What are genital warts?
Genital warts are small fleshy growths, bumps or skin changes that appear on or around the genital or anal area.
Genital warts are very common.
Genital warts are the result of a viral skin infection caused by the human papillomavirus (HPV). They are usually painless and do not pose a serious threat to health. However, they can appear unsightly and cause psychological distress.
Learn more in symptoms of genital warts.
The human papillomavirus (HPV)
The human papillomavirus (HPV) is not a single virus, but a family of over 100 different strains of viruses.
Most cases of infection with HPV cause no visible symptoms. Around 90% of all cases of genital warts are caused by two strains of the virus, type 6 and type 11.
Other strains of HPV can cause cervical cancer. See cervical cancer for more information about this condition.
How do genital warts spread?
Genital warts can be spread during vaginal or anal sex, and by sharing sex toys. However, you do not need to have penetrative sex to pass the infection on because HPV is spread by skin-to-skin contact. Learn more in causes of genital warts.
It can take up to one year for warts to develop after infection with HPV. Therefore, if you are in a relationship and you get genital warts, it does not necessarily mean your partner has been having sex with other people.
HPV is most likely to be transmitted to others when warts are present, although it is still possible to pass the virus on before the warts have developed and after they have disappeared.
Condoms do not provide complete protection because it is possible for the skin around your genital area (not covered by the condom) to become infected.
Learn more in prevention of genital warts.
Genital warts treatment
If you think you have genital warts, see a health professional as they need to be treated.
Wart creams available over-the-counter (OTC) will not work because they are designed to only treat warts on the hands.
You can make an appointment at your local sexual health or genitourinary medicine (GUM) clinic.
You can go to a sexual health clinic whatever age you are. If you're under 16, the service is still confidential and the clinic won't tell your parents.
Several treatments are available, such as creams and cryotherapy (freezing the warts), and they have a good rate of success. However, many treatments can take up to three months before they are fully effective.
If you are diagnosed with genital warts, it is recommended you do not have sex, including anal and oral sex, until your genital warts have fully healed. This will help prevent you passing the infection on to others. It will also help speed your recovery.
Learn more in treating genital warts.
Who is affected?
Genital warts are most common in sexually active teenagers and young adults. The highest rates of genital warts occur in males between 20 to 24 years of age and females between 16 and 19 years of age.
Genital warts symptoms
Genital warts usually appear within two to three months of developing an HPV infection, but gaps of up to a year between HPV infection and the appearance of warts have been reported.
In women, genital warts usually begin as small, gritty-feeling lumps that become larger. In men, the warts look similar to warts that sometimes develop on a person’s hands (firm and raised, with a rough surface).
A person can have a single wart, or clusters of multiple warts that grow together to form a kind of ‘cauliflower’ appearance.
Warts are usually painless, although some people may experience symptoms of itchiness and irritation, particularly if warts develop around the anus (back passage).
Some people experience bleeding from the warts during sex. However, it is recommended you avoid having sex until your genital warts are fully healed. See treatment of genital warts for more information.
Warts that develop near or inside the urethra can disrupt the normal flow of urine. The urethra is the tube connected to the bladder, through which urine passes.
Warts in women
The most common places for genital warts to develop in women are:
- around the vulva (the opening of the vagina), which occurs in 2 out of 3 cases of genital warts
- inside the vagina, which occurs in 1 in 3 cases
- between the vagina and the anus, which occurs in 1 in 3 cases
- around the anus, which occurs in 1 in 4 cases
- on the cervix (the neck of the womb), which occurs in 1 in 10 cases
- at the opening of the urethra, which occurs in 1 in 25 cases
Warts in men
The most common places for genital warts to develop in men are:
- on the shaft of the penis, usually just below the foreskin, which occurs in about half of all cases
- around the anus, which occurs in 1 in 3 cases
- on the glans (the head of the penis), which occurs in 1 in 10 cases
- inside the urethra, which occurs in 1 in 10 cases
- under the foreskin, which occurs in 1 in 12 cases
- between the anus and scrotum (the bag that contains the testicles), which occurs in around 1 in 30 cases
- on the scrotum, which occurs in 1 in 100 cases
When to seek medical advice
Medical advice should always be sought if you suspect you have genital warts. There are three reasons for this:
- It can be easy for people who are not healthcare professionals to mistake a growth, which may be serious, for a genital wart. Therefore, a medical diagnosis is strongly recommended.
- All treatments for genital warts are prescription-only, so you will need to obtain a prescription to get treatment.
- Some treatments should only be applied by a nurse or doctor with appropriate training.
What causes genital warts?
Genital warts are caused by the human papillomavirus (HPV).
HPV targets a type of tissue known as epithelial tissue found on skin, and on the lining of many of the body’s cavities, such as:
- the female genitalia, including the vagina, vulva and cervix
- the anus
- the mouth
The human papillomavirus (HPV) is not a single virus, but a family of over 100 different strains of viruses.
Most cases of HPV infection do not have visible symptoms, so many people can be infected with HPV without realising it.
A few strains of the virus cause genital warts. Around 90% of all cases of genital warts are caused by two strains of the virus, type 6 and type 11.
The most common way HPV can be passed from person to person is during sexual intercourse.
Other forms of sexual activity where HPV can be passed from person to person include oral sex, anal sex, and non-penetrative genital to genital contact.
Less commonly, a mother can pass HPV on to her newborn baby during birth.
Other possible causes
Though no definite links have been proved it has been suggested a person with HPV warts on their hands could pass on an infection by touching somebody else's genitals.
Another theory is that infection could be spread by coming into contact with an object contaminated by HPV, such as bedding or towels.
Genital warts diagnosis
If you think you may have genital warts, visit your local genito-urinary medicine (GUM) clinic (sexual health clinic).
While your doctor will be able to diagnose genital warts, staff at the GUM clinic will have both the access and training required to administer various treatments for genital warts.
Who should go for a check-up?
You should have a check-up if you have obvious signs and symptoms of genital warts, if a recent or current sexual partner develops genital warts or another type of sexually transmitted infection (STI).
You may also wish to have a check-up if:
- you have recently had unprotected sex with a new partner
- you or your partner have had unprotected sex with other partners
- you have another sexually transmitted infection (STI)
- you are pregnant, or planning a pregnancy
All check-ups are free and confidential.
How to diagnose genital warts
Genital warts can usually be easily diagnosed by examining them. At a check-up, the doctor or nurse will examine the warts. They may use a magnifying lens to do this.
Women will also have the inside of their vagina examined using a speculum, which is a specially designed instrument that incorporates a torch and a mirror.
Further testing is usually only required if it is thought there is a higher than average chance that genital warts have developed inside your anus (back passage) or urethra (the tube connected to the bladder, through which urine passes).
Further testing may be recommended if:
- you have recently had anal sex and were the passive partner
- you have warts around your anus
- you have experienced bleeding from your anus or urethra
- your normal urine flow has become distorted
The inside of the anus can be examined with a special metal instrument called a proctoscope. A proctoscope is a small metal tube that incorporates a torch and a magnifying lens.
A similar tool called an endoscope (a thin, flexible tube with a camera at one end) may be used to examine the inside of your urethra.
Genital warts treatment
There are two main types of treatment for genital warts:
- topical treatment, where a cream, lotion or chemical is applied directly to the wart or warts
- physical ablation, where the tissue of the wart is destroyed using external forces, such as lasers or electricity
Different people respond to treatments for genital warts in different ways.
However, topical treatments tend to work better on softer warts, and physical ablation tends to work better on harder and rougher feeling warts. Sometimes, a combination of topical treatment and physical ablation can be used.
Either type of treatment can take several months to remove the warts, so it is important to be patient and persevere with the treatment.
There are several topical treatments that can be used to treat genital warts. These are described below.
Podophyllotoxin is usually recommended to treat clusters of small warts. It comes in liquid form and works by having a toxic (poisonous) effect on the cells of the warts.
A special application stick is used to draw up the correct dosage of the liquid, which is then dripped onto the wart. You may experience some mild irritation when you apply the liquid to the wart.
Treatment with podophyllotoxin is based on cycles. The first treatment cycle involves applying the medication twice a day for three days. This is then followed by a rest cycle where you have four days without treatment. Most people require four to five treatment cycles separated by rest cycles.
Imiquimod is a type of cream usually recommended to treat larger warts.
Imiquimod works by helping stimulate your immune system into attacking the warts. You apply the cream to the warts and then wash it off after six to ten hours. This should be done three times a week.
It can often take several weeks of treatment before you notice an improvement in your symptoms. Common side effects of imiquimod include:
- hardening and flakiness of the skin
- swelling of the skin
- a burning or itching sensation after applying the cream
These side effects are usually mild and should pass within two weeks of stopping treatment with imiquimod.
Trichloroacetic acid (TCA)
Trichloroacetic acid (TCA) may be recommended to treat small warts that are very hard. TCA is also recommended for use by pregnant women because it is thought to be the safest of all the topical treatments to use during pregnancy.
TCA works by destroying the proteins inside the cells of the wart. However, if it is not applied correctly, TCA can damage healthy skin. Therefore, it is not recommended you apply TCA yourself. Instead, you will be asked to visit your local GUM clinic once a week so a doctor or nurse can apply the medication.
After TCA is applied, some people experience an intense burning sensation for around five to ten minutes.
There are four main methods used in the physical ablation of genital warts. They are:
- laser surgery
These treatments are given by a health professional.
Cryotherapy is usually recommended to treat multiple, small warts, particularly those that develop on the shaft of the penis or on, or near, the vulva.
Cryotherapy involves freezing the wart using liquid nitrogen. Freezing helps to kill the cells of the wart by splitting their outer membranes. After being frozen, the wart is allowed to thaw out and, if necessary, it can be frozen and thawed again.
During cryotherapy treatment, you will experience a mild to moderate burning sensation. Once the treatment has finished, it is likely you may develop skin irritation, blistering and pain at the site of the wart. Your skin will take between one and three weeks to heal.
Avoid having sex until the area of skin around the wart has fully healed.
Excision, in which warts are cut away, is sometimes recommended to treat small, hardened warts, particularly where this is a combination of smaller warts that have joined together to form a sort of cauliflower shape.
At the start of the procedure you will be given a local anaesthetic to numb the area of skin around the wart. The wart will then be cut away with a surgical scalpel, and the remaining incision sealed with stitches.
Excision can cause scarring so it may not be suitable for very large warts. The area of skin from where the wart was removed will be sore and tender for around one to three weeks.
You should avoid having sex until the area of skin around the wart has fully healed.
Electrosurgery is often combined with excision to treat large warts that develop around the anus or vulva that have failed to respond to topical treatments.
First, excision is used to remove the outer bulk of the wart. A metal loop is then pressed against the wart. An electric current is passed through the loop in order to burn away the remaining part of the wart.
Removing a large number of warts in this way can be quite painful, so you may be given a regional anaesthetic (where everything below your spine is numbed, similar to an epidural during pregnancy) or a general anaesthetic.
Laser surgery may be recommended to treat large genital warts that cannot be treated using other methods of physical ablation because they are difficult to access, such as deep inside your anus or urethra (the tube that connects the bladder to the penis or vulva, through which urine passes).
Laser surgery may also be recommended for pregnant women who fail to respond to treatment with trichloroacetic acid (TCA).
During the procedure, a surgeon will use a laser to burn away the warts. Depending on the number and size of the warts, laser surgery can be performed under either a local or general anaesthetic.
As with other types of ablation treatment, you should expect soreness and irritation at the site where the warts were removed. This should heal within two to four weeks.
How to prevent genital warts
Using condoms can help protect against the virus that causes genital warts. A vaccine is also available.
Using condoms (male or female) every time you have vaginal or anal sex is the most effective way to avoid getting genital warts, other than being celibate (not having sex) or getting vaccinated (see below).
However protection is not 100%. Genital warts are the result of a viral skin infection caused by the human papillomavirus (HPV). Because HPV is spread by skin-to-skin contact it is possible for skin around your genital area ( not covered by the condom) to become infected.
But condoms remain the safest option. If you have oral sex, cover the penis with a condom. A dental dam, which is a latex or polyurethane (plastic) square, can be used to cover the anal area or female genitals. Dental dams are usually only available at genito-urinary medicine (GUM) clinics, although your local pharmacist may be able to order some for you.
Avoid sharing sex toys. However, if you do share them, wash them or cover with a new condom before anyone else uses them.
Following these measures will also help protect you from getting a number of other sexually transmitted infections (STIs), such as HIV, chlamydia and gonorrhoea.
The Gardasil vaccine
The Gardasil vaccine protects against two strains of the human papillomavirus (HPV) known to cause 70% of cervical cancer and another two strains responsible for around 90% of genital warts.
However, after being vaccinated, it is thought a person’s immunity will gradually reduce after six years.
While vaccination does provide a very good level of protection against genital warts, it does not protect against other STIs. Therefore, the procedure should not be seen as a substitute for using a condom.
In September 2012 Gardasil replaced Cervarix as the vaccine given to all girls entering school year eight (12-13 years).
There is a specific schedule for vaccination with Gardasil. The second dose should be given at least one month after the first dose. The third dose should be given at least three months after the second dose. All three doses should be given within a 12-month period.
The vaccination is injected directly into muscles, either in the upper arm or thigh.
Common side effects of Gardasil include:
- pain, redness, bruising and swelling at the site of the injection
- flu-like symptoms, such as a high temperature and joint and muscle pain