Genital Warts

Overview

Genital warts are one of the most common types of sexually transmitted infections. Nearly all sexually active people will become infected with at least one type of human papillomavirus (HPV), the virus that causes genital warts, at some point during their lives.

Genital warts affect the moist tissues of the genital area. They can look like small, flesh-colored bumps or have a cauliflower-like appearance. In many cases, the warts are too small to be visible.

Some strains of genital HPV can cause genital warts, while others can cause cancer. Vaccines can help protect against certain strains of genital HPV.

Symptoms

In women, genital warts can grow on the vulva, the walls of the vagina, the area between the external genitals and the anus, the anal canal, and the cervix. In men, they may occur on the tip or shaft of the penis, the scrotum, or the anus.

Genital warts can also develop in the mouth or throat of a person who has had oral sexual contact with an infected person.

The signs and symptoms of genital warts include:

• Small, flesh-colored, brown or pink swellings in your genital area
• A cauliflower-like shape caused by several warts close together
• Itching or discomfort in your genital area
• Bleeding with intercourse

Genital warts can be so small and flat as to be invisible. Rarely, however, genital warts can multiply into large clusters in someone with a suppressed immune system.

When to see a doctor

See a health care professional if you or your partner develops bumps or warts in the genital area.

Causes

The human papillomavirus (HPV) causes warts. There are more than 40 strains of HPV that affect the genital area.

Genital warts are almost always spread through sexual contact. Your warts don't have to be visible for you to spread the infection to your sexual partner.

Risk factors

Most people who are sexually active get infected with genital HPV at some time. Factors that can increase your risk of becoming infected include:

• Having unprotected sex with multiple partners
• Having had another sexually transmitted infection
• Having sex with a partner whose sexual history you don't know
• Becoming sexually active at a young age
• Having a compromised immune system, such as from HIV or drugs from an organ transplant

Complications

HPV infection complications can include:

• Cancer. Cervical cancer has been closely linked with genital HPV infection. Certain types of HPV also are associated with cancers of the vulva, anus, penis, and mouth and throat.

  HPV infection doesn't always lead to cancer, but it's important for women to have regular Pap tests, particularly those who've been infected with higher risk types of HPV.

• Problems during pregnancy. Rarely during pregnancy, warts can enlarge, making it difficult to urinate. Warts on the vaginal wall can inhibit the stretching of vaginal tissues during childbirth. Large warts on the vulva or in the vagina can bleed when stretched during delivery.

  Extremely rarely, a baby born to a mother with genital warts develops warts in the throat. The baby might need surgery to keep the airway from being blocked.

Prevention

Limiting your number of sexual partners and being vaccinated will help prevent you from getting genital warts. Using a condom every time you have sex is a good idea, but won't necessarily protect you from genital warts.

Vaccination

The Centers for Disease Control and Prevention (CDC) recommends routine HPV vaccination for girls and boys ages 11 and 12, although it can be given as early as age 9.

It's ideal for girls and boys to receive the vaccine before they have sexual contact.

Side effects from the vaccines are usually mild and include soreness at the injection site, headaches, a low-grade fever or flu-like symptoms.

The CDC now recommends that all 11- and 12-year-olds receive two doses of HPV vaccine at least six months apart, instead of the previously recommended three-dose schedule. Younger adolescents ages 9 and 10 and teens ages 13 and 14 also are able to receive vaccination on the updated two-dose schedule. Research has shown that the two-dose schedule is effective for children under 15.

Teens and young adults who begin the vaccine series later, at ages 15 through 26, should continue to receive three doses of the vaccine.

The CDC now recommends catch-up HPV vaccinations for all people through age 26 who aren't adequately vaccinated.

The U.S. Food and Drug Administration approved the use of Gardasil 9 for males and females ages 9 to 45. If you're ages 27 to 45, discuss your risks with your health care team to decide if you should get the HPV vaccine.

Diagnosis

Genital warts are often diagnosed by appearance. Sometimes a biopsy might be necessary.

Pap tests

For women, it's important to have regular pelvic exams and Pap tests, which can help detect vaginal and cervical changes caused by genital warts or the early signs of cervical cancer.

During a Pap test, a device called a speculum holds open the vagina. The health care professional can then see the passage between the vagina and uterus, called the cervix. A long-handled tool collects a small sample of cells from the cervix. The cells are examined with a microscope for abnormalities.

HPV test

Only a few types of genital HPV have been linked to cervical cancer. A sample of cervical cells, taken during a Pap test, can be tested for these cancer-causing HPV strains.

This test is generally reserved for women age 30 and older. It isn't as useful for younger women because for them, HPV usually goes away without treatment.

Treatment

If your warts aren't causing discomfort, you might not need treatment. But if you have itching, burning and pain, or if you're concerned about spreading the infection, medication or surgery can help you clear an outbreak.

However, warts often return after treatment. There is no treatment for the virus itself.

Medications

Genital wart treatments that can be applied directly to your skin include:

• Imiquimod (Aldara, Zyclara). This cream appears to boost your immune system's ability to fight genital warts. Avoid sexual contact while the cream is on your skin. It might weaken condoms and diaphragms and irritate your partner's skin.

  One possible side effect is skin redness. Other side effects might include blisters, body aches or pain, a cough, rashes, and fatigue.

• Podophyllin and podofilox (Condylox). Podophyllin is a plant-based resin that destroys genital wart tissue. A health care professional applies this solution. Podofilox contains the same active compound, but you can apply it at home.

  Never apply podofilox internally. Additionally, this medication isn't recommended for use during pregnancy. Side effects can include mild skin irritation, sores or pain.

• Trichloroacetic acid. This chemical treatment burns off genital warts, and can be used for internal warts. Side effects can include mild skin irritation, sores or pain.
• Sinecatechins (Veregen). This cream is used for treatment of external genital warts and warts in or around the anal canal. Side effects, such as reddening of the skin, itching or burning, and pain, are often mild.

Don't try to treat genital warts with over-the-counter wart removers. These medications aren't intended for use in the genital area.

Surgery

You might need surgery to remove larger warts, warts that don't respond to medications or, if you're pregnant, warts that your baby can be exposed to during delivery. Surgical options include:

• Freezing with liquid nitrogen (cryotherapy). Freezing works by causing a blister to form around your wart. As your skin heals, the lesions slough off, allowing new skin to appear. You might need to repeat the treatment. The main side effects include pain and swelling.
• Electrocautery. This procedure uses an electrical current to burn off warts. You might have some pain and swelling after the procedure.
• Surgical excision. Warts can be cut off during surgery. You'll need local or general anesthesia for this treatment, and you might have pain afterward.
• Laser treatments. This approach, which uses an intense beam of light, can be expensive and is usually reserved for extensive and tough-to-treat warts. Side effects can include scarring and pain.

Preparing for your appointment

You're likely to start by seeing your health care professional.

What you can do

Make a list of your:

• Symptoms and when they began. Describe your symptoms and note whether your sexual partner has had similar symptoms.
• Sexual history, including all recent exposures to possible sources of infection, particularly if you've had unprotected sex or sex with a new partner.
• Key medical information, including other conditions you're being treated for.
• All medications, vitamins or other supplements you take, including doses.

For genital warts, some basic questions to ask your doctor include:

• What tests do I need?
• Should I also be tested for other sexually transmitted infections?
• What treatment approach do you recommend, if any?
• How soon after I begin treatment can I expect to get better?
• Am I contagious? How can I reduce the risk of passing this infection to others?
• Should my partner be tested for this condition?
• When can I safely have sex again?
• Will my genital warts come back?
• Am I at risk of complications related to genital warts?
• How often should I be screened for other health conditions related to genital warts?
• Are there printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

• How severe are your symptoms?
• Do you practice safe sex? Have you always done so?
• Have you recently had sex with a new partner?
• Has your partner been tested for sexually transmitted infections?
• Have you had the HPV vaccine? When?
• Are you pregnant or planning to become pregnant?