Genital warts
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; Cervical cancer - genital warts
Genital warts are soft growths on the skin and mucous 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.
Causes
The virus that causes genital warts is called human papillomavirus (HPV). HPV infection is the most common sexually transmitted infection (STI). There are more than 180 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, HIV/AIDS, or from medicines
If a child has genital warts, sexual abuse should be suspected as a possible cause.
Worldwide, cervical cancer is the third most common type of cancer in women. Luckily, it's much less common in the United States due to women receiving recommended routine Pap smears, the test designed to find cervical cancer sometimes even before abnormal cells turn to cancer. Cervical cancer starts in the cells on the surface of the cervix, the lower portion of the uterus. There are two types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers come from these squamous cells. The cancer usually starts very slowly as a condition called dysplasia. This precancerous condition can be detected by Pap smear and is 100% treatable. Undetected, precancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for these precancerous changes to turn into cervical cancer. However, patients with cervical cancer do not usually have problems until the cancer is advanced and has spread. Most of the time, early cervical cancer has no symptoms. Symptoms of advanced cancer may include back pain, bone fractures, fatigue, heavy vaginal bleeding, urine leakage, leg pain, loss of appetite, and pelvic pain. If after having a Pap smear, the doctor finds abnormal changes on the cervix, a colposcopy can be ordered. Using a light and a low-powered microscope, the doctor will view the cervix under magnification. The doctor may remove pieces of tissue, called a biopsy, and send the sample to a laboratory for testing. If the woman is diagnosed with cervical cancer, the doctor will order more tests to determine how far the cancer has spread. This is called Staging. Treatment will depend on the stage of the cancer, the size and shape of the tumor, the woman's age and general health, and her desire to have children in the future. Early cervical cancer can be treated with surgery just to remove abnormal tissue, freeze abnormal cells, or burn abnormal tissue. Treatment for more advanced cervical cancer may include radical hysterectomy, removal of the uterus and much of the surrounding tissue, including lymph nodes and the upper part of the vagina. Radiation may be used to treat cancer that has spread beyond the pelvis, or if cancer returns. The woman may also have chemotherapy to kill cancer cells. Almost all cervical cancers are caused by human papilloma virus, or HPV. This common virus is spread through sexual intercourse. HPV vaccines can prevent infection. Practicing safe sex also reduces the risk of getting HPV. But, keep in mind most women diagnosed with cervical cancer have not had their regular Pap smears. Because Pap smears can find precancerous growths that are 100% treatable, it's very important for women to get Pap smears at regular intervals.
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:
- Increased dampness in the genital area near the warts
- Increased vaginal discharge
- Genital itching
- Vaginal bleeding during or after sex
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 provider find and then take samples (biopsy) of abnormal areas in your cervix. Colposcopy is usually done in response to an abnormal Pap test.
The virus that causes genital warts can cause abnormal results on a Pap test. If you have these types of changes, you may need more frequent Pap tests or a colposcopy.
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 provider. Do not use over-the-counter medicines meant for other kinds of warts.
Treatment may include:
- Medicines applied to the genital warts or injected by your provider
- Prescription medicine that you apply at home several times a week
The warts may also be removed with minor procedures, including:
- Freezing (cryosurgery)
- Burning (electrocauterization)
- Laser therapy
- Surgery
If you have genital warts, all of your sexual partners should be examined by a provider and treated if warts are found. Even if you do not have symptoms, you should be treated. This is to prevent complications and avoid spreading the condition to others.
You will need to return to your provider after treatment to make sure all the warts are gone.
Routine Pap tests 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 tests 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. However, they can still pass it on to current and sometimes future sexual partners. Men are at increased risk for cancer of the penis, anus, and throat if they have a history of HPV infection.
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
Contact your provider 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 tests 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 for 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.
An HPV vaccine is available:
- It protects against the HPV types that cause most HPV cancers in women and men. The vaccines DO NOT treat genital warts, they prevent the infection.
- The vaccine can be given to boys and girls 9 to 12 years old. If the vaccine is given at this age, it is a series of 2 shots.
- If the vaccine is given at 15 years or older, it is a series of 3 shots.
- The vaccine can be given to adults up to age 45.
Ask your provider whether the HPV vaccine is right for you or your child.
References
Bonnez W. Papillomaviruses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 143.
Centers for Disease Control and Prevention website. HPV vaccine.
James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Viral diseases. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 19.
Kirnbauer R, Lenz P. Human papillomaviruses. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 79.
Version Info
Last reviewed on: 11/10/2022
Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
