Genital warts 101

Illustration of a pair of legs and a person holding a mirror to inspect their genitals.
Illustration by Marta Pucci
by Nicole Telfer, Science Content Producer

Top things to know

  • Genital warts can present in many shapes and sizes—from large lumpy plaques, to small singular bumps
  • Even if genital warts are not visible, it does not mean a person doesn’t have them. Some warts may be internal (like within the vagina or anus), while other people may carry the virus without showing symptoms
  • Two strains of the human papillomavirus—HPV 6 and HPV 11—are responsible for most cases of genital warts
  • Treatments include at-home topical medications or removal by a healthcare provider

What are genital warts?

Genital warts are a sexually transmitted infection (STI) caused by certain strains of the human papillomavirus (HPV). HPV is a very common virus with over 100 strains (5). Some strains can cause cancerous changes, while others cause no physical symptoms and resolve themselves (4,19).

Two strains of HPV in particular—HPV 6 and HPV 11—are responsible for about 9 out of 10 cases of genital warts (8,9).

Genital warts may also be known by other names such as genitoanal warts, anogenital warts, or condylomata acuminata.

What are the symptoms of genital warts?

Not everyone who has been infected with these strains of HPV will have genital warts. Often people who carry the strains have no symptoms (5). For those who do have symptoms, genital warts come in many shapes, sizes, and presentations.

Appearance

Genital warts can be small, large, singular, or in clumps.

Warts are usually non-pigmented (meaning that they are the same color as the surrounding skin), but sometimes can present in many different colors, such as pink to red to brown, grey, and white (14).

They often appear in groups of 5–15 warts which are 1–5 mm (0.04–0.2 in) each in diameter (14). They may resemble cauliflower, and are often found on moist areas around the genitals and anus, or inside the vagina and the cervix (14,7). Other types of genital warts look more like regular warts (a bump with thickened skin) and are usually on dry skin. Other genital warts appear smooth and flat, and some are difficult to even see (7).

Sensation

Genital warts do not usually cause pain or discomfort. Sometimes they can be itchy, bleed, or make sex painful (14).

Location

Genital warts can be both external or internal. External genital warts appear on people of all genders, such as on the vulva, labia, pubis, glans clitoris, entrance to the urethra, perineum (the area between the genitals and the anus), penis, scrotum, and around the entrance to the anus (7,8,14). If someone suspects that they have genital warts, using a handheld mirror can be helpful to check difficult to see areas.

Other times genital warts can also be present inside of the body, such as in the vagina, the cervix, the inner side of the labia, and inside of the anal canal (7,8,14).

How are genital warts spread?

If a person develops genital warts, this doesn’t necessarily mean that they got them from their most recent partner. It can take months or even years from contracting HPV until wart symptoms actually present (8).

HPV is spread through contact with infected skin and mucous membranes (the soft moist skin present at the openings of your genitals and mouth). This means that warts are usually spread through sex, including penis-in-vagina sex, anal sex, genital-to-genital contact, and oral sex. Genital warts are highly contagious, so even without penetrative sex, HPV can be spread from one person to another (5).

Even if a person does not have any visible genital warts, this does not necessarily mean that they are wart-free (8). People infected can still spread the virus even without any warts present.

How common are genital warts?

HPV is the most common sexually transmitted infection in the United States (6,2) and the world (5).

HPV is extremely common—in the United States, most sexually active people will get at least one strain of HPV during their lifetime (11).

Since genital warts are not considered a reportable disease to the Centers for Disease Control (CDC) it is difficult to estimate how many people actually have genital warts across the United States.

How can I prevent genital warts?

Using a barrier device (like a condom or a dental dam) can help prevent the spread of genital warts. However, if someone’s warts are outside of where the condom covers (like on the scrotum or base of the penis) and skin contact occurs, genital warts can be spread to the partner. Even when no genital warts are present, HPV can still be present on the skin and spread during sexual contact.

Vaccination

There are currently vaccinations available that protect against certain strains of HPV that cause cervical cancer (like HPV 16 and 18). One type also protects against HPV 6 and 11, which cause most cases of genital warts. These vaccinations are becoming more common and are recommended for adolescents and young adults (5,18). These vaccines do not treat existing HPV infections, and are most protective when administered before becoming sexually active. Speak to your healthcare provider to learn if an HPV vaccination is right for you.

How are genital warts diagnosed?

Genital warts are usually diagnosed by visual inspection during a pelvic exam (8). Sometimes a healthcare provider may take a biopsy (a small sample of the wart) and send it off to the lab for confirmation (8).

If diagnosed, it is important to get current sexual partners also assessed by a healthcare practitioner, as well as to notify previous sexual partners, from at least the last 6 months (14).

Being diagnosed with genital warts, like being diagnosed with any STI, can have negative psychological effects. Having genital warts can lead to feelings of anxiety, depression, and feelings of decreased quality of life, especially around the time of first diagnosis (13).

How are genital warts treated?

The goals of treatment for genital warts are to remove the wart(s) and reduce any symptoms (8). The type of treatment for warts depends on many factors, including size, shape, location, cost, and the preferences of the patient and healthcare provider (8).

Do not use over the counter wart treatment products. These are designed for different types of warts on thicker-skinned areas (like the soles of the feet) and should not be used on the genitals, which are much more sensitive.

Self-applied treatments

Some people are prescribed topical medications that are applied on the warts for a specified period of time (usually weeks or months). This type of treatment comes with instructions and follow-up visits to the healthcare provider (8).

Healthcare provider treatments

In some cases, healthcare providers need to apply treatment themselves in a clinical setting. These treatments can include cryotherapy (freezing warts with liquid nitrogen), electrocautery (heat generated through electricity), laser removal, surgical removal, or application of chemical therapy (8).

Sometimes genital warts may reappear after they have already been treated—this is common within the first 3 months (8). While treatment for warts is not a cure, given enough time, a healthy body will usually resolve the infection on its own.

Sometimes genital warts go away on their own when left untreated, while other times they stay the same, or even increase in number and size. There is no “one size fits all” treatment.

Special cases and additional information

Cancer

When DNA from human papillomavirus is measured from samples of genital warts, sometimes more than one type of HPV shows up. About a third of HPV strains found from genital wart biopsies can also contain high-risk, cancer-causing HPV strains (12).

This is why it is important to always get diagnosis and treatment from a professional, especially if the warts are bleeding, very firm or hard to the touch, or sores (14). If left untreated, these high risk strains can cause cancer of the vulva, anus, or penis (14).

Smoking

People who smoke cigarettes are more likely to have, or acquire, genital warts (16). Smoking cigarettes is also associated with a recurrence of genital warts (16).

Immunosuppression

People who are a lowered immune system (like with HIV, diabetes, or undergoing immunosuppressive therapy) may be more likely to contract and develop genital warts, and additionally may be harder to treat (14,8).

Remember, not all bumps on the genitals are due to genital warts. Some small bumps are normal body variations, while other can be caused by skin infections, or by STIs such as genital herpes. When in doubt, talk to a healthcare provider.

Download Clue to track protected and unprotected sex.

References

  1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2016. Atlanta, GA: US Department of Health and Human Services; Sep 2017:1-138. Available from: https://www.cdc.gov/std/stats16/CDC_2016_STDS_Report-for508WebSep21_2017_1644.pdf
  2. Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Su J, Xu F, Weinstock H. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013 Mar;40(3):187-93.
  3. Plummer M, Schiffman M, Castle PE, Maucort-Boulch D, Wheeler CM; ALTS Group. A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion. J Infect Dis. 2007 Jun 1;195(11):1582–9.
  4. Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998 Feb 12;338(7):423-8.
  5. World Health Organization. Human papillomavirus (HPV) and cervical cancer fact sheet. World Health Organization: Feb 2018. Available from: http://www.who.int/mediacentre/factsheets/fs380/en/
  6. Centers for disease control and prevention. Genital warts. Atlanta, GA. 2017 Sep 15. Available from: https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/GenitalWarts.html
  7. Handsfield HH. Clinical presentation and natural course of anogenital warts. Am J Med. 1997 May 5;102(5A):16-20.
  8. 2015 Sexually Transmitted Diseases Treatment Guidelines. Anogenital Warts. Available from: https://www.cdc.gov/std/tg2015/warts.htm
  9. Garland SM, Steben M, Sings HL, et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis 2009;199:805-14.
  10. Park IU, Introcaso C, Dunne EF. Human papillomavirus and genital warts: a review of the evidence for the 2015 centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2015 Dec 15;61 Suppl 8:S849-55.
  11. Chesson HW, Dunne EF, Hariri S, Markowitz LE. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis. 2014 Nov;41(11):660-4.
  12. Garland SM, Steben M, Sings HL, James M, Lu S, Railkar R, Barr E, Haupt RM, Joura EA. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis. 2009 Mar 15;199(6):805-14.
  13. Lawrence S, Walzman M, Sheppard S, Natin D. The psychological impact caused by genital warts: has the Department of Health's choice of vaccination missed the opportunity to prevent such morbidity? Int J STD AIDS. 2009 Oct;20(10):696-700.
  14. Lacey CJ, Woodhall SC, Wikstrom A, Ross J. 2012 European guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol. 2013 Mar;27(3):e263-70.
  15. Stern PL, van der Burg SH, Hampson IN, Broker TR, Fiander A, Lacey CJ, Kitchener HC, Einstein MH. Therapy of human papillomavirus-related disease. Vaccine. 2012 Nov 20;30 Suppl 5:F71-82.
  16. Kaderli R, Schnüriger B, Brügger LE. The impact of smoking on HPV infection and the development of anogenital warts. Int J Colorectal Dis. 2014 Aug;29(8):899-908.
  17. Wiley DJ, Elashoff D, Masongsong EV, Harper DM, Gylys KH, Silverberg MJ, Cook RL, Johnson-Hill LM. Smoking enhances risk for new external genital warts in men. Int J Environ Res Public Health. 2009 Mar;6(3):1215-34.
  18. Centers for Disease Control and Prevention. Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018. Atlanta, GA: 2018 Feb 6. Available from: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#f14.
  19. Louvanto K, Syrjänen KJ, Rintala MA, Grénman SE, Syrjänen SM. Genotype-specific clearance of genital human papillomavirus (HPV) infections among mothers in the Finnish family HPV study. J Clin Microbiol. 2010 Aug;48(8):2665-71.