Definition
Genital warts are growths or bumps that appear:
- On the vulva
- In or around the vagina or anus
- On the cervix
- On the penis, scrotum, groin, or thigh
- In the mouth or throat (rare)
Genital warts is one of the most common sexually transmitted infections (STIs). Most people will be exposed to a form of HPV at some point in their lives. Not everyone will become infected or develop symptoms.
Causes
Genital warts are caused by the human papillomavirus (HPV). There are many different types of HPV. Only a few types are thought to cause genital warts. Many types of HPV are associated with harmless skin warts found on the fingers or feet.
HPV is easily spread during oral, genital, or anal sex with an infected partner. Almost two-thirds of people who have sex with an infected partner will also develop genital warts.
Risk Factors
Factors that may increase your risk for HPV and genital warts include:
- Multiple sexual partners
- First male sexual partner has had two or more previous sexual partners (for women)
- Sex without condoms
- Having a weakened immune system
- Sex at an early age
- Skin-to-skin contact with an infected partner
- Previous history of genital warts or other STIs
Symptoms
Genital warts often look like fleshy, raised growths. They can have a cauliflower shape, and often appear in clusters. Some warts may be flat. The warts may not be easy to see with the unaided eye. Warts can take several weeks or months to appear after the infection.
In women, warts may be found in the following areas:
- Vulva or vagina
- Inside or around the vagina or anus
- Cervix
In men, warts are less common. If present, they are usually found in these areas:
- Tip or shaft of the penis
- Scrotum
- Around the anus
While warts do not usually cause symptoms, the following may occur:
- Bleeding
- Itching
- Irritation
Complications of HPV
Cancer
Certain types of HPV may cause cervical cancer. Less commonly, cancers of the vulva, anus, or penis occur.
For women, it is important to have Pap tests. This test can detect HPV-related problems before they become cancerous. During the Pap test, a sample of cells is taken from the cervix. The sample is studied to look for abnormal cells and HPV.
If you are a healthy woman, many professional health organizations offer these recommendations for screening:
- If you are aged 21-29 years—Pap test every three years
- If you are aged 30-65—Pap test along with the HPV test every five years or you can continue to have just the Pap test every three years
- If you are aged 65 or older—you may be able to stop having Pap and HPV tests if you have had three normal results in a row and no abnormal results in the past 10 years
You may need to have Pap tests done more often if you have had abnormal results or certain conditions. Your doctor can help determine the right screening schedule for you.
Pregnancy and Childbirth Complications
Genital warts may get larger during pregnancy. This may make it hard to urinate.
Warts in the vagina can also disrupt the normal stretching process of the vagina during labor. Warts can also be spread to the infant during delivery.
Diagnosis
Genital warts may be diagnosed by:
Visual Exam
A doctor can usually diagnose genital warts by looking at them. If external warts are found on a woman, then the cervix is usually also checked. A doctor may use a special solution to help find lesions that do not have classic features.
Pap Test
An abnormal Pap test result may indicate HPV. Your doctor will order more accurate tests, like a colposcopy, to diagnose HPV.
Colposcopy and Biopsy
During a colposcopy, a special device is used to see if there are warts in the cervix and vagina. A sample of tissue will be taken and tested for HPV.
HPV Testing
An HPV test only requires a swab of cells from the affected area. This test will be able to identify the specific type of HPV causing the problems.
Treatment
Treatment helps the symptoms, but does not cure the virus. The virus stays in your body. This means the warts or other problems may recur.
Your treatment depends on the size and location of the warts. Not all warts need to be treated. If left untreated, some may go away on their own, but others may stay. Some warts may also get larger or spread.
Treatments may include:
Topical Treatments
Topical medication is applied directly to the skin. Your doctor may recommend one of these medications:
- Imiquimod cream
- Sinecatechins ointment
- Podophyllin resin
- Podofilox solution
- Trichloroacetic acid or bichloroacetic acid
Cryosurgery, Electrocautery, or Laser Treatment
Methods that instantly destroy warts include:
- Cryosurgery (freezing)
- Electrocautery (burning)
- Laser treatment
These methods are used on small warts. It may be used on larger warts that have not responded to other treatment. A large wart can also be removed with surgery.
Prevention
The only way to completely prevent HPV from spreading is to avoid physical contact with infected partners.
Latex condoms may help reduce the spread of HPV infection and genital warts. Condoms are not 100% effective because they do not cover the entire genital area.
Other ways to help prevent infection include:
- Abstain from sex
- Have a monogamous relationship
- Get regular check-ups for STIs
Vaccine
There is a vaccine for HPV. It is given over a series of three injections to girls and boys aged 11-12 years old. If you are aged 26 or younger and were not vaccinated, you can receive a catch-up vaccine series.
Special Considerations
Genital warts are rare in children. This diagnosis may indicate sexual abuse. Abuse needs to be reported.