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Genital warts

Genital warts are fleshy growths that can develop in your genitals and around your anus. They’re the most common sexually transmitted viral infection in the UK, particularly in men and women aged 16 to 24.

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  • About About genital warts

    Around 130,000 people in the UK are treated for genital warts each year. The numbers are getting lower each year, which is thought to be due to the introduction of a vaccine (see Prevention of genital warts below).

    Genital warts are caused by the human papilloma virus (HPV). If HPV infects the skin around your genitals and anus, it can cause the cells to multiply faster than usual, which leads to warts.

    Genital warts on dry, hairy skin are often hard, whereas if you get them on moist skin that doesn’t have hair on it, they tend to be soft. You might just get one wart, or you can get many in groups. They can vary in size from a few millimetres to several centimetres.

    Although you can treat genital warts, no treatment can completely remove the virus that causes them (HPV) from your body.

  • Symptoms Symptoms of genital warts

    Many people don’t get any symptoms of being infected with HPV and don’t have any genital warts. The HPV virus can stay in your body and not cause any symptoms for years. So if you’re in a committed relationship now, developing a wart isn’t necessarily a sign of infidelity. But you can pass on the virus even if you don’t have any visible genital warts.

    If you do get genital warts, they can begin to grow three weeks to eight months after you’re infected, but it can be as long as 18 months later.

    In women, you might get genital warts:

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

    In men, you might get genital warts:

    • on your penis (on or under your foreskin or on the shaft)
    • on your scrotum
    • inside your urethra
    • inside or outside your anus

    It’s also possible to get warts (caused by the same virus) on your lips and in your mouth, nose or throat. But this doesn’t happen often.

    Although genital warts aren’t usually painful, they can become inflamed or itchy, and may bleed. You might notice blood in your urine if you have genital warts in your urethra that begin to bleed. You might notice some blood on toilet paper or in the toilet if you have anal warts that bleed.

  • Diagnosis Diagnosis of genital warts

    If you think you have genital warts, go to a sexual health clinic or contact your GP for advice.

    You can make your own appointment to go to a sexual health clinic – you don’t need to see your GP. All visits are confidential and your details won’t be sent to your GP without your consent.

    At the sexual health clinic, a doctor or nurse will examine you and ask about your medical history. Genital warts are usually diagnosed by a doctor or nurse looking at them. They might also examine you internally by looking in your vagina or anus to see if there are any genital warts there. Sometimes they’ll take a small sample of tissue (biopsy) from a genital wart to confirm the diagnosis, but this isn’t common.

    If you have genital warts, it’s possible that you might have another sexually transmitted infection (STI) too. It’s a good idea to have tests for other STIs at the same time, if you’re offered them.

  • Private GP appointments

    With our GP services, we aim to give you an appointment the next day, subject to availability. Find out more today.

  • Treatment Treatment of genital warts

    There are lots of ways to treat genital warts, but it’s also an option not to have treatment at all. The warts might clear up on their own (three to six months), but for others it can take a long time – a year in some people. If you do have treatment, the type you have will depend on the size of your warts, where they are and how many you have. And your personal preference of the type of treatment you’d like, of course. You might need more than one treatment to get rid of genital warts because they can be difficult to remove, or may come back. If you smoke, the treatments may not work as well as for non-smokers.

    Don’t use any treatments for removing warts from hands and feet. These aren’t suitable for treating genital warts, and could damage the sensitive tissues in your genital area.

    Medicines

    Medicines used to treat genital warts include:

    • imiquimod
    • podophyllotoxin
    • trichloroacetic acid
    • green tea leaf extract (Catephen)

    These come as creams or liquids that you put on your genital warts. If you’re prescribed imiquimod, podophyllotoxin or Catephen, you might be able to do this yourself at home. You’ll need to go to a sexual health clinic to have some treatments such as trichloroacetic acid because these aren’t suitable for use at home.

    Some creams can interfere with certain types of contraception, such as condoms, diaphragms and caps, so you might need to use an alternative contraceptive. The creams might also irritate your partner’s skin. Ask your doctor or nurse for advice on what contraceptive to use while you’re using the cream.

    Non-surgical treatments

    • Cryotherapy uses liquid nitrogen to freeze genital warts. You’ll usually need to have cryotherapy every week for four weeks. If it hasn’t worked after this time, you might need to try another type of treatment.
    • Laser therapy can break down genital warts, particularly if you have lots, or they’re in hard-to-reach areas such as inside your anus or vagina.
    • Heat treatment (electrocautery or loop electrosurgical excision procedure) can burn off genital warts.

    You may have a local anaesthetic for these procedures. This will completely block pain from the area and you’ll stay awake.

    Surgery

    You might need to have an operation to remove your genital warts if they’re quite large, or in difficult to reach places. This can be done under local anaesthesia.

    Emotional support

    It can be difficult to deal with having genital warts, so it’s natural to feel anxious or upset about them. If you’re finding it hard to cope, talk to your GP or doctor at a sexual health clinic. They might be able to refer you to see a counsellor to get some support.

    Special considerations

    If you're pregnant

    Tell your doctor, midwife, or obstetrician (a doctor who specialises in pregnancy and childbirth) if you get genital warts while you’re pregnant. Your doctor will prescribe a treatment for you that’s safe for your baby.

    Genital warts can get bigger or multiply during pregnancy, or may reappear after years of having no warts. If you have genital warts in your vagina that grow very large, you might need to have them removed. This is so they don’t cause problems when you give birth. If you’re not able to have them removed, you may be offered a caesarean, but this is rare.

    Also, although very rare, it’s possible you could pass on the HPV infection to your baby when you give birth. This could affect your baby’s throat or genitals, and they may need treatment for the infection after birth.

    If you have a weakened immune system

    Genital warts are likely to be more severe and treatment is less likely to work if you have a weakened immune system. This could be because you have HIV/AIDS, for example, or are having treatment for cancer. This means genital warts are more likely to come back. It’s important to go to follow-up appointments to make sure you get the right treatment for you.

  • Causes Causes of genital warts

    Genital warts are caused by the human papilloma virus (HPV). There are over 100 types of HPV. About 40 of them can cause genital warts, but most warts are caused by type 6 or type 11.

    You can get genital warts through skin-to-skin contact with somebody who has genital warts. They can also spread through genital secretions, so you can get them if you have vaginal, anal and oral sex, or share sex toys. Your risk of getting genital warts increases with the number of people you have sex with.

    You can pass on the infection even if you have no visible genital warts, and by having close skin contact without having sex.

    If you’re pregnant and have genital warts, you can pass them on to your baby when you give birth, but this is rare.

  • Prevention Prevention of genital warts

    Using a condom every time you have any form of sex will reduce your risk of getting infected with HPV. But condoms can’t completely prevent you getting the infection because the areas of skin where there are genital warts aren’t always covered by them.

    Before you have sex with a new partner, you could both consider being checked for sexually transmitted infections, including genital warts.

    Vaccines

    There are two vaccines available in the UK 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.

    Cervarix® used to be offered as part of the national immunisation programme, but from 2012 this was switched to Gardasil®. Gardasil® is offered to all girls aged 12 to 13 to protect them against HPV types 16 and 18 that cause cervical cancer. It also protects against types 6, 11 that cause genital warts. For more information, see FAQ: HPV vaccine below.


     


     


  • FAQ: HPV and fertility Can HPV affect my fertility?

    No, HPV types that cause genital warts don’t affect fertility in men or women. But in women, some types of HPV have been associated with cervical cancer. Cervical cancer and some of the treatments for it, can affect your fertility. See our topic on cervical cancer and FAQ: Genital warts and cervical screening for more information.

  • FAQ: Genital warts and cervical screening Will genital warts affect my smear test?

    If your smear result is abnormal or shows particular strains of HPV, you will be called back for another test.

    Usually, genital warts are caused by HPV type 6 or 11. These HPV types do not cause cervical cancer. However, genital warts are occasionally caused by HPV type 16 or 18. These HPV types can cause cervical cancer. This means you may be more at risk of cervical cancer if you have genital warts, depending on the HPV types causing your warts. As HPV vaccine doesn’t prevent all types of HPV, it’s really important to go to cervical screening appointments.

  • FAQ: Infecting others Can I pass on HPV after I’ve been treated?

    Yes, you can still pass on HPV after you’ve had treatment for genital warts. But you’re more likely to do so if you still have untreated warts. Using condoms every time you have sex can help to reduce the risk of passing on the infection.

    You still carry HPV even after you’ve treated genital warts – and the virus can still be shed from your skin or in genital secretions.

    Your immune system will usually clear the visible signs of infection (genital warts). It’s thought that about three in 10 people with genital warts get better without treatment within three to six months, but it can take a lot longer. You’re more at risk of passing on the infection to others if you have genital warts. If you have a weakened immune system, for example, because you have HIV/AIDS or are having treatment for cancer, it may take even longer. This means you have a greater risk of passing on the infection.

  • FAQ: Genital warts coming back What happens if they come back after treatment?

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

    New genital warts after treatment may be caused by the original infection or by a new infection from a partner. You can have the same treatment again, or you can try a different one or a combination of treatments. Ask your doctor what’s best for you.

    If you have treatment to remove genital warts, it doesn't mean you're free from HPV. There isn’t a cure, you will always have the virus, but treatment can get rid of the warts so you don’t have visible symptoms of HPV.

  • FAQ: No treatment What happens if I don't get treatment for warts?

    Without treatment, genital warts can get bigger, or you can get more of them. But it’s also possible that they may stay the same, or even clear up and disappear. In about three in 10 people, the warts go away on their own within three to six months, but it can take a year in some people.

    You might decide not to have any treatment for genital warts. But it’s a good idea to discuss your options with a doctor at a sexual health clinic. If you have genital warts, you’re more likely to pass the HPV infection on to someone else through sexual contact. This is possible even if you use condoms because they might not cover the affected area of skin. Treating them can help to reduce the risk of you passing them on to your partner.

  • FAQ: HPV vaccine Who is the HPV vaccine offered to?

    At the moment, in the UK the HPV vaccine against types 6, 11, 16 and 18 is offered to girls aged 12 to 13. There’s also a ‘catch-up’ campaign for girls 14 to 18.

    As HPV is so common, most sexually active women will already have been infected. That’s why the vaccine is limited to girls at the moment – in the UK, women older than 18 aren’t routinely vaccinated. If you’re already infected with an HPV type that the vaccine can protect against, you won’t benefit fully from the vaccine – it isn’t as useful.

    The vaccine isn't offered to boys or men because the main purpose of this vaccination is to prevent cervical cancer. Provided girls are vaccinated before they start having sex, it isn’t necessary to vaccinate men for this to help. But research is continuing, so we’ll learn more about the effects of the vaccine in time, and if it will be offered to others.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Genital warts. BMJ Best Practice. bestpractice.bmj.com, last updated 17 June 2016
    • Health protection report: infection report. Public Health England. www.gov.uk, published 11 October 2016
    • Genital warts and human papillomavirus (HPV): guidance, data and analysis. Public Health England. www.gov.uk, last updated 7 October 2016
    • Immunisation against infectious disease. Public Health England. www.gov.uk, last updated 2 September 2014
    • UK national guidelines on the management of anogenital warts 2015. British Association of Sexual Health and HIV. www.bashhguidelines.org, published April 2015
    • Sexually transmitted infections in primary care. Royal College of General Practitioners. www.rcgp.org.uk, published 2013
    • External genital and perianal warts: green tea (Camellia sinensis) leaf extract 10% ointment. National Institute for Health and Care Excellence (NICE), December 2015. www.nice.org.uk
    • Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(RR–03):1–137. www.cdc.gov
    • Genital warts. Medscape. emedicine.medscape.com, updated 17 November 2016
    • Making it work. A guide to whole system commissioning for sexual health, reproductive health and HIV. Public Health England. www.gov.uk, revised March 2015
    • Genital warts. fpa. www.fpa.org.uk, last updated July 2014
    • Anogenital warts. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed 30 November 2016
    • Recurrent respiratory papillomatosis. Medscape. emedicine.medscape.com, updated 31 December 2015
    • Human papillomavirus vaccines. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed 30 November 2016
    • Anogenital warts. PatientPlus. patient.info/patientplus, last checked 29 June 2015
    • Cervical cancer and HPV. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2014
    • Human papillomavirus. Medscape. emedicine.medscape.com, updated 28 October 2016
    • Human papillomavirus (HPV) vaccination. PatientPlus. patient.info/patientplus, last checked 20 October 2014
    • The HPV vaccine. Beating cervical cancer – questions and answers. Public Health England. www.gov.uk, last updated August 2014
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    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, February 2017

    Expert reviewer Dr Adrian Raby, General Practitioner, Abingdon Medical Practice

    Next review due February 2020

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