Genital Warts

Written by: Dr Charlotte Sidebotham

Let’s be real: any sort of sexually transmitted infection (STI) can feel humiliating and worrying. Genital warts perhaps more than others, since frankly, the name is so unpleasant. The truth is, genital warts (also sometimes called ‘anogenital warts’) are one of the most common kinds of STIs, so it’s time to get over the embarrassment and get yourself informed.

What causes genital warts?

Genital warts are caused by some types of human papilloma virus (HPV). There are over 100 types of this virus, but most genital warts are caused by types 6 or 11. The common warts that many people have on their hands and feet are caused by a different type of HPV. Genital warts are most seen in people between the ages of 16 to 25.

How do people get genital warts?

Most of the time, genital warts are sexually transmitted. Usually, people are infected around the time that they start to have sex. HPV is spread through microscopic breaks in the skin, so you need close skin-to-skin contact to pass on the virus. You do not, however, necessarily need to have penetrative sex to transmit the infection. For example, you can get anal warts even if you have not had anal sex. HPV can be passed on by sharing sex toys, and rarely from hand warts. Whilst condoms protect against most STIs, they are not completely effective against HPV. There is a wide variation in the time between infection and symptoms, so it can be challenging to work out how long someone has had the infection or who gave it to them. Plus, a person can be infected with HPV, but not develop warts.

What do genital warts look like?

Genital warts can be small, large, flat, or raised, and usually appear as a skin-coloured bump or collection of bumps in the genital area. Men tend to develop them on the skin of the penis, whilst women normally develop them on the vulva (the outer skin of the vagina). Warts can also occur around the back passage (anus) and inside the vagina. More unusual places they could occur are the mouth and lips or on the cervix (the opening / passage between the vagina and the womb). Although very uncommon, sometimes large and unusually shaped warts may be caused by something else, like cancer.

What are the symptoms of genital warts?

Often, people do not have symptoms with genital warts; they just look down and notice a lump or lumps. Depending on their size, location and number some people find them itchy and sore, especially if they are around the back passage or inside the vagina. Sometimes, genital warts can bleed. They may make sex uncomfortable. Genital warts can cause embarrassment and distress, particularly when they interfere with sex.

How are genital warts diagnosed?

Genital warts have a typical appearance and can usually be diagnosed by a doctor or nurse after an examination of the genitalia. Your GP will normally be able to diagnose genital warts but will usually refer you to a sexual health service for review and treatment. If you are worried you have genital warts, you can attend a sexual health clinic by booking an appointment or as a ‘walk in’. Clinics can be found online by using the NHS ‘Find a sexual health clinic’ portal - Find a sexual health clinic - NHS. These services are confidential and anonymised. The healthcare professionals will not write to your GP unless you ask them to.

Although tests are not normally needed to diagnose genital warts, other infections may be screened for at the time of the appointment, because genital warts may also occur with other STIs. Other tests may include a swab of the vagina to test for chlamydia and gonorrhoea, and a blood test to check for HIV and hepatitis B. Chlamydia and gonorrhoea are common in the United Kingdom, HIV and hepatitis B less so. However, they are routinely screened for in most sexual health services as early diagnosis and treatment are important. In rare cases, when the diagnosis of a genital wart is unclear, a biopsy of the lump may be needed. This is a small clinic-based procedure where a small sample of tissue is taken and sent to the laboratory to be looked at.

How are genital warts treated?

There are several treatments available for genital warts, and the doctor or nurse will be able to discuss your options. Treatment is based on your preference, as well as the size, site and number of warts. Treatment may take weeks or months to work, and the warts may return. In some, the treatment does not work at all. Smokers tend to respond less well to treatment, so stopping smoking can help.

Options for therapy include:

Cream or liquid – this usually needs to be applied several times a day for a few weeks
Freezing – a doctor or nurse will freeze the warts; often the treatment needs repeating
Surgery – a doctor or nurse may cut, laser or burn the warts.

There is no cure for genital warts, but it is possible that your body may fight the virus over time. Given that around one third of warts resolve spontaneously within six months, you may choose not to have treatment at all. Still, it’s best to speak to a doctor instead of waiting and seeing.

Do genital warts increase the risk of cancers such as cervical cancer?

No, the types of HPV (Human Papilloma Virus) that we call high risk HPV that increase the risk of cancers include types 16 and 18, not the genital wart types of HPV (usually 6 or 11). The high risk HPVs usually have no symptoms and can be detected with cervical screening.

These high risk HPVs can be vaccinated against and this is currently offered on the NHS for girls and boys aged 12 to 13 years. The one used by the NHS is called Gardasil and also covers against genital warts.

Personal story

Becky is a 24-year-old student. She has had several boyfriends in the past, but no one serious. Recently though, she started dating someone who she really likes. Some months into their relationship, she notices that she has developed several lumps around her vulva. After examining herself in the mirror and googling her symptoms, she believes she may have genital warts. Becky decides to go to her local sexual health clinic for advice. She feels upset that her boyfriend may have given her genital warts and wonders if he has been unfaithful. At the clinic, the doctor examines her and does a STI screen. Afterwards, she confirms that Becky has genital warts, but that there are numerous treatments available. The doctor takes time to explain that genital warts are caused by a virus, which may have been present in the body long before she met her partner. Becky feels relieved. She opts to return to the clinic for the genital warts to be frozen. After a few weeks, the genital warts disappear.