Introduction

Genital warts is a common sexually transmitted infection (STI) passed on through vaginal, anal and, rarely, oral sex. Treatment from a sexual health clinic can help them go away.

Go to a sexual health clinic if you have:

  • 1 or more painless growths or lumps around your vagina, penis or anus
  • itching or bleeding from your genitals or anus
  • a change to your normal flow of pee (for example, sideways) that doesn't go away
  • a sexual partner who has genital warts, even if you have no symptoms

Go if you have 1 or more of these symptoms so you can find the cause. Treatment can help get rid of the warts and prevent the infection being passed on.

Why you should go to a sexual health clinic

You can see a GP but they will probably refer you to a sexual health clinic if they think you might have genital warts.

Sexual health clinics treat problems with the genitals and urine system.

Many sexual health clinics offer a walk-in service where you don't need an appointment. They'll often get test results quicker than GP practices, and you don't have to pay a prescription charge.

Find a sexual health clinic

What happens at a sexual health clinic

A doctor or nurse can usually diagnose warts by looking at them. They will:

  • ask you about your symptoms and sexual partners
  • look closely at the lumps around your genitals and anus
  • possibly need to look inside your vagina, anus or urethra (where pee comes out) depending on where your warts are

It's not possible to find out who you got genital warts from or how long you've had the infection.

Treatment for genital warts

Treatment for genital warts needs to be prescribed by a doctor.

The type of treatment you'll be offered depends on what your warts are like. The doctor or nurse will discuss this with you.

  • cream or liquid: you can usually apply this to the warts yourself a few times a week for several weeks, but in some cases you may need to go to the clinic every week for a doctor or nurse to apply it – these treatments can cause soreness, irritation or a burning sensation
  • surgery: a doctor or nurse can cut, burn or laser the warts off – this can cause irritation or scarring
  • freezing: a doctor or nurse freezes the warts, usually every week for 4 weeks – this can cause soreness

It may take weeks or months for treatment to work, and the warts may come back. In some people the treatment doesn't work.

There's no cure for genital warts but it's possible for your body to clear the virus over time.

Do

  • tell the doctor or nurse if you're pregnant or thinking of becoming pregnant, as some treatments won't be suitable
  • avoid perfumed soaps or bubble baths during treatment as these can irritate the skin
  • ask the doctor or nurse if your cream treatment will affect condoms, diaphragms or caps

Don't

  • use wart treatment from a pharmacy – these are not made for genital warts
  • smoke – many treatments for genital warts work better if you don't smoke
  • have vaginal, anal or oral sex until the warts have gone – if you do, use a condom

How genital warts are passed on

The genital warts virus can be passed on whether or not there are visible warts.

Many people with the virus don't have symptoms but can still pass it on. If you have genital warts, your current sexual partners should get tested as they may have warts and not know it.

If symptoms do appear, it can happen over a year after infection.

You can get genital warts from:

  • skin-to-skin contact, including vaginal and anal sex
  • sharing sex toys
  • rarely, oral sex

The virus can also be passed to a baby from the mother at birth, but this is rare.

You can't get genital warts from:

  • kissing
  • things like towels, cutlery, cups or toilet seats

Preventing the spread of genital warts

You can prevent warts passing on by:

  • using a condom every time you have vaginal, anal or oral sex – but if the virus is present in skin not protected by a condom, it can still be passed on
  • not having sex while you're having treatment for genital warts

Why genital warts come back

Genital warts are caused by a virus called human papilloma virus (HPV). There are many types of HPV.

The HPV virus can stay in your skin, and warts can develop again.

Warts may go away without treatment but this can take many months. You can still pass the virus on, and the warts may come back.

Genital warts and cancer

Genital warts are not cancer and don't cause cancer.

The HPV vaccine offered to girls in the UK to protect against cervical cancer also protects against genital warts.

From April 2018, the HPV vaccine has also been offered to men who have sex with men (MSM), trans men and trans women who are eligible.

Find out more about the HPV vaccine.

Genital warts and pregnancy

Important

Tell your midwife or doctor if:

  • you're pregnant, or think you're pregnant, and you have genital warts or think you have genital warts

During pregnancy, warts:

  • can grow and multiply
  • might appear for the first time, or come back after a long time of not being there
  • can be treated safely, but some treatments should be avoided
  • may be removed if they're very big, to avoid problems during birth
  • may be passed to the baby during birth, but this is rare – the virus can cause infection in the baby's throat or genitals

Most pregnant women with genital warts have a vaginal delivery. You might be offered a caesarean depending on your circumstances.

Call NHS Direct Wales

If you can't speak to your GP or don't know what to do next call NHS Direct Wales on 0845 46 47 or NHS 111 if available in your area.

 

 

^^ Back to top

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.
^^ Back to top

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.

^^ Back to top

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.

^^ Back to top

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.

^^ Back to top

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
^^ Back to top


The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 10/10/2018 11:04:51