Genital Warts

What do genital warts look like?

Genital warts vary a lot in appearance:

• small, flesh-colored, pink, gray or brown bumps, from 1 mm up to more than 1 cm across
• smooth and flat on moist skin, or rough and cauliflower-like on drier skin
• single, or in clusters that can join into larger plaques
• usually painless, though they may itch, feel irritated or bleed slightly with friction

Where they appear

• Women: the vulva, the vaginal opening, inside the vagina, the cervix, the perineum and around the anus. Warts inside the vagina or on the cervix may cause no symptoms and are found during an exam.
• Men: the shaft or head of the penis, the foreskin, the scrotum, the groin and around the anus. Warts at the urethral opening can affect the urine stream.
• Both: the inner thighs, around and inside the anus (even without anal sex), and rarely the mouth or throat after oral sex.

Genital warts vs other bumps

Causes and how genital warts spread

Genital warts are caused by HPV, a very common virus. More than 40 HPV types affect the genital area. Types 6 and 11 cause about 90% of genital warts. These are low-risk types that do not cause cancer. High-risk types such as 16 and 18 cause cervical, anal and throat cancers, but they usually cause no visible warts. A person can carry both kinds at once.

HPV spreads by direct skin contact during:

• vaginal or anal sex
• oral sex, less commonly
• genital-to-genital contact without penetration
• rarely, from mother to baby during birth

Warts can appear weeks to months after contact, usually 2 to 3 months, and sometimes much longer. That makes it almost impossible to know when or from whom the infection came. Many people carry the virus without ever getting warts and can still pass it on.

Risk factors

• not being vaccinated against HPV
• new or multiple sexual partners
• smoking
• a weakened immune system, including HIV, which causes more, larger and harder-to-treat warts
• pregnancy, when warts can grow faster

Diagnosis

A clinician usually diagnoses genital warts just by looking. A magnifying lens or, rarely, dilute acetic acid applied to the skin can help. A biopsy is done if warts are unusual in appearance, pigmented, bleeding, ulcerated, resistant to treatment, or in someone with a weak immune system.

There is no routine blood or swab test to find low-risk HPV, and testing for HPV types does not change wart treatment. Women still need routine cervical screening (Pap and HPV tests) on the usual schedule. Warts do not change how often you need it. Because other STIs often occur together, your clinician may offer tests for chlamydia, gonorrhea, syphilis and HIV.

Genital warts treatment

Treatment removes visible warts and relieves symptoms. It does not remove the virus from the skin, so warts can come back. Choice depends on the number, size and location of warts, and on your preference.

Treatments you apply at home (prescription)

Treatments done in the clinic

• Cryotherapy: freezing with liquid nitrogen, repeated every 1 to 2 weeks. Good for small, scattered warts and safe in pregnancy.
• Trichloroacetic acid (TCA): a strong acid painted carefully on each wart. Safe in pregnancy.
• Surgical removal: cutting, scraping, electrocautery or laser for large, many or stubborn warts, under local or general anesthetic.

Most people need several treatments over weeks to months. Do not use over-the-counter wart treatments made for hands or feet on genital skin, because they can burn it.

Do genital warts go away on their own?

Yes, sometimes. Without treatment, about a third clear within a year as the immune system controls the virus. Others stay the same or grow. Waiting is a reasonable choice if the warts do not bother you.

Recurrence and outlook

Warts come back in about a third or more of people within a few months of treatment, because virus remains in nearby skin. Recurrences usually become less frequent over time, and most people clear the infection within 1 to 2 years. Low-risk HPV types do not cause cancer, so genital warts are not a cancer risk by themselves.

Genital warts in pregnancy

Warts may grow and bleed during pregnancy and often shrink after birth. Cryotherapy, TCA or surgical removal can be used, but imiquimod, podofilox and sinecatechins are avoided. A C-section is rarely needed, only when warts block the birth canal or would cause heavy bleeding. Rarely, babies develop warts in the throat (recurrent respiratory papillomatosis).

Preventing genital warts

• HPV vaccination: Gardasil 9 protects against types 6 and 11 as well as 7 high-risk types. It is routinely recommended at age 11 to 12 (it can start at 9), and catch-up vaccination is recommended through age 26. Some adults aged 27 to 45 may benefit after discussion with a doctor. Countries with high vaccine coverage have seen genital warts fall dramatically.
• Condoms and dental dams: they lower the risk but do not cover all genital skin.
• Avoiding sexual contact with visible warts until they are treated and healed.
• Telling partners: current partners may want to be checked, though many will already carry the virus.

Frequently asked questions

How do you get genital warts?

You get them through skin-to-skin contact with someone who has HPV types 6 or 11, usually during vaginal, anal or oral sex. Penetration is not needed. The other person often has no visible warts. Warts typically appear 2 to 3 months after contact but can take much longer.

Are genital warts curable?

Visible warts can be removed with creams, freezing or surgery, and the body clears the virus in most people within 1 to 2 years. There is no medicine that kills HPV itself, so warts can come back after treatment, especially in the first few months.

Can genital warts turn into cancer?

No. Genital warts are caused by low-risk HPV types that do not cause cancer. However, you can carry high-risk HPV types at the same time, so women should keep up with routine cervical screening.

How can I tell if it is a genital wart or a pimple?

A pimple is usually red, tender, centered on a hair, may contain pus and clears within 1 to 2 weeks. A genital wart is painless, flesh-colored or gray, often rough, does not contain pus, and persists or grows over weeks. If unsure, have it examined.

Can I have sex if I have genital warts?

It is best to avoid sexual contact with the affected area until the warts are treated and the skin has healed. Condoms reduce but do not remove the risk, because warts can be on skin a condom does not cover. Some creams can weaken latex condoms.

What do genital warts look like in women?

In women they appear as small, soft, flesh-colored or gray bumps on the vulva, around the vaginal opening or anus, often in clusters. Warts inside the vagina or on the cervix usually cause no symptoms and may only be seen during a pelvic exam.