Genital warts

Genital warts are one of the most common sexually transmissible infections. They are caused by the human papillomavirus (HPV), of which there are more than 200 strains. Only some types of HPV affect the genitals, and not all of these cause visible warts.

What genital warts look like#

Warts can appear around the genitals and anus, and sometimes inside the vagina, rectum or urethra. They are usually painless growths and may be:

• flat or raised
• single or in clusters
• cauliflower-like in appearance

In many cases HPV causes a “subclinical” infection. This means you can carry the virus on your skin even though you have no visible warts. Subclinical infection is common in people of all genders.

How genital warts spread#

HPV is passed on through direct skin-to-skin contact with a visible wart, or with genital skin where the virus is present. This can happen even when there are no visible warts. It spreads through vaginal, anal and oral sex, although passing the virus to the mouth through oral sex is rare.

Warts may appear within a few weeks after contact with someone who has HPV. Sometimes they take months to appear, or never appear at all. This can make it hard to know when you acquired the virus or from whom. For most people, the body’s immune system clears the virus over time.

Treatment#

It is important to remember that treatment does not get rid of the virus. It only removes the visible warts, usually for cosmetic reasons.

Over-the-counter wart treatments are not suitable for genital warts, so always talk to your doctor about your options. These may include:

• Cryotherapy – the warts are frozen off with liquid nitrogen.
• Podophyllotoxin – a lotion applied at home, most effective on multiple warts that are easy to reach. It cannot be used during pregnancy.
• Imiquimod cream – applied once a day, three times a week for up to three months. It is not recommended during pregnancy.
• Laser or diathermy treatment – used for larger numbers of warts, or when other options have not worked. It is carried out in hospital under general anaesthetic.

Several treatments may be needed, and care should be taken to protect the surrounding healthy skin. None of these treatments removes the virus itself; they only clear the visible warts.

After treatment, the virus may persist on the skin even though the wart has gone, so warts can reappear. If a wart returns, it does not necessarily mean you have caught the infection again. In most cases the wart eventually clears for good as the body’s immune system clears the virus.

HPV and cervical cancer#

Certain types of HPV can infect the cervix. These can cause cell changes that may, over many years, increase the risk of cervical cancer if the body does not clear the virus naturally. The types of HPV that cause visible genital warts do not progress to cervical cancer.

Cervical screening is recommended for anyone with a cervix who has been sexually active, even if they have had the HPV vaccine. To do this test, a doctor or nurse can give you a swab to self-collect a sample from high in the vagina, or they can collect the sample for you if you prefer.

Most HPV found on the cervix clears naturally without treatment. If you are at higher risk, you may need closer monitoring and treatment. Some people who have had a hysterectomy may still need cervical screening, so discuss this with your health provider.

HPV vaccination#

HPV vaccines help prevent infection with the types of HPV that cause most cervical cancers and genital warts. Types 16 and 18 cause around 70% of cervical cancers, while types 6 and 11 cause almost all genital warts. Some vaccines also protect against further types (31, 33, 45, 52 and 58) that cause an additional 15% of cervical cancers.

The vaccine provides the best protection when completed before a person becomes sexually active. It is not usually recommended for adults aged 26 and over, as they may already have been exposed to HPV. If you are 26 or older and would like to be vaccinated, speak with your doctor. People who are immunocompromised may need three doses for protection.

Preventing the spread#

Because condoms do not cover all the genital skin exposed during sexual contact, you can still acquire HPV through skin-to-skin contact. Even so, using internal and external condoms reduces the risk of spreading genital warts and other infections. Transmission can occur when a wart is present, and sometimes when there are none.

Key points#

• Treatment does not get rid of the virus; it only removes the visible warts, usually for cosmetic reasons.
• Always consult your doctor about treatment options.
• Over-the-counter wart treatments are not suitable for genital warts.
• Treatment options include cryotherapy, in which warts are frozen off with liquid nitrogen.
• For most people, the immune system clears the virus over time.

Where to get help#