Genital warts are small fleshy lumps of abnormal skin that can grow in and around your genitals.
- They are caused by the human papillomavirus (HPV) – a group of viruses that is also linked to certain types of cancer.
- HPV is HPV is very common and is usually passed on through skin-to-skin contact.
- Most people with HPV infection do not develop warts. However, you can still spread the virus to other people even without having warts.
- See your doctor if you think you might have genital warts, or if you have had sexual contact with someone who has HPV or genital warts.
- Treatment of genital warts can include applying creams at home or freezing the warts with liquid nitrogen (which is done by your doctor).
- The most effective way to prevent genital warts is vaccination against HPV. This is funded for all New Zealanders aged 9–26.
(Dr Mike Evans, 2012)
What are the causes of genital warts?
Genital warts are caused by the human papillomavirus (HPV). They are commonly passed on through:
- direct skin-to-skin contact including vaginal or anal sex – you don’t need to have penetrative sex to pass on the virus
- sharing sex toys
- oral sex (rare)
- from mother to baby during vaginal delivery (rare).
Most people with HPV don’t know they have it. Once you have been in contact with HPV, genital warts can take months or even years to develop. However, you can spread the virus to other people even if you haven't yet developed warts (but you are more likely to spread the virus with active warts).
There are more than 100 strains of HPV, 40 of which affect your genitals. The strains that cause warts on your genitals are type 6 and 11. These are known as low-risk types of HPV.
High-risk types of HPV (especially type 16 and 18) can cause abnormal cell changes of your cervix and lead to cervical cancer. This is why women should have regular cervical smears to pick up changes in your cervix that might lead to cancer if not treated. Read more about HPV and cervical screening.
What are the symptoms of genital warts?
Most people who come in contact with HPV will not develop genital warts. If you do develop warts, it could happen months or even years, after you first came into contact with the virus.
Genital warts appear as fleshy bumps or growths found on and around your genital area. They vary in size and shape and can be described as:
- small or large
- raised or flat
- single or multiple (which can take a cauliflower appearance)
- inside or surrounding your vagina or cervix
- on your scrotum or penis
- inside or surrounding your anus.
Genital warts are usually painless, although in rare cases they can become itchy, inflamed and cause bleeding. See images of genital warts here.
See your doctor if you think you might have genital warts, or if you have had sexual contact with someone who has HPV or genital warts.
How are genital warts diagnosed?
Your doctor will need to examine your genitals to diagnose genital warts. Warts have a classic appearance, which means they can be diagnosed just by looking at them. Sometimes, a sample (biopsy) of the wart may be taken to rule out other causes if the appearance is not typical. There is no test for HPV, so you can’t check if someone is carrying the virus.
If you have genital warts, your doctor may also check for other sexually transmitted infections (STIs) or do a sexual health check. Read more about (STIs).
How are genital warts treated?
Treatment is only recommended if the symptoms of genital warts are disturbing, eg, they cause pain, inflammation, bleeding or embarrassment. Your doctor may recommend no treatment if your warts don’t cause any symptoms or problems.
Treatment for genital warts depends on several factors such as the size and number of warts, the location, whether you are pregnant and your gender. Your doctor will discuss the treatment options with you depending on your condition. There are 2 main types of treatment for genital warts:
- Applying a cream or solution to the warts (called topical treatment).
- Examples include podophyllotoxin solution (Condyline®) or imiquimod cream (Aldara®).
- These are available on prescription only. Do not use wart medications that you can buy at pharmacies – these are specially formulated for treating warts found on your hands and feet and are not suitable for your genital region.
- Freezing with liquid nitrogen (cryotherapy) destroys the surface of the wart, allowing your body to heal the abnormal tissue. This is done by your doctor every week until the warts have disappeared.
- While the warts are healing, the risk of transmission is greater, so skin to skin contact with those areas is not recommended. This means you should avoid unprotected sexual intercourse.
For most people, it can take several months to remove the warts, so it’s important to stick with the treatment. Although treatment can lead to the warts disappearing, the viral infection (HPV) is not gone. The virus can remain dormant (inactive) in your skin after treatment. In many cases, warts don’t come back after a course of treatment, but sometimes they do return or you may develop warts in a different area..
Read more about the treatment of genital warts.
What is the outlook for someone with genital warts?
Most genital warts will disappear by themselves over time if untreated. In 20–30% of treated cases, genital warts can regrow in a previously treated area or new area.
How can I prevent genital warts?
The most effective way to prevent genital warts is vaccination against HPV. Correct use of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading HPV, as skin-to-skin contact can happen around the condom.
The HPV vaccine (Gardasil 9)
The HPV vaccine protects against 9 different strains of HPV including:
- types 6 and 11, which cause around 90% of genital warts
- types 16 and 18, which are linked to more than 70% of cases of cervical cancer.
In New Zealand, the HPV vaccine is available free for everyone aged 9–26 years (males and females). Women and men of any age can still have the vaccination by visiting their family doctor and discussing whether it would be of benefit to them and how much it will cost.
The HPV vaccine is only able to prevent HPV infection; it does not treat the infection. For best protection, girls and boys need to be vaccinated before they are likely to be exposed to HPV, which means before they start having any sexual contact.
Read more about the HPV vaccine.
What support is available with genital warts?
If you think you have genital warts or any other sexual health concerns, you can see or talk to your GP. Other places you can get help are:
- Human Papilloma Virus (HPV) Auckland Regional HealthPathways, NZ
- Guidelines for the management of genital, anal and throat HPV infection in New Zealand The HPV Project, NZ, 2017
- Genital warts The HPV Project, NZ
- Genital warts HealthInfo Canterbury, NZ
- Anogenital warts DermNet, NZ
- Genital warts NHS, UK
|Dr Phoebe Hunt is currently working as a registrar in sexual health at ADHB. Her interests are in women’s health, sexual health and lifestyle medicine. Phoebe is planning on starting GP training next year.|