Genital warts

  • Definition
    • Genital warts are soft growths on the skin and mucus membranes of the genitals. They may be found on the penis, vulva, urethra, vagina, cervix, and around and in the anus.

      Genital warts are spread through sexual contact.

  • Alternative Names
    • Condylomata acuminata; Penile warts; Human papillomavirus (HPV); Venereal warts; Condyloma; HPV DNA test; Sexually transmitted disease (STD) - warts; Sexually transmitted infection (STI) - warts; LSIL-HPV; Low-grade dysplasia-HPV; HSIL-HPV; High-grade dysplasia HPV; HPV

  • Causes
    • The virus that causes genital warts is called human papillomavirus (HPV). There are more than 70 different types of HPV. Many cause no problems. Some cause warts on other parts of the body and not the genitals. Types 6 and 11 are most commonly linked to genital warts.

      Certain other types of HPV can lead to precancerous changes in the cervix, or to cervical cancer. These are called high-risk types of HPV. They can also lead to vaginal or vulvar cancer, anal cancer, and throat or mouth cancer.

      Important facts about HPV:

      • HPV infection spreads from one person to another through sexual contact involving the anus, mouth, or vagina. The virus can be spread, even if you do not see the warts.
      • You may not see warts for 6 weeks to 6 months after becoming infected. You may not notice them for years.
      • Not everyone who has come into contact with the HPV virus and genital warts will develop them.

      You are more likely to get genital warts and spread them more quickly if you:

      • Have multiple sexual partners
      • Are sexually active at an early age
      • Use tobacco or alcohol
      • Have a viral infection, such as herpes, and are stressed at the same time
      • Are pregnant
      • Have a weakened immune system due to a condition such as diabetes, pregnancy, HIV/AIDS, or from medicines

      If a child has genital warts, sexual abuse should be suspected as a possible cause.

  • Symptoms
    • Genital warts can be so tiny, you cannot see them.

      The warts can look like:

      • Flesh-colored spots that are raised or flat
      • Growths that look like the top of a cauliflower

      In females, genital warts can be found:

      • Inside the vagina or anus
      • Outside the vagina or anus, or on nearby skin
      • On the cervix inside the body

      In males, genital warts can be found on the:

      • Penis
      • Scrotum
      • Groin area
      • Thighs
      • Inside or around the anus

      Genital warts can also occur on the

      • Lips
      • Mouth
      • Tongue
      • Throat

      Other symptoms are rare, but can include:

  • Exams and Tests
    • The health care provider will perform a physical exam. In women, this includes a pelvic exam.

      An office procedure called colposcopy is used to spot warts that cannot be seen with the naked eye. It uses a light and a low-power microscope to help your health care provider find and then take samples (biopsy) of abnormal areas in your cervix.

      The virus that causes genital warts can cause abnormal results on a Pap smear. If you have these types of changes, you will probably need more frequent Pap smears for a while.

      An HPV DNA test can tell if you have a high-risk type of HPV known to cause cervical cancer. This test may be done:

      • If you have genital warts
      • As a screening test for women over age 30
      • In women of any age who have a slightly abnormal Pap test result

      Make sure you are screened for cervical, vaginal, vulvar, or anal cancer if you have been diagnosed with genital warts.

  • Treatment
    • Genital warts must be treated by a doctor. Do not use over-the-counter medicines meant for other kinds of warts.

      Treatment may include:

      • Medicines applied to your skin or injected by your doctor
      • Prescription medicine that you apply at home several times a week

      The warts may also be removed with minor procedures, including:

      If you have genital warts, all of your sexual partners must be examined by a health care provider and treated if warts are found. Even if you do not have symptoms, you must be treated. This is to prevent complications and avoid spreading the condition to others.

      You will need to return to your health care provider after treatment to make sure all the warts are gone.

      Regular Pap smears are recommended if you are a woman who has had genital warts, or if your partner had them. If you had warts on your cervix, you may need to have Pap smears every 3 to 6 months after the first treatment.

      Women with precancerous changes caused by HPV infection may need further treatment.

  • Outlook (Prognosis)
    • Many sexually active young women become infected with HPV. In many cases, HPV goes away on its own.

      Most men who become infected with HPV never develop any symptoms or problems from the infection. They can still pass it on to current and sometimes future sexual partners.

      Even after you have been treated for genital warts, you may still infect others.

  • Possible Complications
    • Some types of HPV can cause cancer of the cervix and vulva. They are the main cause of cervical cancer.

      Genital warts may become numerous and quite large. These will need further treatment.

  • When to Contact a Medical Professional
    • Call your doctor if:

      • A current or past sexual partner has genital warts
      • You have visible warts on your external genitals, itching, discharge, or abnormal vaginal bleeding. Keep in mind that genital warts may not appear for months to years after having sexual contact with an infected person.
      • You think a young child might have genital warts

      Women should begin having Pap smears at age 21.

  • Prevention
    • HPV can be passed from person to person even when there are no visible warts or other symptoms. Practicing safer sex can help reduce your risk of getting HPV and cervical cancer:

      • Always use male and female condoms. But be aware that condoms cannot fully protect you. This is because the virus or warts can also be on the nearby skin.
      • Have only one sexual partner, who you know is infection-free.
      • Limit the number of sexual partners you have over time.
      • Avoid partners who take part in high-risk sexual activities.

      Two vaccines are available:

      • They protect against the HPV types that cause most cervical cancers in women.
      • They are recommended for girls and women ages 9 through 26.
      • They are given as a series of three shots.
      • One of the two vaccines protects against genital and anal warts in boys and men. It is recommended for boys and men ages 9 through 26.

      Ask your health care provider whether the HPV vaccine is right for you.

  • References
    • Berman BM, Amini S. Condyloma acuminata. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 46.

      Bonnez W. Papillomaviruses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 146.

      Centers for Disease Control and Prevention (CDC). Genital warts. In: Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):70-4. PMID: 21160459

      Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists; Immunization Expert Work Group of the American College of Obstetricians and Gynecologists. Committee opinion No. 588: human papillomavirus vaccination. Obstet Gynecol. 2014;123:712-8. PMID: 24553168