Introduction

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. In Wales, they are the second most common type of sexually transmitted infection (STI) after chlamydia.

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.

There is no evidence that your fertility will be affected by genital warts.

Read more about the 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.  Different strains usually affect different parts of the body, including the hands or feet.

Although around 30 different types of HPV can affect the genital skin, 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.

The types of HPV that cause visible genital warts do not cause genital cancer.  Other strains of HPV can cause cervical cancer.

How do they 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.

Read more about the causes of genital warts.

It can take months, or even years, 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.

Read more about preventing of genital warts.

Treating genital warts

If you think you have genital warts, see a health professional as they may need to be treated.  It is possible to have more than one STI at a time, so if you think you have warts, it is a good idea to have a check-up.

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. Find your local sexual health or GUM clinic.

Wart creams available over-the-counter (OTC) will not work because they are designed to only treat warts on the hands.

The treatment for genital warts depends on how many warts you have and where they are. Several treatments are available, such as liquids or creams and freezing the warts (cryotherapy).

You should not use wart creams that are available over the counter because they are designed to only treat warts on the hands or verrucas.

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 up your recovery.

Read more about treating genital warts.

Will the warts come back?

Some people only ever get one episode of genital warts. For many others, the warts will come back weeks, months or years later.

If you do develop a new wart, it is not possible to say if these are a result of the original infection or a new infection with HPV.

Who is affected?

Both men and women can be affected by genital warts. According to Public Health Wales, in 2012 there were 4053 new cases of genital warts diagnosed by GUM (genitor-urinary medicine) clinics across Wales. This compares with 4,870 new cases of chlamydia in 2010.

Genital warts and Chlamydia are most common in sexually active teenagers and young adults. In females, chlamydia and genital warts were the most commonly diagnosed infections in 2012. In males, chlamydia was of the highest incidence in 2012, though the rate of genital warts was also high.

HPV vaccinations

HPV vaccines in the UK are offered to all girls in year 8 (aged 12 to 13 years).

Since September 2012, the vaccine Gardasil has been used and can help protect against HPV types 6 and 11, which cause around 90% of genital warts. It also protects against types 16 and 18, which are linked to more than 70% of cases of cervical cancer in the UK.

Before September 2012, a different vaccine called Cervarix was used to protect against HPV types 16 and 18.

HPV vaccines cannot protect against all types of HPV. If you are a woman and have received HPV vaccinations, you should still attend cervical screening (smear tests) as the vaccines do not guarantee that you will not develop cervical cancer in the future.

Read more about cervical screening.

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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.
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Causes

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.

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Diagnosis

If you think you may have genital warts, visit your local sexual health or genitourinary medicine (GUM) clinic.

Your GP will be able to diagnose genital warts and provide certain treatments, but the nurses and doctors at your local clinic will have access to a wider variety of treatments.

Staff at the clinic will have specialist training to help diagnose, treat and support you. There is no blood test to check for an active HPV infection.

You can find your local GUM clinic in search for services: sexual health.

Who should go for a check-up?

You should have a check-up if you have obvious signs and symptoms of genital warts, or if a recent or current sexual partner develops genital warts or any other 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 STI
  • you are pregnant, or planning a pregnancy

All check-ups in sexual health and GUM clinics are free and confidential.

Diagnosing genital warts

Genital warts can usually be easily diagnosed with a simple examination. At a check-up, the doctor or nurse will examine the warts. They may use a magnifying lens to do this.

You may also be advised to have other areas of your genital skin examined – for example, inside the vagina or around your anus.

Further testing

Depending on where your warts are, you may be advised to have a more detailed examination. If you are advised to have a vaginal examination, this will usually be performed with a small plastic or metal tube called a vaginal speculum.

This will allow the doctor or nurse to see inside the vagina. It is a simple examination and is not usually painful.

If you are advised to have an examination of the inside of your anus, this will usually be performed using a small plastic tube called a proctoscope. This will allow the doctor or nurse to see the skin inside the anus. It is not usually painful.

If you are experiencing problems with the flow of urine, you may be advised to have a special examination of the urethra (the tube that urine flows through). This is usually only performed by a specialist.

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Treatment

Treatment for genital warts depends on the type of warts you have and where they are located. You do not need treatment if there are no visible warts.

There are two main types of treatment for genital warts:

  • applying a cream, lotion or chemical to the warts (topical treatment)
  • destroying the tissue of the warts by freezing, heating or removing them (physical ablation)

Most 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 treatments is recommended.

For some people, treatment can take several months to remove the warts, so it is important to persevere.

You may be advised to avoid perfumed soap, bath bubbles or lotions while you are having treatment for warts as these can sometimes irritate the skin.

Topical treatment

There are several topical treatments that can be used to treat genital warts. Some creams can weaken latex condoms, diaphragms and caps. Remember to check this with the doctor or nurse, who can advise you.

Topical treatments are described below.

Podophyllotoxin

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 liquid or cream to the wart. Cream is usually advised for areas where applying liquid is difficult.

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.  Podophyllotoxin should not be used if you are pregnant.

Imiquimod

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.

You may experience skin irritation after you apply the cream. Usually this is mild, but contact the doctor or clinic if it does not improve.

It can often take several weeks of treatment before you notice an improvement in your warts.

Imiquimod is not usually used if you are pregnant.

Trichloroacetic acid (TCA)

Trichloroacetic acid (TCA) may be recommended to treat small warts that are very hard.

It works by destroying the proteins inside the cells of the wart. But if it is not applied correctly, TCA can damage healthy skin.

TCA is though to be safe to use during pregnancy.

It is not recommended that 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 5 to 10 minutes.

Physical ablation

There are four main methods used in the physical ablation of genital warts. They are:

  • cryotherapy
  • excision
  • electrosurgery
  • laser surgery

These treatments are performed by a trained doctor or nurse.

Cryotherapy

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

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

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

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).

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.

Genital warts and sex

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 your recovery, as skin friction that occurs during sex can cause treated skin to become irritated and inflamed.

Even after the warts have gone, there may still be traces of human papillomavirus (HPV) in your skin cells. Therefore, it is recommended you use a condom during sex for the first three months after the warts have cleared up.

Smoking

For reasons still unclear, many treatments discussed on this page are more effective in non-smokers than in smokers.

If you are a smoker, quitting smoking may help speed up healing from genital warts.

Quitting smoking will also bring a range of other important health benefits, such as significantly reducing your risk of developing lung cancer and heart disease.

The Stop Smoking Wales website provides support and advice and products for people who want to stop smoking. Your GP may also be able to prescribe medication that can help you quit.

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Prevention

Using condoms can help protect against the virus that causes genital warts. A vaccine is also available.

Condoms

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).

Condoms also helps protect you from other sexually transmitted infections (STIs) and pregnancy.

However protection offered by condoms 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.

HPV vaccines

HPV vaccines are currently not available for free outside of the NHS vaccination schedule. In the UK, HPV vaccines are offered to all girls in school year 8 aged 12 to 13 years.

Since September 2012, the vaccine Gardasil has been used and can help protect against HPV types 6 and 11, which cause around 90% of genital warts.

It also protects against types 16 and 18, which are linked to more than 70% of cases of cervical cancer in the UK.

Before September 2012, a different vaccine called Cervarix was used to protect against HPV types 16 and 18.

HPV vaccines cannot protect against all types of HPV. If you are a woman and have received HPV vaccinations, you should still attend cervical screening (smear tests) as the vaccines do not guarantee that you will not develop cervical cancer in the future.

HPV vaccines are designed to try to help protect you from developing certain types of HPV infection. They are likely to be of most benefit before you have had sexual contact. It is not clear if there would be any benefit in receiving HPV vaccination if you:

  • are a man
  • are a woman too old to have been included in the NHS vaccination schedule
  • have already had sex
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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 11/09/2014 15:49:23