Genital Warts

This factsheet is for people who have genital warts or who would like information about them.

Genital warts are fleshy growths that form on or around the genitals or anus. Genital warts are caused by certain types of the human papilloma virus (HPV). HPV is transmitted by skin-to-skin contact, such as during unprotected sex.

About genital warts
Genital warts are the most common sexually transmitted viral infection in the UK, particularly in men in their early 20s and 16 to 19 year old women.

You can get genital warts if you're infected with certain types of HPV. HPV attacks the surface (epithelial) cells in your skin, which causes them to multiply abnormally. The warts are often hard on dry hairy skin or soft on moist hairless skin. You may have several warts clustered together or just one.

Symptoms of genital warts
Most people who have a HPV infection don't go on to develop genital warts. If you do develop genital warts, these may appear about three weeks after you get the virus or they can appear months or sometimes years later.

In women, genital warts usually appear:
* on the upper thighs;
* on the inside or outside of the vagina;
* in the cervix (neck of the womb);
* on or inside the anus;

In men, genital warts usually appear:
* the upper thighs;
* on the tip or shaft of the penis;
* on the scrotum;
* in the urethra (the tube that carries urine from the bladder and out through the penis);
* on or inside the anus;

In both men and women, genital warts can sometimes be found in the mouth, nose or throat.

Genital warts are generally painless but can itch and may bleed or become inflamed. You may have blood in your urine or from your anus because the genital warts inside your urethra or anus may bleed.

Causes of genital warts
Genital warts are caused by HPV - there are over 100 types of HPV and about 40 can cause genital warts. Types 6 and 11 most commonly cause genital warts. HPV infection is a risk factor in cervical cancer.

Genital warts are transmitted by skin-to-skin contact during unprotected vaginal, oral or anal sex and by sharing sex toys. If you have genital contact with an infected partner and don't have sex, you can still get HPV. You can pass the virus on even if you don't have symptoms.

People who have more than one sexual partner or frequently change sexual partners are more at risk.

If pregnant women get genital warts, they can pass them to their baby during a vaginal birth but this is rare.

Diagnosis of genital warts
If you think you may have genital warts, you can see your GP, visit a genitourinary medicine (GUM) clinic, or a sexual health clinic to be tested. You can have a test for genital warts even if you don't have any symptoms.

You don't have to ask your doctor to refer you to a GUM or sexual health clinic, you can make your own appointment. All visits are confidential and you don't have to give your real name. Details won't be sent to your GP without your consent.

Your doctor or nurse will ask about your symptoms and examine you. The majority of genital warts are diagnosed by a health professional looking at them.

Tests for genital warts include:
* an internal examination of the vagina or anus;
* taking a biopsy of the wart for closer examination, although this is rare (a biopsy is a small sample of tissue, which is sent to a laboratory for testing);

If you have genital warts, you may also have another sexually transmitted infection (STI). You may be advised to have tests for other STIs at the same time. It's also important to contact your previous partners who may be at risk to prevent them from spreading the infection to others. Clinics can send anonymous letters on your behalf if you're willing to provide details.

Treatment of genital warts
You may decide you don't want treatment. A third of people with genital warts find they go away without treatment after six months. Some warts can last longer. Rarely, warts can develop into cauliflower-like growths.

Genital warts are treated according to their size and location.
* Chemicals such as imiquimod and podophyllotoxin may be used to remove visible warts. These chemicals may come in a home-kit that you can apply yourself, or you may need to go to a clinic or hospital to have them applied by a doctor or nurse. This will depend on the location and how much skill is required to apply them.;
* Cryotherapy is a technique which freezes the genital wart using liquid nitrogen;
* Laser therapy can be used to break down the genital wart. You may need a local anaesthetic - this completely blocks feeling from the area and you will stay awake during the procedure;
* Heat treatment (electrocautery or loop electrosurgical excision procedure (LEEP)) can get rid of the genital wart. You will have a local anaesthetic for this procedure;
* Surgery can be used to remove the genital wart, for which you will have a local anaesthetic;

You may need to have repeat treatments to get rid of the genital warts as they can re-occur. If you smoke, you will probably not respond as well to treatment as a non-smoker.

Treatments designed to remove warts on other parts of the body (such as feet and hands) shouldn't be used as they are too harsh for the genital area.

Some creams can interfere with some forms of contraception, such as condoms, diaphragms and caps, so you may need to use an alternative contraceptive. Ask your nurse or doctor for advice.

It's important to wait until the doctor gives you the 'all clear' before you have vaginal, anal or oral sex again. Wait until you and your partner have both finished treatment, or you could become re-infected.

Special considerations

If you're pregnant
If you develop genital warts when you're pregnant, it's important to tell your doctor or your obstetrician (a doctor who specialises in pregnancy and childbirth) so that you're prescribed a suitable treatment that is safe for your baby.

Genital warts can get larger during pregnancy - if they get very big, you may need to have them removed so you don't have any problems giving birth. If this isn't possible, you may be advised to have a caesarean delivery but this is very rare.

The virus can be passed to your baby but again, this is rare. The infection can be treated during pregnancy but it may be delayed until after you have given birth.

Weakened immune system
If you have a weakened immune system, you may not respond as well to treatment and the risk of the warts coming back is higher. Follow-up appointments will ensure your treatment is tailored to your needs.

Prevention of genital warts
Using condoms for vaginal, anal and oral sex can help reduce your risk of getting HPV infection - the virus that causes genital warts. But condoms can't fully protect you. Reducing the number of partners reduces your risk of having genital warts.

Limit the number of sexual partners you have and the frequency with which you change your sexual partners. Before having sex with a new partner, you should both consider having a test for sexually transmitted infections.

Vaccine
There is a national HPV vaccine programme to protect against the types of HPV infection that cause cervical cancer. This programme is offered to all girls aged 12 to 13 and uses a vaccine called Cervarix. This isn't effective against the type of HPV that causes genital warts.

An alternative vaccine to protect against HPV, called Gardisil, is also effective against the type of HPV that causes genital wart infections. This vaccine is designed to be given to children and adults between the ages of nine and 26. You will need to pay for the Gardisil vaccine as it's not available on the NHS. Ask your doctor for advice.

Genital warts Q&As
See our answers to common questions about genital warts, including:
* If I am diagnosed with genital warts, do I need extra cervical smear tests or an HPV test?
* Does the national HPV vaccination programme protect against genital warts?
* Is it safe to treat genital warts in pregnant women?
* What happens if genital warts come back after treatment?
* What happens if I don't have the genital warts treated?
* Can I pass on HPV after a genital wart has been treated and gone away?
* Can HPV affect my fertility?
* Will the HPV vaccine be offered to older girls, women or men?

Related topics
* Sexual Health Advice & Leaflets
* Cervical cancer
* Cervical screening
* Contraception
* The HPV Vaccine
* Warts and Verruca

Further information
* fpa (Family Planning Association)
0845 122 8690
www.fpa.org.uk
* Terrence Higgins Trust
0845 12 21 200
www.tht.org.uk

Sources
* Warts - anogenital. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 19 November 2009;
* United Kingdom national guideline on the management of anogenital warts, 2007. British Association for Sexual Health and HIV. www.bashh.org, accessed 19 November 2009;
* Human papillomavirus (HPV) - cervical cancer and genital warts. Health Protection Agency (HPA). www.hpa.org.uk, accessed 19 November 2009;
* STI annual data tables. Health Protection Agency (HPA). www.hpa.org.uk, accessed 13 November 2009;
* Genital warts. fpa (The Family Planning Association). www.fpa.org.uk, accessed 19 November 2009;
* What is the HPV virus? Cancer Research UK. www.cancerhelp.org.uk, accessed 20 November 2009;
* Where can I get information and advice? fpa (The Family Planning Association). www.fpa.org.uk, accessed 11 November 2009;
* Warts (genital). Clinical Evidence. www.clinicalevidence.bmj.com, accessed 19 November 2009
* Specific management of genital (anogenital) warts. GP Notebook. www.gpnotebook.co.uk, accessed 19 November 2009;
* Salicyclic acid. British National Formulary. www.bnf.org, accessed 19 November 2009;
* Immunisation. NHS Immunisation Information. www.immunisation.nhs.uk, accessed 19 November 2009;
* Human papilloma virus vaccines. British National Formulary. www.bnf.org, accessed 19 November 2009;
* How cancer of the cervix develops. Macmillan. www.macmillan.org.uk, accessed 20 November 2009;
* NHS cervical screening programme. Cancer Screening Programmes. www.cancerscreening.nhs.uk, accessed 20 November 2009;
* HPV sentinel sites implementation project. Cancer Screening Programmes. www.cancerscreening.nhs.uk, accessed 20 November 2009;
* HPV testing for women with a cervical screening result of borderline or mild dyskaryosis: Information for women. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, accessed 20 November 2009;
* The vaccines. NHS Immunisation Information. www.immunisation.nhs.uk, accessed 20 November 2009;
* What is the best management of genital warts in pregnancy? Attract. www.attract.wales.nhs.uk, accessed 20 November 2009;
* Fertility and cervical cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 20 November 2009;
* HPV vaccines (to prevent cervical cancer). Macmillan. www.macmillan.org.uk, accessed 20 November 2009;
* Impact assessment of introduction of HPV vaccination. Department of Health. www.dh.gov.uk, accessed 20 November 2009;
* BJOG press release: Should boys be vaccinated against HPV? Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, accessed 20 November 2009;