Genital warts: why they develop, how they can be treated and what you should bear in mind

If you've just developed genital warts for the first time and know nothing about them – neither why they've appeared nor how to get rid of them quickly – then you're most likely feeling uneasy, or perhaps even downright frightened. So let's start with the most important thing: stay calm.

There's no reason to panic and no reason to be afraid. Genital warts may look unsightly and can cause a certain amount of discomfort, but in most cases they pose no immediate danger to your health. And there's more good news: they can be treated completely, so that they disappear altogether! The virus that causes them may remain in the body, but there's every chance that even this will clear within two years.

Now that we've given you the good news, let's go through things step by step and clear everything up. Here you'll find out what genital warts are, why they appear and how they can be treated.

What are genital warts?

Genital warts are a sexually transmitted condition. They are small, spot-like or nodular growths known as warts or condylomas.

They occur in the genital and anal area (on the moist tissues of the genital region). In women, they are found on the vulva, outside or just inside the vaginal opening and around the anus, and can even spread as far as the cervix. In men, they may appear on the thighs, in the groin, on the scrotum, on the penis and around or inside the anal opening. If oral sex was also involved during sexual contact, the infection can additionally spread to the lips, tongue, lining of the mouth and larynx.

You can usually recognise them by their appearance:

• They are generally small, soft or firm raised bumps on the surface of the skin.
• They may look like skin-coloured or reddish-grey spots.
• The warts may appear singly or in clusters.
• Clustered growths resemble a cauliflower in appearance (the so-called cauliflower-like appearance).
• Their surface may be smooth or feel slightly bumpy.
• They may also remain invisible because they are smooth and exactly the same colour as the skin.

Who can get genital warts?

Genital warts are the result of infection with a sexually transmitted virus and are easily passed on through skin-to-skin contact. This means that any sexually active person – regardless of sex, age or medical history – risks catching the virus that causes genital warts if their partner is infected. (Your partner may not have genital warts themselves, yet still carry the virus and pass it on.)

For this reason, using a condom is the only way to protect yourself against transmission to or from your partner.

How common are genital warts?

Surprising or not, statistics confirm that genital warts are the most common sexually transmitted infection. So it's a far more widespread problem than you might have expected.

It's also worth knowing the risk factors:

• Men are somewhat more prone to developing genital warts.
• The risk of infection rises considerably if you don't use a condom or dental dam.
• The risk also increases if you have multiple sexual partners or change partners frequently.

Causes of genital warts

Here too, statistics show what the main cause of genital warts is: in 90% of cases, there is an infection with certain types of HPV (human papillomavirus). Of the more than 30 types of human papillomavirus that can cause problems in the genital area, it is HPV types 6 and 11 that lead to the development of warts.

The good news is that these HPV types do not lead to cancer (if you'd like to find out more about human papillomavirus, we've prepared a separate article on our blog about HPV infection and everything you need to know about vaccination and treatment), and that your general health isn't put at risk simply because these growths appear. On the contrary: in people with a strong immune system, the warts may even clear up on their own after around 6 months without any treatment. A visit to the doctor is still advisable, though – we'll come to that shortly.

So if you're wondering how and why genital warts develop, some of the possible causes include:

• Unprotected oral sex with someone who is infected with HPV or has genital warts – either in the intimate area or in the mouth (tongue, lips, mouth).
• Contact between both partners' genitals, even without ejaculation.
• Unprotected sexual intercourse, including anal sex and including between people of the same sex.

 Symptoms of genital warts

Genital warts aren't always painful, and sometimes there is no symptom other than their unsightly appearance. In other cases they are accompanied by burning or pain. Here are the most common symptoms by which you can recognise them:

• Small, soft raised bumps in pink, red, brown or whitish-grey in the genital area.
• A smooth or cauliflower-like appearance when the warts occur in clusters.
• Burning, itching, soreness, pain and discomfort in the intimate area.
• Slight bleeding during or after sexual intercourse.

How contagious are genital warts?

Both genital warts and HPV in general are highly contagious sexually transmitted conditions. They can be passed on very easily by an infected partner, even after a single instance of unprotected contact.

And once you've caught human papillomavirus, it doesn't always leave the body again. Visible genital warts may disappear, but even if they never return, you may remain permanently infected and could pass the virus on to a new partner at any time.

How quickly do genital warts appear after infection?

They don't appear immediately after sexual intercourse. In some cases genital warts become visible just a few weeks after HPV infection, but it can also take several months or years. It's therefore rather difficult to predict exactly how quickly genital warts will appear – it varies from person to person and depends, among other things, on how healthy your immune system is.

It's also possible that genital warts never appear at all, yet you are still infected with HPV and pass the virus on to other partners. Or they may be located inside the vagina or anus, so you have no idea of their existence or of the infection – meaning you are a carrier and are transmitting the virus without knowing it.

Regular gynaecological check-ups are important: they can pick up visible signs and, where necessary, treatment can be recommended.

Risk factors for genital warts

We've essentially already listed the main risk factors above: unprotected sexual intercourse is the most common route by which sexually active people catch genital warts. The factors that increase the risk of infection therefore include:

• Unprotected sex with multiple partners or with a new partner
• Sexual intercourse with a partner without knowing their sexual health status
• Starting your sex life at an early age
• Previous other sexually transmitted conditions
• A weakened immune system, for example in the case of HIV infection

Genital warts: when you should see a doctor

See a doctor as soon as possible once you notice genital warts or any unusual change in the intimate area that might indicate a sexually transmitted condition.

The same applies to your partner: both of you should see a doctor as soon as possible if he is affected. If your sexual partner is infected with HPV, there's a very high chance that you have the virus too.

How are genital warts diagnosed?

There are other sexually transmitted infections, or even moles, that can look very similar to genital warts. So don't try to diagnose yourself, because you could be mistaken. The diagnosis is made by a gynaecologist – and it's crucial for choosing the right treatment.

Here's how they are identified:

• In the case of external warts, the diagnosis is made after the doctor has examined the visible skin changes. In some cases a biopsy may also be carried out to confirm that they really are genital warts.
• For internal warts, a vaginal and anal examination is carried out to confirm the diagnosis. In the vaginal area, a smear test (Pap test) allows analysis of the changes the warts cause on the cervix, and colposcopy (examination of the vulva, vagina, cervix and lower part of the uterus using an endoscope) allows assessment of the cervix and vagina. In the anal area, the doctor may use a rectal speculum (anoscope) to examine warts inside the anus.

Treatment of genital warts

If your immune system is very healthy, it can fight the virus, and small genital warts may even clear up on their own within 6 months.

With larger or numerous warts, however, they can become very uncomfortable and even painful. So although no treatment can guarantee a cure for HPV infection, it's important to treat and remove genital warts in order to reduce the risk of further spread.

There are several treatment options for genital warts, including:

• Creams, gels or ointments, which may cause irritation, burning or pain.
• Cryotherapy (cold treatment): liquid nitrogen is applied using a special device, which freezes and destroys the warts at very low temperatures.
• Electrocautery, in which the warts are burned off and destroyed using an electrical current.
• Laser treatments, in which the laser light destroys the small blood vessels supplying the warts, cutting off their blood supply and thereby eliminating them.
• Surgery, in which large warts that cannot be removed by any other method are cut away.

Here are a few more things you should know and bear in mind about treating genital warts:

• Avoid unprotected sexual intercourse during treatment wherever possible, to prevent passing the infection to your partner (or at the very least use a condom).
• Treatment does not cure HPV infection; it only works on the genital warts themselves.
• You'll need patience: it can take a few weeks or even months for the warts to disappear completely – but you will get rid of them in the end.
• Sometimes the treatments don't work and surgery is required.
• Even once you've got rid of the warts, they can come back.
• If you're pregnant or planning to become pregnant, tell your doctor so that a suitable treatment method can be chosen (some are not appropriate during or in the run-up to pregnancy).
• Some creams or gels can damage condoms or a diaphragm and make them thinner. So talk to your doctor if you use these contraceptive methods, to get the best advice.

How do you treat genital warts at home?

You don't. Appropriate treatment of genital warts only follows a correct diagnosis – and only a specialist can make that.

Your gynaecologist will recommend the right treatment for you, and all you need to do at home is follow their advice and recommendations. What you can do:

• Avoid unprotected sexual intercourse during treatment and after it has finished.
• Apply the cream, gel or ointment – or use other treatment methods – exactly as your doctor has recommended.
• Pay attention to intimate hygiene and use only water and a natural intimate wash to keep the vulva and vagina clean without upsetting the balance of your bacterial flora.
• Don't use remedies or treatments you've simply heard about from others – they can cause injury and make the discomfort worse.
• Don't treat genital warts with wart plasters from the pharmacy that are intended for ordinary warts – these are two different conditions, and wart plasters are not designed for use in the genital area.

How can genital warts be prevented?

For sexually active people: here's how you can both prevent catching HPV and developing genital warts if you're not infected, and prevent passing it on to your partner if you are:

• Always use a condom every time you have sex.
• Always use a dental dam when giving or receiving oral sex.
• See your gynaecologist regularly so that any kind of sexually transmitted infection can be detected and treated early.
• Make sure you know your partner's medical history as well as possible and are properly informed about their sexual health status (whether they have a sexually transmitted condition).
• Equally, be honest and open with your partner and tell them if you have this infection, so that they can protect themselves, keep an eye on their health through regular check-ups and be treated promptly if they do catch it.
• Avoid douching.
• Get vaccinated against HPV.

Is there a vaccine against genital warts?

Yes, there is a vaccine that helps prevent genital warts. On the NHS, the HPV vaccine is offered free in school year 8 and, if missed, until your 25th birthday; gay, bisexual and other men who have sex with men can get it free at sexual health clinics up to age 45. Anyone else can pay privately.

There are over 100 types of HPV, more than 30 of which can cause problems in the genital area. Fortunately, there is a vaccine that protects you against certain types of human papillomavirus – including those that can cause cancer or genital warts. Even if HPV infection is already present in your body, the vaccine can protect your health by preventing more serious complications.

Questions and answers about genital warts

If you still have further questions about genital warts, we hope you'll find the answers you're looking for here. Here are some of the most frequently asked questions about genital warts.

 How long do genital warts last?

If you have a strong immune system, genital warts may clear up on their own within a few months (up to 6 months), even without any treatment. Alternatively, they will remain until effective treatment is given. Creams and topical treatments may take a few weeks to work, whereas surgery can remove the warts immediately.

Can genital warts come back after they've gone?

Yes. Once you're infected with HPV, the virus stays in the body – even after the genital warts have disappeared completely. This is why new warts can form in the genital area.

 What complications can arise with genital warts?

Genital warts may clear up on their own without any further complications, or they may become painful because of their size. However, there aren't many complications: the HPV types that cause genital warts (6 and 11) carry a low risk of cervical cancer.

Complications can, on the other hand, arise with other HPV types that are frequently responsible for cancer of the vulva, penis, anus or oesophagus. Types 16 and 18, for example, are linked to a great many cases of cervical cancer. This is why vaccination against human papillomavirus and the use of barrier methods every time you have sex are crucial in avoiding any complications.

 Do genital warts lead to cancer?

No, genital warts are generally not malignant and do not lead to cancer. The risk of cervical cancer is very low with HPV types 6 and 11 – that is, the types that cause vaginal or anal warts.

How do genital warts affect pregnancy?

Normally genital warts have no effect on pregnancy whatsoever. They may cause itching, burning, pain or discomfort, but they cannot harm the baby. (Only in very rare cases can they be passed from mother to baby during birth.)

Pregnancy can, however, affect the genital warts. Significant hormonal fluctuations can weaken the immune system, so the warts may grow more quickly or become larger – which in turn can lead to symptoms such as discomfort or burning when passing urine.