Many people have no symptoms of being infected with HPV and don’t have any genital warts. You can still pass on the virus even if you have no visible genital warts. Genital warts can begin to grow weeks or months after you become infected.
In women, genital warts may appear:
- on the vulva
- inside or outside the vagina
- on the cervix (neck of the womb)
- inside the urethra (the tube that carries urine from the bladder and out through the vulva)
- inside or outside the anus
In men, genital warts may appear:
- on the penis
- on the scrotum
- inside the urethra (the tube that carries urine from the bladder and out through the penis)
- inside or outside the anus
It’s also possible to get warts caused by the same virus on your lips and in your mouth, nose or throat.
Although genital warts are usually painless, they can become inflamed or itchy and may bleed. You may notice blood in your urine if genital warts in your urethra begin to bleed. Blood may appear on toilet paper or in the toilet if there is bleeding from anal warts.
If you think you have genital warts, go to a sexual health clinic or see your GP for advice on treatment and prevention. If your GP diagnoses you with genital warts, he or she may refer you to a sexual health clinic for treatment.
You don’t need to be referred by your GP to go to a sexual health clinic; you can make your own appointment. All visits are confidential and you don't have to give your real name. The clinic will not send details to your GP without your consent.
At your sexual health clinic or GP surgery, 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. He or she may also carry out an internal examination of your vagina or anus to look for internal genital warts. Sometimes a biopsy (a small sample of tissue) is taken of the genital warts to confirm the diagnosis, but this is uncommon.
If you have genital warts, you may also have another STI. You may be advised to have tests for other STIs at the same time.
There are a number of ways to treat genital warts, but you may decide you don’t want treatment. If left untreated, genital warts may clear up on their own. This can take a long time – years in some people.
Genital wart treatment varies depending on the size, location and number of genital warts.
You may be prescribed medicines, such as imiquimod and podophyllotoxin, in the form of creams or liquids to apply to the genital warts. You may be able to do this for yourself at home. You may want to ask a partner to help if the location of the genital warts makes this difficult. Alternatively, you may need to go to a sexual health clinic to have treatments applied.
Cryotherapy uses liquid nitrogen to freeze your genital warts. You will usually be advised to have a course of cryotherapy, for example, every week or two for six to 12 weeks. Your nurse or doctor will advise you if you require more treatment.
Laser therapy can be used to break down your genital warts. You will be given a local anaesthetic. This completely blocks pain from the area and you will stay awake during the procedure.
You may be offered heat treatment (electrocautery or loop electrosurgical excision procedure) to get rid of your genital warts. You will be given a local anaesthetic for this procedure.
You may have surgery to remove your genital warts under local anaesthesia.
You may need to have repeat treatments to get rid of your genital warts as they can be difficult to remove or they may come back after treatment. If you smoke, you will probably not respond as well to treatment as a non-smoker.
Don’t use treatments designed for removing warts from other areas of the body (such as the hands and feet) because these aren’t suitable for treating genital warts, and could cause damage to the sensitive tissues in the genital area.
Some creams can interfere with certain forms of contraception, such as condoms, diaphragms and caps, so you may need to use an alternative contraceptive. Avoid unprotected sex soon after applying the creams because these can cause skin irritation in your partner. Ask your doctor or nurse for advice.
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 is safe for your developing baby.
Genital warts can grow larger in size or number during pregnancy or may reappear after years of having no warts. If you have genital warts in your vagina that grow very large, they may need to be removed to make sure that they don’t cause a problem during childbirth. Rarely, if you’re unable to have your genital warts removed and there is a possibility that they could cause a complication, you may be offered a caesarean.
It’s rare, but the HPV infection could pass to your baby during a vaginal birth. This could affect his or her throat or genitals. Your baby may need treatment for this infection once he or she is born.
If you have a weakened immune system
Genital warts are likely to be more severe and treatment is less likely to be successful if you have a weakened immune system, for example, if you have HIV/AIDS or are being treated for cancer. This means that you have a higher risk of the genital warts coming back. It’s important to go to follow-up appointments to make sure your treatment is tailored to your needs.
Genital warts are caused by HPV. There are many different types of HPV. About 40 of the 100 types of HPV can cause genital warts, but most are caused by type 6 or type 11.
Genital warts are passed on by skin-to-skin contact, such as during vaginal, anal and oral sex, or when sharing sex toys. You can still pass on the infection if you have no visible genital warts and by having close skin contact even without having sex. The virus is usually passed by sexual contact, but can also be passed on from warts on the hands.
People who change sexual partners frequently are more at risk of getting genital warts.
If you’re pregnant and have genital warts, these can be passed on to your baby during a vaginal birth, but this is rare.
Using a condom every time you have vaginal, anal or oral sex will reduce your risk of infection with HPV. Condoms can’t completely prevent you getting the infection because the areas of skin where there are genital warts aren’t always covered by a condom.
Before having sex with a new partner, you could both consider having a test for STIs.
There are two vaccines 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 and Gardasil are available in the UK. 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 and types 6, 11, that cause genital warts.
Can HPV affect my fertility?
No, HPV that causes genital warts hasn’t been shown to affect fertility in men or women.
HPV types that cause genital warts don't affect fertility. However, in women, some types of HPV have been associated with cervical cancer. A smear test is designed to look for changes in cells in the cervix (neck of the womb) that may go on to become cancerous. In this way, it can be treated before cancer develops. Cervical cancer and its treatment can affect fertility.
Can I pass on HPV after I’ve been treated for genital warts and they have gone away?
Yes, you can still pass on HPV, but this is more likely when you still have untreated genital warts. By using condoms every time you have sex you can help to reduce the risk of passing on the infection.
All the time you have the HPV infection you can pass on the virus. You can still be carrying HPV even after your genital warts have been treated because the virus can still be shed from the skin or in genital secretions. Your immune system usually clears the infection. In around one in three people the infection is cleared after six months, but it can take a number of years. If you have a weakened immune system, for example, because you have HIV/AIDS or are being treated for cancer, this may take longer – this means you have a greater risk of passing on the infection.
If I’m diagnosed with genital warts, do I need extra cervical smear tests or a human papilloma virus (HPV) test?
No, you won’t need extra smear tests unless your smear result is abnormal or shows particular strains of HPV. Usually genital warts are caused by a different type of HPV to the ones that can lead to cervical cancer.
However, infection with one type of HPV means you may also be infected with another. Women with genital warts are therefore more likely to develop cervical cancer. So you should have cervical screening every three to five years.
All women aged between 25 and 64 are eligible for free cervical screening (smear) tests. Cervical screening tests can detect cell changes in your cervix (neck of the womb) before they turn cancerous.
Usually genital warts are caused by HPV types 6 or 11. However, in one in 10 people they are caused by HPV types 16 or 18, which can lead to cervical cancer. Also, if you have genital warts, you are more at risk of having other sexually transmitted infections, including HPV types 16 or 18. This means you are at a higher risk of cervical cancer if you have genital warts.
It is important that you attend regular smear tests, even if you have had the HPV vaccine. The vaccine does not prevent all types of HPV that can cause cancer.
If your smear test shows that you have borderline or low-grade cervical abnormalities, you will automatically have an HPV test carried out on the same sample of cells collected during the smear. You won’t need any additional examinations at this stage.
If HPV is found, you will be referred for a colposcopy. This involves using a special instrument, called a colposcope, to look directly at the cervix to check for abnormal areas. Samples of tissues (biopsies) can be taken to check for abnormal cells. If HPV isn’t found, you will be asked to attend routine screening every three or five years depending on your age.
Is it safe to treat genital warts in pregnant women?
Genital warts can be treated in pregnant women. You must tell your doctor that you’re pregnant or think that you could be because the treatment you’re offered needs to be safe for your developing baby. Some of the usual medicines used to treat genital warts aren’t suitable if you’re pregnant.
Genital warts can appear for the first time or reappear during pregnancy after years with no warts. They may also increase in size and number during pregnancy and so become more noticeable at this time. Genital warts don’t usually cause a problem during pregnancy, but you may need to have them treated if they are in your vagina and could interfere with childbirth. Rarely, the HPV infection can be passed to your baby during childbirth, which could cause him or her to have warts in the throat or genital area. Your baby would need treatment for these.
One option for treating genital warts during pregnancy is cryotherapy. This is when liquid nitrogen is used to freeze the genital warts. Another option is surgery to remove the genital warts.
Certain medicines, such as imiquimod and podophyllotoxin, aren’t suitable as they could harm your baby’s development. You also shouldn’t use over-the-counter treatments that are meant for warts on your hands and feet as these aren’t designed to be used in the genital area.
Speak to your doctor or obstetrician (a doctor who specialises in pregnancy and childbirth) if you’re concerned about treatment for genital warts.
What happens if genital warts come back after treatment?
Genital warts can come back after treatment. If they do, you can be treated again.
New genital warts that come back after treatment may be caused by the original infection or a new infection from a partner. You can be treated again, so if the first treatment didn’t work, you can try a different one or a combination of treatments.
Infection with the types of HPV that cause genital warts happens by skin-to-skin contact during vaginal, oral or anal sex, or by sharing sex toys. If you have genital contact with an infected partner, you can get HPV even if you don't have penetrative sex. The virus can be passed on even if the infected person has no symptoms. Removing the genital warts doesn't mean you're free from HPV.
What happens if I don't have the genital warts treated?
Without treatment, your genital warts may increase in size or number, remain the same, or they may clear up and disappear.
You may choose not to have treatment. However, it’s important to discuss your options with your doctor at a sexual health clinic.
While you have visible genital warts, you may be more likely to pass the HPV infection on to someone else through sexual contact. This is possible even when using condoms correctly because they may not cover the affected area.
Genital warts can cause problems if you become pregnant or if you have an illness that affects your immune system, such as HIV/AIDS, or are being treated for cancer. The genital warts may grow larger in size or number and you may not clear the virus as quickly as someone with a healthy immune system. This may increase your risk of passing on the infection to someone else.
Treating genital warts can help to reduce the risk of you passing them on to your partner (or for pregnant women, to their baby during delivery).
Will the HPV vaccine be offered to older girls, women or men?
At present, in the UK the HPV vaccine against types 6, 11, 16 and 18 is offered to girls aged 12 to 13. There are no plans to extend this vaccination to other groups.
The HPV vaccine is effective in preventing the types of HPV infection that cause most cervical cancers and genital warts.
As HPV is so common, most sexually active women will already have been infected. Therefore, vaccination wouldn't be useful because the vaccine isn't thought to reduce the risk of developing cervical cancer in women who are already infected. In the UK, women older than 18 are not routinely vaccinated. Research is continuing, and, in a few years time, we will know more about the effects of the vaccine.
The vaccine isn't being offered to boys or men because the main purpose of this vaccination is to prevent cervical cancer. Provided girls are vaccinated before becoming sexually active, it isn’t necessary to vaccinate men for this to be effective.
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- Human papillomavirus. Medscape. emedicine.medscape.com, published 20 August 2013
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