Genital warts

About genital warts

Genital warts are the most common sexually transmitted viral infection in the UK, particularly in men in their early 20s and women aged 16 to 19.

Certain types of HPV can infect the skin around the genitals and anus and cause the cells to multiply faster than usual, which leads to warts. Genital warts are often hard on dry, hairy skin or soft on moist, hairless skin. You may have only one genital wart or there may be many in groups.

Genital warts can be successfully treated, but no treatment can completely remove the virus from your body.

Symptoms of genital warts

Many people have no symptoms of being infected with HPV and don’t have any genital warts. You can still pass on the virus even if you have no visible genital warts. Genital warts can begin to grow weeks, months or even years after you become infected.

In women, genital warts may appear:

  • on the upper thighs
  • on the cervix (neck of the womb)
  • on the vulva
  • inside or outside the vagina
  • inside the urethra (the tube that carries urine from the bladder and out through the vulva)
  • inside or outside the anus

In men, genital warts may appear:

  • on the upper thighs
  • on the penis
  • on the scrotum
  • inside or outside the anus
  • inside the urethra (the tube that carries urine from the bladder and out through the penis)

It’s also possible to get genital warts on your lips and in your mouth, nose or throat, but this is less common.

Although genital warts are usually painless, they can become inflamed or itchy and may bleed. You may notice blood in your urine if genital warts in your urethra begin to bleed, or blood may come out of your anus if there is bleeding from any warts there.

Causes of genital warts

Genital warts are caused by HPV. There are many different types of HPV. About 40 of the 100 types of HPV can cause genital warts, but most are caused by type 6 or type 11.

Genital warts are passed on by skin-to-skin contact, such as during unprotected vaginal, anal and oral sex, or when sharing sex toys. You can still pass on the infection if you have no visible genital warts and by having close skin contact even without having sex. The virus is usually passed by sexual contact, but can also be passed on from warts on the hands.

People who have more than one sexual partner or change partners frequently are more at risk of getting genital warts.

If you’re pregnant and have genital warts, these can be passed on to your baby during a vaginal birth, but this is rare.

Diagnosis of genital warts

If you think you have genital warts, see your GP or go to a sexual health clinic for advice on treatment and prevention. If your GP diagnoses you with genital warts, he or she will refer you to a sexual health clinic for treatment.

You don’t need to be referred by your GP to go to a sexual health clinic; you can make your own appointment. All visits are confidential and you don't have to give your real name. Details won't be sent to your GP without your consent.

At your GP surgery or a sexual health clinic, a doctor or nurse will examine you and ask about your medical history. Genital warts are usually diagnosed by your doctor or nurse looking at them. He or she may also carry out an internal examination of your vagina or anus to look for internal genital warts. Sometimes a biopsy (a small sample of tissue) is taken of the genital warts to confirm the diagnosis, but this is uncommon.

If you have genital warts, you may also have another STI. You may be advised to have tests for other STIs at the same time.

Treatment of genital warts

There are a number of ways to treat genital warts, but you may decide you don’t want treatment. If left untreated, genital warts may clear up on their own, but this can take a long time – many years in some people.

Genital wart treatment varies depending on the size, location and number of genital warts.

  • You may be prescribed medicines, such as imiquimod and podophyllotoxin, in the form of creams or liquids to apply to the genital warts. You may be able to do this for yourself at home, or you may need to go to your GP surgery or a sexual health clinic if the location of the genital warts makes it difficult to apply the medicine yourself.
  • Cryotherapy uses liquid nitrogen to freeze your genital warts. You will usually be advised to have a course of cryotherapy, for example, once a week for four weeks. Your nurse or doctor will advise you if you require further treatment.
  • Laser therapy can be used to break down your genital warts. You will be given a local anaesthetic – this completely blocks pain from the area and you will stay awake during the procedure.
  • You may be offered heat treatment (electrocautery or loop electrosurgical excision procedure) to get rid of your genital warts. You will be given a local anaesthetic for this procedure.
  • You may have surgery to remove your genital warts under under local anaesthesia.

You may need to have repeat treatments to get rid of your genital warts as they can be difficult to remove or they may come back after treatment. If you smoke, you will probably not respond as well to treatment as a non-smoker.

Don’t use treatments designed for removing warts from other areas of the body (such as the hands and feet) because these aren’t suitable for treating genital warts.

Some creams can interfere with certain forms of contraception, such as condoms, diaphragms and caps, so you may need to use an alternative contraceptive. Avoid unprotected sex soon after applying the creams because these can cause skin irritation in your partner. Ask your doctor or nurse for advice.

Special considerations

If you're pregnant

Tell your doctor or obstetrician (a doctor who specialises in pregnancy and childbirth) if you get genital warts while you’re pregnant. He or she will prescribe a treatment for you that is safe for your developing baby. Genital warts can grow larger in size or number during pregnancy or may reappear after years of having no warts. If you have genital warts in your vagina that grow very large, they may need to be removed to make sure that they don’t cause a problem during childbirth. Rarely, if you’re unable to have your genital warts removed and there is a possibility that they could cause a complication, you may be offered a caesarean.

It’s rare, but the HPV infection could pass to your baby during a vaginal birth. This could affect his or her throat or genitals. Your baby would need treatment for this infection once he or she is born.

If you have a weakened immune system

Treatment for genital warts is less likely to be successful if you have a weakened immune system, for example, if you have HIV/AIDS or are being treated for cancer. This means that you have a higher risk of the genital warts coming back. It’s important to go to follow-up appointments to make sure your treatment is tailored to your needs.

Prevention of genital warts

Using a condom every time you have vaginal, anal or oral sex will reduce your risk of infection with HPV. Condoms can’t completely prevent you getting the infection because the areas of skin where there are genital warts aren’t always covered by a condom.

Before having sex with a new partner, you could both consider having a test for STIs.

Vaccine

There are two vaccines that can protect against some HPV types. One vaccine, called Gardasil, protects against HPV types 6, 11, 16 and 18. The other vaccine, called Cervarix, protects against HPV types 16 and 18 only.

Gardasil is available in the UK, but it isn’t part of an immunisation programme so you would have to pay for it. This vaccine protects against both genital warts and cervical cancer. It’s available to people aged between nine and 26. Ask your GP whether this vaccine is suitable for you.

Cervarix is available as part of the national immunisation programme. It’s offered to all girls aged 12 to 13 to protect them against HPV types 16 and 18 that cause cervical cancer. These HPV types don’t cause genital warts so this vaccine doesn’t prevent vaccinated girls from getting them.

If I’m diagnosed with genital warts, do I need extra cervical smear tests or a human papilloma virus (HPV) test?

Answer

No, you won’t need extra smear tests. Having genital warts doesn’t increase your risk of getting cervical cancer because these conditions are caused by different HPV types. You should still have smear tests every three to five years. For further information about cervical smear tests, see Related topics. 

Explanation

All women aged between 25 and 64 are eligible for free cervical screening (smear) tests. Cervical screening tests can detect cell changes in your cervix (neck of the womb) before they turn cancerous, but having genital warts doesn't make you more likely to develop cervical cancer.

You will be tested for HPV in an 'HPV triage' system. This means that if you’re found to have borderline or low-grade cervical abnormalities in your smear test, you will automatically have an HPV test carried out on the same sample of cells collected during the smear test. You won’t need any additional examinations at this stage. If HPV is found, you will be referred for a colposcopy (this involves using a special instrument, called a colposcope, to look in detail at abnormal cells in the cervix). If HPV isn’t found, you will be asked to attend routine screening every three or five years depending on your age.

Is it safe to treat genital warts in pregnant women?

Answer

Genital warts can be treated in pregnant women. You must tell your doctor that you’re pregnant or think that you could be because the treatment you’re offered needs to be safe for your developing baby. Some of the usual medicines used to treat genital warts aren’t suitable if you’re pregnant.

Explanation

Genital warts can appear for the first time or reappear during pregnancy after years with no warts. They may also increase in size and number during pregnancy and so become more noticeable at this time. Genital warts don’t usually cause a problem during pregnancy, but you may need to have them treated if they are in your vagina and could interfere with childbirth. Rarely, the HPV infection can be passed to your baby during childbirth, which could cause him or her to have warts in the throat or genital area. Your baby would need treatment for these.

One option for treating genital warts during pregnancy is having cryotherapy, where liquid nitrogen is used to freeze the genital warts. Another option is surgery to remove the genital warts.

Certain medicines, such as imiquimod and podophyllotoxin, aren’t suitable as they could harm your baby’s development. You also shouldn’t use over-the-counter treatments that are meant for warts on your hands and feet as these aren’t designed to be used in the genital area.

Speak to your doctor or obstetrician (a doctor who specialises in pregnancy and childbirth) if you’re concerned about treatment for genital warts.

What happens if genital warts come back after treatment?

Answer

Genital warts can come back after treatment. If they do, you can be treated again. 

Explanation

New genital warts that come back after treatment may be caused by the original infection or a new infection from a partner. You can be treated again, so if the first treatment didn’t work, you can try a different one or a combination of treatments.

Infection with the types of HPV that cause genital warts happens by skin-to-skin contact during unprotected vaginal, oral or anal sex, or by sharing sex toys. If you have genital contact with an infected partner, you can get HPV even if you don't have sex. The virus can be passed on even if the infected person has no symptoms. Removing the genital warts doesn't mean you're free from HPV.

What happens if I don't have the genital warts treated?

Answer

Without treatment, your genital warts may increase in size or number, or they may clear up and disappear. 

Explanation

You may choose not to have treatment. However, it’s important to discuss your options with your GP or with a doctor at a sexual health clinic.

While you have visible genital warts, you may be more likely to pass the HPV infection on to someone else through sexual contact. This is possible even when using condoms correctly because they may not cover the affected area.

Genital warts can cause problems if you become pregnant or if you have an illness that affects your immune system, such as HIV/AIDS, or are being treated for cancer. The genital warts may grow larger in size or number and you may not clear the virus as quickly as someone with a healthy immune system. This can increase your risk of passing on the infection to someone else.

Treating genital warts can help to reduce the risk of you passing them on to your partner (or for pregnant women, to their baby during delivery).

Can I pass on HPV after I’ve been treated for genital warts and they have gone away?

Answer

Yes, you can still pass on HPV, but this is more likely when you still have untreated genital warts. By using condoms every time you have sex you can help to reduce the risk of passing on the infection. 

Explanation

All the time you have the HPV infection you can pass on the virus. You can still be carrying HPV even after your genital warts have been treated. Your immune system usually clears the infection, but if you have a weakened immune system, for example, because you have HIV/AIDS or are being treated for cancer, this may take longer – this means you have a greater risk of passing on the infection.

Can HPV affect my fertility?

Answer

No, HPV that causes genital warts hasn’t been shown to affect fertility in men or women. 

Explanation

HPV types that cause genital warts don't affect fertility. However, in women, some types of HPV have been associated with cervical cancer. A smear test is designed to look for changes in cells in the cervix (neck of the womb) that may go on to become cancerous. In this way, it can be treated before cancer develops. Cervical cancer and its treatment can affect fertility.

Will the HPV vaccine be offered to older girls, women or men?

Answer

At present, the HPV vaccine against types 16 and 18 is offered to girls aged 12 to 13, there are no plans to extend this vaccination to other groups. 

Explanation

The HPV vaccine is effective in preventing the two types of HPV infection that cause most cervical cancers. It’s only effective in girls who aren’t already infected with the virus.

As HPV is so common, most sexually active women will already have been infected. Therefore, vaccination wouldn't be useful because the vaccine isn't thought to reduce the risk of developing cervical cancer in women who are already infected. There are no plans to offer the vaccine to women older than 18. Research is continuing, and, in a few years time, we will know more about the effects of the vaccine.

The vaccine isn't being offered to boys or men because the main purpose of this vaccination is to prevent cervical cancer. It isn’t necessary to vaccinate men for this to be effective. Trials are taking place to see whether vaccination of young men with the vaccine against HPV types 6, 11, 16 and 18 is effective in reducing the risk of genital warts.