatment that gets rid of genital warts. Here’s the lowdown:

• the right genital warts treatment for you depends on things such as their size, where they are, and how many you have
• treatments can take several months to be effective, and don’t always work – or the warts come back – because they don’t get rid of HPV
• not all treatment is suitable during pregnancy
• you may prefer to have no treatment – about 30% of people find that their warts go away on their own within 6 months. In some cases, however, the warts don’t go away, or grow in size and number, so talk to your doctor about the best option for you

Treatment options include:

Genital warts medication

Your doctor might prescribe a cream or ointment that you can apply to the warts yourself, such as:

Imiquimod

• this is a cream you apply for several weeks
• it’s an ‘immune response modifier’ – it works by increasing your immune system’s activity, to fight the warts
• side effects can include skin redness (54% to 61% of people) and itching (20% of people)
• you should avoid unprotected sex when using it – it can irritate your partner and weaken condoms and diaphragms

Podofilox

• this is a solution or gel you apply for up to 4 weeks
• side effects can include mild to moderate inflammation (63% of people), burning (63% of people) and itching (44% to 48% of people)

Sinecatechins

• this is a botanical ointment that that uses green tea extract, which you can apply for up to 16 weeks
• it’s not clear how it treats warts, but it’s thought to have an effect on your immune system
• side effects can include skin redness (70% of people), itching (69% of people) or burning (67% of people)

None of these medications are suitable if you’re pregnant, so speak to your doctor about other options.

Procedures from your doctor

Treatments that can be done by a healthcare professional include:

• cryotherapy – where your warts are frozen off using liquid nitrogen. It’s usually the first treatment option if you’re pregnant. It works best on multiple, small warts that are external – on your vulva, for example. You might need more than 1 treatment, and side effects include pain, swelling and possibly scarring
• laser therapy – with this one-off treatment, a beam of infrared light is used to target your warts. It’s best for larger or more extensive warts in difficult-to-reach areas, such as your urethra. Side effects include mild burning of skin tissue around the wart, but little to no scarring
• electrosurgery – with this one-off procedure, electrical currents are used to destroy your warts, and it’s recommended for external warts. It can be painful, so you might need local or general anesthetic
• trichloroacetic acid or bichloroacetic acid – these acids can be applied directly to the warts to burn them off. It’s a safe treatment for pregnant women. You can have the treatment once a week for 4 to 6 weeks, until the warts have disappeared

Self-care for genital warts

• DON’T use shop-bought wart treatments on genital warts – they’re not suitable for your vagina/vulva/anus
• DO avoid perfumed soaps, shower gels and bath products when you’re having treatment for warts, because they can irritate your skin
• DON’T have vaginal, anal or oral sex until warts have gone
• DO avoid reaching for your cigarettes if you’re a smoker – many genital warts treatments work better when you don’t smoke