Genital warts

You can have genital warts but not notice them. This makes it hard to estimate how common they are. However, it is estimated that genital warts affect about one in 10 sexually active men and women. They’re the most common type of viral sexually transmitted infection (STI). 

Genital warts are normally passed on during vaginal or anal sex. However, in rare cases, you can get them from having oral sex. Sexually active men and women with many partners are most at risk. You’re also more at risk if you:

• Are stressed
• Have a poor diet
• Have a weakened immune system
• Have another viral infection
• Smoke
• Were sexually active at a young age

Treatment options include prescribed creams and ointments, freezing, cauterisation or surgical removal. Treatment doesn’t always work, but for most people, the virus eventually goes away by itself thanks to the body’s immune system.

If you or your partner have genital warts, you should avoid sex, stop smoking, and ask your GP for advice.

The symptoms of genital warts are easier to spot in men as the warts occur on the outer skin of the penis. In females, genital warts may be hidden inside the vagina or around the cervix (entrance to the womb).

You may have just one wart or lots of them. Several warts can join together to form one large warty area. They may be soft or hard, depending on where they are. Soft warts tend to occur on warm, soft skin that is not hairy, eg the vulva. Hard warts tend to occur on dry, hairy skin, eg the bottom. Their colour can vary too. They can be the same colour as your skin, red, pink, grey or white.

Genital warts may be painless but they can also be irritated, inflamed and make you feel sore. They may bleed when you have intercourse or if they are in your anus, may bleed when you pass stools. Genital warts in your urethra — the tube through which you pass urine — can also cause bleeding and change the flow of your urine. You may also experience anal discharge or itchy genitals.

You should see your GP if you have: 

• An itchy or bleeding anus or genitals 
• One or more growths around your anus, vagina or penis
• Noticed your flow of urine has changed 

If you have no symptoms but your sexual partner has genital warts, you should also see your GP. You can then get treatment to stop yourself passing on genital warts.

Your doctor can usually diagnose genital warts by examining your skin, genitals or anus. They may also carry out an internal examination of your vagina or anus. If they’re uncertain, they may refer you to a sexual health specialist for further assessment.

A specialist will also carry out a physical examination of your skin, genitals or anus, and may need to carry out an internal examination of your vagina, anus or urethra. They can usually diagnose genital warts on seeing them and may ask you questions about your symptoms and sexual partners. 

They may also recommend you have tests for other STIs. That’s because around one in five people with genital warts also has another STI. It is not usually possible to identify who you caught your genital warts from or how long you’ve had them.

During pregnancy, genital warts might appear for the first time or recur after a long period without them. If you think you have genital warts and are pregnant, it is important that you tell your midwife or doctor. This is because during pregnancy:

• Genital warts can grow and increase in number
• Genital warts can infect the baby during birth 
• Genital warts may need to be removed to reduce the risk of complications during birth 
• Some treatments for genital warts are not suitable 

Most pregnant women with genital warts will still have a vaginal delivery. However, depending on your particular case, you may be offered a Caesarean section.

Genital warts are caused by human papillomavirus (HPV). However, not everyone with HPV develops them. Also, there are many different types of HPV — warts on hands and feet are caused by a different type of HPV to the type that causes genital warts. 

HPV is spread by sexual activity — it isn’t spread by mouth-to-mouth kissing, sharing towels, cutlery, utensils or toilet seats. However, skin to skin contact, vaginal and anal sex, and sharing sex toys can spread HPV. In rare cases, oral sex spreads HPV. 

You can get anal warts without having anal sex. Also, using a condom doesn’t mean you’re fully protected unless it completely covers the warts. 

Some people have HPV without any symptoms but the virus can still be passed on. Symptoms can take weeks or months to develop. In some cases, symptoms can appear over a year after infection. Even if the warts aren’t visible, or have been treated and are now gone, you can still pass on HPV. In rare cases, a mother can pass HPV onto her baby during birth. 

Some types of HPV have been linked to cancer (see below). However, the type of HPV that causes genital warts doesn’t cause cancer and cancer doesn’t cause genital warts.

HPV is linked to cervical cancer, as well as cancers of the anus, mouth, penis and vulva. The types of HPV that cause genital warts — usually types six and 11 — do not cause cancer and cancer does not cause genital warts.

However, you can be infected with more than one type of HPV at the same time. As most cervical cancers are caused by HPV, if you are a woman with genital warts it is important to attend your regular cervical screenings.

One in three people finds that their warts disappear in six months without treatment. Sometimes they come back a while later.

Your doctor can advise on how to get rid of genital warts. 

Treatments can include:

• Burning off the warts (electrocautery)
• Cream or acid treatment prescribed by your doctor that you will need to apply at home a few times a week or in some cases will need to see your doctor so they can apply it — you may experience burning, irritation and/or soreness due to this treatment 
• Freezing with liquid nitrogen (cryotherapy) — warts can be frozen each week for four consecutive weeks  
• Laser treatment or cauterisation
• Surgical removal — warts can be cut off, which may cause some irritation and/or scarring

Treatment is usually but not always successful. It can take several weeks or months for treatments to work and sometimes your warts can return. Genital warts can also clear up without treatment.

If you have genital warts, always remember to:

• Ask your doctor if your treatment will affect your contraception, eg caps, condoms or diaphragms 
• Avoid perfumed soaps or bubble baths during your treatment
• Tell your doctor or midwife if you are pregnant or trying to become pregnant

Do not:

• Have anal, oral or vaginal sex until your warts have gone
• Smoke — this reduces the effectiveness of treatment
• Use over-the-counter wart treatment — this is not suitable for genital warts

Although your warts may disappear on their own or with treatment, the virus that causes genital warts, HPV, can remain in your skin. This is why warts can return and why you can infect someone even if you have no warts. 

To reduce the risk of passing on genital warts:

• Do not have sex when being treated for genital warts
• Get vaccinated with the HPV vaccine
• Use a condom when you have sex

Up to a third of cases of genital warts clear up without treatment in three to six months. Most cases of genital warts can be successfully treated. However, genital warts recur in at least one in four cases, usually due to the original HPV infection becoming active again. If your genital warts recur, they can be treated as before. 

HPV usually clears up in two years or less after infection without any treatment.