Genital warts

Overview

Genital Warts are a curable sexually transmitted infection (STI) caused by human papillomaviruses or HPVs. Although there are over a hundred different types of HPV, most genital warts are caused by HPV 6 and HPV 11. Warts on the fingers or soles of the feet (verrucas) are caused by different HPVs which do not spread to the genital skin.

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, it's begun to flow sideways) that does not go away
a sexual partner who has genital warts, even if you do not have symptoms

These symptoms mean you may have genital warts. Go to a sexual health clinic to be checked.

Sexual health clinics are sometimes called genitourinary medicine (GUM) clinics, or sexual and reproductive health (SRH) services.

Treatment can help remove the warts and stop 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 specialise in treating problems with the genitals and urine system.

Many sexual health clinics offer a walk-in service where you do not need an appointment.

A sexual health clinic will often get test results quicker than a GP surgery.

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 at the lumps around your genitals and anus, maybe using a magnifying lens
possibly need to look inside your vagina, anus or urethra (where pee comes out) depending on where the warts are

It may not be 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 the warts look like and where they are. The doctor or nurse will discuss this with you.

Treatments include:

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 a sexual health clinic where a doctor or nurse will apply it. These treatments can cause pain, irritation or a burning sensation
surgery: a doctor or nurse may cut, burn or use a laser to remove the warts. This can cause pain, irritation or scarring.
freezing: a doctor or nurse freezes the warts. Sometimes the treatment is repeated several times. This can cause pain.

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

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

tell the doctor or nurse if you're pregnant or thinking of becoming pregnant, as some treatments will not be suitable for you
avoid perfumed soap, shower gel or bath products during treatment as these can irritate your skin
ask the doctor or nurse if your treatment will affect condoms, diaphragms or caps

Don't

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

How genital warts are passed on

The genital warts virus can be passed on even when there are no visible warts.

Many people with the virus do not have symptoms but can still pass it on.

If you have genital warts, your current sexual partners should get tested because they may have warts and not know it.

After you get the infection, it can take weeks to many months before symptoms appear.

You can get genital warts from:

Genital warts develop after direct skin-to-skin contact with someone who has HPV in their skin. Infection with HPV can occur –

following unprotected sex (without a condom) with a person who has HPV in their skin. This can be vaginal, anal or oral sex.
if HPV is passed from a mother with genital warts to her baby during childbirth. This is very uncommon.

Warts cannot be caught from hugging, sharing baths, towels, sheets, toilet seats or swimming pools.

How to stop genital warts being passed on

You can stop genital warts from being passed on by:

using a condom every time you have vaginal, anal or oral sex – but if the virus is in any skin that's not protected by a condom, it can still be passed on
not sharing sex toys; if you do share them, wash them or cover them with a new condom before anyone else uses them
You should not have sex if you have just put wart treatment creams or lotions on your skin. Having unprotected sex while you have warts makes it much more likely that you will pass on wart virus to your partner. Using condoms may help to protect your partner from infection with the virus, if the condom covers the affected skin and is put on before skin contact occurs.

Why genital warts come back

It is quite common for warts to come back, usually in the first three months after they have disappeared. In most cases this happens because there is still HPV in the skin. People who smoke are more likely to see their warts come back. However, over time most people will get rid of HPV and will not develop new warts.

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

Genital warts and cancer

It is extremely rare for warts to become cancerous. This is because the HPVs which cause most warts (HPV 6 and 11) are ‘low risk’ viruses.

Which HPVs can cause cancer? Of the hundred or so HPVs which can infect humans, 13 are known to cause cancer. The most important of these ‘high risk’ viruses are HPV 16 and 18.

The HPV vaccine offered to girls and boys aged 12 to 13 in Wales protects against cervical cancer and genital warts.

The HPV vaccine is also offered to men (up to the age of 45) who have sex with men (MSM), trans men and trans women, sex workers, and men and women living with HIV.

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

It’s not unusual for women to develop genital warts for the first time during pregnancy. Changes in the woman’s immune system and blood supply can allow warts to develop. Warts can be treated during pregnancy but it can be more difficult to get rid of them. Most women will notice that their warts go away in the weeks following the birth of their baby.

Can warts affect my baby? It is rare for babies of mothers with genital warts to develop warts themselves. If this does happen, these are usually on the baby’s skin. Very rarely, warts can develop in the baby’s windpipe.

Will I need a caesarean section? Having genital warts in pregnancy is not usually a reason for having a caesarean section. Most pregnant women with warts will deliver their baby in the normal way.

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

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.

Who can get it

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.

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.

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.

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

The HPV vaccine offered to girls and boys aged 12 to 13 in Wales protects against the viruses that can cause cervical cancer and genital warts.