Genital Warts (HPV): Symptoms, Treatment & Prevention

What Are Genital Warts?

Genital warts (condyloma acuminata) are small, flesh-colored growths that appear in the genital and anal areas, caused by certain strains of human papillomavirus (HPV). They are one of the most common sexually transmitted infections worldwide, affecting approximately 1% of the sexually active population at any given time.

Genital warts are caused by specific types of human papillomavirus, primarily HPV types 6 and 11, which together account for approximately 90% of all genital warts cases. These are classified as "low-risk" HPV types because they very rarely cause cancer, unlike the "high-risk" types (mainly 16 and 18) that are responsible for most HPV-related cancers.

The warts themselves are benign growths that develop on the moist surfaces of the genital and anal areas. They can appear as single warts or in clusters, sometimes resembling a cauliflower in shape. While the warts can be distressing cosmetically and psychologically, they are generally not dangerous to your health. Most people who develop genital warts will see their infection clear naturally as their immune system fights off the virus, though this can take one to two years or longer.

It's important to understand that HPV infection is extremely common. Most sexually active people will contract at least one type of HPV at some point in their lives, though the majority will never develop visible warts. The immune system often suppresses or eliminates the virus before any symptoms appear. When warts do develop, it means the virus has replicated enough to cause visible changes in the skin tissue.

How Common Are Genital Warts?

Genital warts are among the most frequently diagnosed sexually transmitted infections globally. Studies suggest that approximately 1% of sexually active adults have visible genital warts at any given time, while the lifetime risk of developing genital warts is estimated at 5-10%. The incidence is highest in young adults aged 20-24, reflecting both higher rates of new sexual partnerships and the time needed for the immune system to develop natural immunity to HPV.

Before the introduction of HPV vaccination programs, genital warts were becoming increasingly common. Countries that have implemented widespread HPV vaccination have seen dramatic reductions in genital warts cases—some reporting decreases of 90% or more in vaccinated populations. This demonstrates both the effectiveness of the vaccine and the public health impact of HPV vaccination programs.

The Difference Between Genital Warts and Cancer-Causing HPV

A common source of confusion and anxiety is the relationship between genital warts and HPV-related cancers. It's essential to understand that these are typically caused by different HPV types. The HPV types that cause visible genital warts (types 6 and 11) are classified as low-risk because they almost never lead to cancer. The high-risk HPV types that can cause cervical, anal, and other cancers (primarily types 16 and 18) usually do not cause visible warts.

However, it's possible to be infected with multiple HPV types simultaneously. Having genital warts does not mean you have cancer or are at significantly increased risk of developing cancer, but it also doesn't mean you're not infected with other HPV types. Regular screening (such as cervical smear tests for women) remains important regardless of whether you have or have had genital warts.

What Are the Symptoms of Genital Warts?

The primary symptom of genital warts is the appearance of small, flesh-colored or gray growths in the genital or anal area. Warts may be flat or raised, single or multiple, and can sometimes have a cauliflower-like texture. Many people experience no other symptoms, though some report mild itching, burning, or discomfort.

Not everyone infected with HPV types 6 or 11 will develop visible warts. Many people carry the virus without ever showing symptoms, which is one reason why HPV spreads so easily—people can transmit the virus without knowing they're infected. When warts do appear, they typically develop one to six months after exposure, though the incubation period can sometimes extend to several years.

The appearance of genital warts can vary significantly from person to person. Some people develop a single small wart, while others may have clusters of warts that, over time, can grow larger if left untreated. The warts themselves are usually painless, though their location can sometimes cause discomfort, particularly during sexual activity or when wearing certain types of clothing.

Appearance and Location

Genital warts can appear in various locations depending on the type of sexual contact through which HPV was transmitted. In women, warts commonly appear on the vulva (external genitalia), inside the vagina, on the cervix, and around the anus. In men, warts typically appear on the penis (especially around the head and under the foreskin), on the scrotum, and around the anus. Warts can also develop in the mouth or throat following oral sex with an infected partner, though this is less common.

The warts themselves may appear as:

• Small, flesh-colored or gray bumps: The most common appearance, often similar in color to surrounding skin
• Flat or slightly raised lesions: Some warts are barely noticeable without close examination
• Cauliflower-like clusters: When multiple warts grow close together, they can form larger, textured masses
• Soft and moist texture: Unlike common skin warts, genital warts typically have a softer consistency

Associated Symptoms

While the warts themselves are the defining symptom, some people experience additional symptoms that can impact their quality of life. These may include:

• Itching or irritation: Mild itching around the affected area is relatively common
• Burning sensation: Some people report a burning feeling, especially after urination
• Bleeding during intercourse: Warts in certain locations may bleed during sexual activity
• Increased vaginal discharge: Women may notice changes in vaginal discharge
• Psychological distress: The emotional impact of having a visible STI can be significant

When Should You See a Doctor for Genital Warts?

You should see a healthcare provider if you notice any new growths or changes in your genital or anal area, particularly if you've had sexual contact with someone who has HPV or genital warts. A proper diagnosis is important because other conditions can look similar, and treatment options are available.

Many people feel embarrassed about seeking medical help for potential genital warts, but healthcare providers who work in sexual health see these conditions regularly and are trained to provide non-judgmental care. Getting an accurate diagnosis is important for several reasons: it confirms whether the growths are actually genital warts, it allows you to discuss treatment options, and it provides an opportunity to get tested for other sexually transmitted infections.

You should contact a healthcare provider promptly if you experience any of the following:

• New growths or bumps in your genital or anal area
• A partner has been diagnosed with genital warts or HPV
• Existing warts are growing, spreading, or changing in appearance
• You're experiencing significant itching, pain, or bleeding
• Over-the-counter treatments haven't worked (note: wart removers sold for common skin warts should never be used on genital warts)
• You're pregnant and have or suspect genital warts

Where to Seek Care

You can seek care for suspected genital warts from several types of healthcare providers. Your options include your primary care physician or general practitioner, sexual health clinics (also called STI clinics or GUM clinics in some countries), dermatology clinics, gynecologists (for women), and urologists (for men). Sexual health clinics are often a good choice because they specialize in these conditions and typically offer confidential services.

How Do You Get Genital Warts?

Genital warts are transmitted through direct skin-to-skin contact during sexual activity with an infected person. The virus can be transmitted even when no warts are visible, and condoms reduce but do not eliminate transmission risk because HPV can infect areas not covered by the condom.

Human papillomavirus, the cause of genital warts, is primarily transmitted through intimate skin-to-skin contact during vaginal, anal, or oral sex. The virus enters the body through tiny breaks or abrasions in the skin, which is why the moist, delicate tissues of the genital area are particularly vulnerable. Once the virus enters the cells, it may remain dormant for weeks, months, or even years before causing visible warts—or it may never cause symptoms at all.

One of the challenges in preventing HPV transmission is that the virus can spread even when no warts are visible. Many infected individuals never develop symptoms but can still transmit the virus to their partners. This is why HPV is so widespread—people often don't know they're carrying the virus. The longer you remain symptom-free after an infection, the less likely you are to transmit the virus, as viral levels typically decrease over time.

Risk Factors for Genital Warts

Several factors can increase your risk of developing genital warts after HPV exposure:

• Multiple sexual partners: Having more partners increases your chances of encountering the virus
• Starting sexual activity at a young age: Younger individuals may have less developed immune responses to HPV
• Weakened immune system: Conditions or medications that suppress the immune system increase susceptibility
• Having another STI: Some research suggests other infections may facilitate HPV transmission
• Smoking: Tobacco use has been linked to increased risk of developing genital warts
• Pregnancy: Hormonal changes during pregnancy can affect immune function and HPV expression

Can Genital Warts Be Transmitted Through Other Means?

While sexual contact is the primary transmission route, there are some other, less common ways HPV can spread. Transmission from mother to infant during vaginal delivery is possible, though rare—this can potentially cause a condition called recurrent respiratory papillomatosis in the child. Non-sexual transmission between adults is extremely uncommon but theoretically possible through shared contaminated objects or close skin contact, though this route of transmission is not well-documented for genital HPV types.

How Can You Prevent Genital Warts?

The most effective prevention for genital warts is HPV vaccination, which protects against the HPV types causing approximately 90% of genital warts. Consistent condom use reduces transmission risk, though it doesn't provide complete protection since HPV can infect areas not covered by condoms.

Prevention of genital warts involves a combination of vaccination, safer sex practices, and awareness. The HPV vaccine represents a major advance in preventing both genital warts and HPV-related cancers, and is now recommended for all adolescents and many adults. Understanding how HPV spreads and taking appropriate precautions can significantly reduce your risk of infection.

HPV Vaccination

The HPV vaccine is the most effective tool for preventing genital warts. Current vaccines protect against HPV types 6 and 11, which cause approximately 90% of genital warts, as well as the high-risk types 16 and 18 that cause most HPV-related cancers. The vaccine is most effective when given before any exposure to HPV, which is why it's typically recommended for children and adolescents aged 11-12, though it can be given as early as age 9.

For individuals who didn't receive the vaccine as adolescents, vaccination is still beneficial. The vaccine is approved for people up to age 45 in many countries. Even if you've already been exposed to one or two HPV types, the vaccine can still protect against the other types it covers. Many countries offer free HPV vaccination for children through school-based programs, while older individuals may need to pay for the vaccine or check their insurance coverage.

Safer Sex Practices

While condoms don't provide complete protection against HPV (because they don't cover all potentially infected skin), consistent condom use still significantly reduces transmission risk. Studies suggest that consistent condom use can reduce HPV transmission by approximately 70%. Additional protective measures include:

• Limiting number of sexual partners: Fewer partners means fewer opportunities for exposure
• Mutual monogamy: Being in a committed relationship with an uninfected partner eliminates transmission risk
• Open communication: Discussing sexual health history with partners allows for informed decisions
• Avoiding sex during active outbreaks: When warts are visible, transmission risk is higher

How Are Genital Warts Diagnosed?

Genital warts are usually diagnosed through visual examination by a healthcare provider. The characteristic appearance of the warts is often sufficient for diagnosis, though in unclear cases, a biopsy may be performed to examine the tissue under a microscope. There is no blood test that can detect the HPV types causing genital warts.

Diagnosing genital warts is typically straightforward for experienced healthcare providers. The distinctive appearance of the warts—their location, texture, and grouping pattern—usually makes clinical diagnosis reliable. During the examination, your healthcare provider will visually inspect the genital and anal areas, possibly using magnification to identify smaller warts. They may apply a dilute acetic acid (vinegar) solution to the area, which can make flat warts more visible by causing them to turn white temporarily.

In some cases, additional testing may be recommended. If the diagnosis is uncertain, or if the appearance is atypical, your provider may perform a biopsy—removing a small sample of tissue for examination under a microscope. This can confirm the diagnosis and rule out other conditions, including certain types of cancer. While biopsies are generally safe, they do require local anesthesia and may cause minor discomfort.

Testing for Other STIs

If you're diagnosed with genital warts, your healthcare provider will likely recommend testing for other sexually transmitted infections, particularly chlamydia. Having one STI can indicate increased risk for others, and some infections can be present without symptoms. Regular STI screening is an important part of sexual health maintenance, especially for people with new or multiple partners.

How Are Genital Warts Treated?

Genital warts can be treated with topical medications applied at home, or removed by a healthcare provider using methods such as cryotherapy (freezing), electrocautery, or surgical excision. Treatment removes the visible warts but does not eliminate the underlying HPV infection, which is why recurrence is common.

Treatment for genital warts focuses on removing the visible warts rather than curing the underlying HPV infection. Many people choose treatment because the warts are bothersome, cosmetically distressing, or causing symptoms like itching or discomfort. However, it's worth noting that many genital warts will eventually clear on their own as the immune system controls the infection—this can take months to years, and some people prefer to wait rather than undergo treatment.

The choice of treatment depends on several factors, including the number, size, and location of warts, patient preference, healthcare provider expertise, and potential side effects. Treatment typically requires multiple sessions or applications, and recurrence rates are high regardless of which method is used. This is because treatment removes the warts themselves but doesn't eliminate the virus from surrounding tissues.

Patient-Applied Treatments

Several prescription treatments can be applied at home by patients:

Podophyllotoxin (Condyline, Warticon): This medication is applied directly to the warts twice daily for three consecutive days, followed by four days without treatment. This cycle is repeated for up to four weeks. Podophyllotoxin works by inhibiting cell division in the wart tissue. Side effects may include local irritation, redness, and soreness. This medication should not be used during pregnancy.

Imiquimod (Aldara): Applied three times per week at bedtime for up to 16 weeks, imiquimod works by stimulating the local immune response against HPV. The cream is left on for 6-10 hours before washing off. Side effects can include redness, swelling, and flu-like symptoms in some users. Imiquimod may be particularly useful for larger areas of warts.

Sinecatechins (Veregen): A newer treatment derived from green tea extracts, applied three times daily for up to 16 weeks. It has anti-viral and anti-proliferative properties. Side effects are generally mild and include local skin reactions.

Provider-Administered Treatments

When home treatments are ineffective or not suitable, healthcare providers can remove warts using several methods:

Cryotherapy (freezing): The most common in-office treatment, cryotherapy uses liquid nitrogen to freeze and destroy wart tissue. The freezing causes the wart to blister and eventually fall off. Multiple sessions are usually required, typically at 1-2 week intervals. Side effects include pain during treatment and potential blistering.

Electrocautery: This method uses electrical current to burn off the warts. It's effective for removing warts and can also stop bleeding. Local anesthesia is required, and there may be some scarring.

Surgical excision: For larger warts or those not responding to other treatments, surgical removal using a scalpel or scissors may be recommended. This is done under local anesthesia and allows for precise removal of wart tissue.

Laser treatment: Using focused laser light to destroy wart tissue, this method is sometimes used for extensive or difficult-to-treat warts. It can be expensive and may require specialized equipment.

Treatment During Pregnancy

If you're pregnant and have genital warts, discuss treatment options with your healthcare provider. Some treatments, particularly podophyllotoxin, should not be used during pregnancy. Genital warts can grow larger during pregnancy due to hormonal and immune changes. In most cases, genital warts do not affect the pregnancy or delivery, though very large warts in the vaginal canal might occasionally complicate vaginal delivery.

Why Do Genital Warts Come Back?

Genital warts commonly recur after treatment because treatment removes visible warts but not the underlying HPV infection in surrounding tissues. Recurrence rates range from 20-50% within the first few months after treatment. The immune system eventually controls the infection in most people, after which recurrence becomes unlikely.

One of the most frustrating aspects of genital warts for many patients is their tendency to recur after treatment. This happens because current treatments target the visible warts—the abnormal cell growths—rather than the HPV virus itself. The virus can remain in seemingly normal-looking skin surrounding the treated area, and may reactivate to form new warts. This doesn't mean treatment failed; it simply reflects the nature of HPV infection.

Several factors can influence the likelihood of recurrence. Individuals with weakened immune systems tend to have higher recurrence rates. Larger initial wart burdens and longer duration of infection before treatment may also predict higher recurrence. Smoking has been associated with increased recurrence risk, providing another reason to quit if you smoke.

The good news is that with time, the immune system in most people will gain control over the HPV infection. Once this happens, recurrence becomes unlikely. While some people may experience multiple recurrences over months or even years, the majority eventually see their infection resolve completely. Maintaining overall good health, managing stress, and avoiding smoking can support your immune system in fighting the infection.

Living with Genital Warts: Psychological Impact and Relationships

Being diagnosed with genital warts can cause significant psychological distress, including anxiety, shame, and concerns about relationships. It's important to remember that genital warts are extremely common, treatable, and usually temporary. Open communication with partners and support from healthcare providers can help manage the emotional impact.

The emotional impact of a genital warts diagnosis often outweighs the physical symptoms. Many people experience feelings of shame, embarrassment, anxiety about telling partners, and worries about their sexual future. These feelings are understandable but often based on misconceptions about HPV and sexually transmitted infections in general.

It helps to remember some key facts: HPV is extremely common, with most sexually active people contracting it at some point. Having genital warts does not reflect on your character or behavior. The infection is temporary in most cases, with the body clearing the virus over time. Effective treatments are available, and many couples continue healthy, fulfilling relationships after a genital warts diagnosis.

Telling Partners

Deciding when and how to tell sexual partners about genital warts can be challenging. Current partners should be informed so they can make informed decisions and watch for symptoms themselves. For new relationships, there's no universally "right" time to disclose—some people prefer to share before any sexual contact, while others wait until the relationship develops. What's important is honest communication before any sexual activity occurs.

When having this conversation, keep in mind that many partners will already be familiar with HPV and genital warts, or may even have been exposed previously themselves. Providing accurate information about transmission, treatment, and the typically temporary nature of the infection can help ease concerns. Some couples choose to abstain from sexual contact during active outbreaks, while others may accept the risk of transmission as part of their relationship.

What Are the Complications of Genital Warts?

Genital warts caused by low-risk HPV types rarely cause serious complications. The main concerns are recurrence after treatment, potential psychological impact, and rare transmission to infants during childbirth. Genital warts do not significantly increase cancer risk, as they're caused by different HPV types than those causing cancer.

For most people with healthy immune systems, genital warts remain a localized problem that eventually resolves. The warts themselves are benign growths that don't spread to other parts of the body or cause systemic illness. However, there are some potential complications to be aware of.

Pregnancy and Childbirth

During pregnancy, hormonal changes can cause existing genital warts to grow larger or multiply. In rare cases, very large warts in the vaginal canal might obstruct labor, potentially requiring cesarean delivery. The HPV virus can very rarely be transmitted to the baby during vaginal delivery, potentially causing a condition called recurrent respiratory papillomatosis—a rare condition where warts grow in the child's throat. However, this complication is uncommon, and most healthcare providers do not recommend cesarean delivery solely to prevent HPV transmission unless warts are causing obstruction.

Impact on Quality of Life

While not a medical complication per se, the psychological impact of genital warts can significantly affect quality of life. Depression, anxiety, relationship problems, and sexual dysfunction have all been associated with genital warts diagnosis. Seeking support from healthcare providers, counselors, or support groups can help manage these effects.

Genital Warts During Pregnancy

Genital warts during pregnancy can grow larger due to hormonal and immune changes, but rarely cause complications. Most pregnant women with genital warts can safely deliver vaginally. Treatment options are limited during pregnancy, and some treatments should be avoided. Discuss management with your healthcare provider.

If you have genital warts during pregnancy, or develop them while pregnant, you'll want to discuss management with your healthcare provider. Pregnancy causes changes in hormone levels and immune function that can affect how your body handles HPV infection. Some women see their warts grow larger during pregnancy, while others may develop warts for the first time during pregnancy due to immune changes.

Treatment options during pregnancy are more limited because some medications can potentially harm the developing baby. Podophyllotoxin should not be used during pregnancy. If treatment is necessary, cryotherapy or surgical removal are generally considered safer options. However, many healthcare providers recommend waiting until after delivery to treat genital warts unless they're causing significant symptoms.

Regarding delivery, most women with genital warts can safely deliver vaginally. The risk of transmitting HPV to the baby during delivery is very low, and the potential complications of cesarean delivery generally outweigh the small risk of HPV transmission. However, if warts are very large and potentially obstructing the birth canal, cesarean delivery may be recommended.