What are genital warts?

Genital warts are a sexually transmitted infection (STI) passed on through sexual contact. They appear as small bumps or growths on or close to your genitals and rectum and are common. Occasionally they can cause pain, discomfort, or itching. Treating the warts can help prevent spreading the virus to any sexual partners.

Genital warts are caused by certain types of human papillomavirus (HPV), which is usually passed on by vaginal or anal sex, shared sex toys, or in some cases, oral sex. HPV does not always cause genital warts, and many people infected with these types of HPV are symptom free. The strains of HPV most commonly related to genital warts are different to the ones related to cancer.

What are the symptoms of genital warts?

Genital warts appear as growths which are rough and skin-coloured. They can be bumpy and have the shape of a cauliflower, but sometimes they are flat. Their size varies and can change over time. Sometimes they can appear as a single flesh coloured bump; other times they can be a cluster. They can also be too small to be seen.

For those who are assigned male at birth, genital warts can appear on the:

• penis
• scrotum
• groin
• inside or around the anus, even if you did not have anal sex
• upper thighs

For those assigned female at birth, genital warts can appear:

• on the outside on the vagina or anus
• inside of the vagina or anus
• on the cervix
• on the upper thighs

In some cases, they can cause:

• a burning sensation
• mild bleeding
• discomfort
• itching or irritation
• vaginal discharge

They can also appear on the lips, tongue, throat, or mouth after oral sex with someone who has HPV.

How long do genital warts take to appear?

Genital warts can develop within weeks of infection, but often they take months or years to appear. If you have multiple sexual partners, or change partners, this can make it difficult to know where you got the infection from.

You can also be infected with HPV and have no genital warts, or they may not be visible. In this case, you could potentially infect others without knowing.

How long do genital warts last?

It is different for each person. However, for nearly a third of people, they tend to go away in six months.

It is important you get treatment for genital warts, and do not just wait for them to go away, as they can cause further medical problems.

Are there any complications with genital warts?

Genital warts could lead to problems passing urine if these affect your urethra, the tube that transports urine from your bladder. 

Some types of HPV can increase your risk of cancer, but the types of HPV that most commonly cause genital warts are different to these. About 90% of genital warts are caused by HPV 6 and HPV 11, which are non-oncogenic (non-cancer causing).

Genital warts and pregnancy

An outbreak of genital warts whilst pregnant can lead to changes in hormones which cause the warts to bleed, enlarge, or multiply.

In rare cases, genital warts can cause pregnancy complications, including:

• a wart blocking the birth canal, possibly meaning delivery via caesarean section
• in extremely rare cases, HPV passes onto the baby, causing warts to form inside the baby’s airways which require surgery

When should I talk to my doctor about genital warts?

You should talk to your doctor if you have:

• one or more growths or lumps around your anus, vagina, or penis, even if they are not painful
• had sexual contact with someone who has genital warts, even if you don’t have any symptoms
• a change to the flow of your urine, such as going sideways

What causes genital warts?

Genital warts are a highly contagious sexually transmitted infection which occurs when certain strains of HPV, a virus, are passed on. It is transmitted by skin-to-skin sexual contact in the genital or rectal areas and, rarely, through oral sex. Symptoms can take months or years to develop.

Sometimes you can have the type of HPV infection that causes genital warts but no symptoms. The HPV types that cause genital warts are low risk, however, it is important to get your genital warts treated. Having HPV does not necessarily mean you will get genital warts.

The strains of HPV which cause genital warts are different to the ones which cause warts on other parts of your body. You cannot get genital warts from touching yours or someone else’s warts in other places, such as on hands or feet. 

Genital warts can be caused by:

• anal, vaginal-penile, and vaginal-vaginal intercourse
• skin-to-skin genital touching, even without ejaculation
• giving oral sex to a person who has genital warts or HPV
• receiving oral sex from a person who has genital warts on their mouth, lips, or tongue, or who has HPV

How are genital warts diagnosed?

If warts appear in your genital or rectal area, you should get them checked. They can be diagnosed by a doctor, either by submitting photos and answering a short questionnaire online or in a sexual health clinic via a physical examination. You will be asked questions about your health and sexual history. Genital warts can often be diagnosed just by looking at them.

Genital warts can also occur deeper inside your body. If you have a vulva, the doctor might do a pelvic examination to look for them. 

Other tests for internal warts include:

• blood tests to test for STIs often associated with HPV
• an anal exam, using an anoscope to look for warts
• a biopsy: cutting away a very small piece of body tissue for testing

Do genital warts look like other skin conditions?

Genital warts can be mistaken for other common skin conditions that can affect your genitals, including:

• genital skin tags, harmless egg or oval-shaped growths with a fleshy stalk that often appear where skin folds
• fordyce spots, yellow, red, or flesh-coloured spots usually 1 to 3 millimetres in diameter, which often become more visible when you stretch the skin
• Sometimes a wart can be confused with a verruca. A verruca is a type of wart which only affects the bottom of your feet.

Being checked and diagnosed by a doctor can help avoid confusion.

How are genital warts treated?

Genital warts can be treated in different ways depending on their condition, number, and location. This can include creams or liquids, surgery, or freezing the warts. Treatment can take time to work, and in some cases, it does not work.

Treatments for genital include:

• cream or liquid applied to the warts several times per week either by you or a health professional
• surgery, via cutting, burning, or laser removal
• freezing of the warts by a doctor or nurse
• injecting a substance called interferon into the warts

Do not attempt to treat genital warts with treatments designed for normal warts, as these aren’t formulated for use on the skin in your genital area.

Can genital warts and HPV be cured?

There is no cure for HPV, which causes genital warts. Treatment can often get rid of the warts from your skin, but this is not always permanent, and they may come back again in future. Even if you have been treated, you may still be able to pass on the HPV infection to sexual partners.

Medical treatments for genital warts

There are several medications available for genital warts . They include:

Aldara, a cream which contains the active ingredient imiquimod. It works by boosting your immune system to tackle HPV. Aladra is recommended as the first line for anal warts.

Condyline, a liquid solution containing podophyllotoxin, an antiviral plant extract. It is used to treat small and soft external genital and anal warts. It works by stopping the wart cells from multiplying, which, over time, kills them. Condyline is the recommended first line treatment for warts affecting the genitals. 

Warticon, a cream also containing podophyllotoxin. It works in the same way as Condyline, and is often used for clusters of warts.

These treatments can often work within a few weeks but can take up to 4 months. However, sometimes they are not effective, and your warts may need to be cut off, frozen, or chemically removed by a doctor or nurse.

Treating genital warts naturally

There’s little evidence that genital warts can be helped by home remedies and sometimes can make your symptoms worse. Some remedies that people have been known to try include:.

• tea tree oil
• witch hazel
• green tea
• apple cider vinegar

Further studies are needed on whether eating cruciferous vegetables such as broccoli, cabbage, brussels sprouts, cauliflower, and kale could help with genital warts.

How to prevent genital warts

You can reduce the risk of getting or passing on genital warts by:

• limiting your number of sexual partners
• using condoms, however, HPV can still spread through skin-to-skin genital contact in areas not covered by the condom
• not sharing sex toys. If you do, wash them thoroughly or cover them with a condom
• not having sex while you’re getting treated for HPV or genital warts
• telling your sexual partners if you have genital warts or HPV 

Vaccination against HPV

In the UK, the NHS has a vaccination programme for HPV, which is the virus that causes genital warts.

The vaccines are automatically offered to anyone born after 1st September 2006 when they reach 12 or 13 years old.

Vaccines are also available to anyone who is gay, bisexual, or a man up to 45 years old who has sex with men (MSM).

Some transgender people are also eligible for the HPV vaccine. Trans women (persons who were assigned as male at birth) can get it if their risk of getting HPV is similar to an eligible MSM. Trans men (persons who were assigned female at birth) who are 45 or under can get it if they have sex with other men. Trans men who previously had the HPV vaccine as part of the girls’ vaccination programme do not require further doses.

Speak to a doctor or nurse from the specialist sexual health service (SHS) or a HIV clinic for further information. You can also get the HPV vaccine at a Superdrug Health Clinic with a trained nurse.

Sources

Genital Warts NHS [accessed 11th August 2022]

Genital Warts VeryWellHealth [accessed 11th August 2022]

Genital Warts Healthline [accessed 11th August 2022]

Genital Warts Cleveland Clinic [accessed 11th August 2022]

HPV Right As Rain [accessed 14th August 2022]

Warts and Veruccas NI Direct [accessed 14th August 2022]

Who Should Have HPV Vaccine NHS [accessed 14th August 2022]

Genital Human Papillomavirus Infections—Current and Prospective Therapies JNCI Monographs [accessed 15th August 2022]