Genital warts
Some trans women and trans men are eligible for the HPV vaccine if they have sex with MSM and are aged 45 or under.
Genital warts and HPV
Information about the human papilloma virus (HPV) and genital warts – their symptoms, how they’re passed on and how they’re treated.
Genital warts are caused by HPV. There are over 100 different types of HPV, some of which you can be vaccinated against. Warts are usually not painful and are not a serious threat to your health.
What are genital warts?
Genital warts are small fleshy growths, bumps or skin changes anywhere on the genitals or around the anus or on the upper thighs. (You can see pictures of genital warts on a vagina, penis and anus at NHS Choices.)
- If they’re in the anus, inside the vagina or on the cervix you may not know they’re there.
- You may just have one wart or a cluster that can look like a cauliflower.
- Warts can appear weeks, months or years after infection with HPV.
- You may only get them once, although many people find they come back.
Symptoms of genital warts
Genital warts are usually painless, but they can:
- be uncomfortable and itch
- become inflamed or bleed
- change the normal flow of your pee
- look unpleasant, which can be distressing.
If you don’t get warts treated, they may:
- eventually go away
- stay the same size
- grow larger in size or number.
What is the link between HPV and cancer?
- HPV types 6 and 11 cause most cases of genital warts. They do not cause cancer of the cervix, vulva, anus or penis.
- HPV types 16 and 18 can cause cell changes that may lead to cancer. They are linked to the majority of cervical cancer cases in the UK.
How HPV is passed on
During sex, HPV is passed on:
- when someone’s skin touches another person’s warts (which you won’t see if they’re inside the rectum or vagina)
- through genital contact
- sharing sex toys
- (very rarely) through oral sex.
In extremely rare cases:
- a mother can pass HPV to her baby during birth
- someone can pass on HPV through warts on their hands, by touching someone’s genitals.
Sometimes the virus is passed on without any warts being present.
Using an external or internal condom cuts the risk of passing on HPV – but only if the condom covers the skin where the wart virus is.
Other types of contraception, such as the contraceptive pill, offer no protection against sexually transmitted infections (STIs) including genital warts.
Tests and treatment for genital warts
The sooner you get genital warts treated, the easier it is to get rid of them.
A doctor has to treat them and you can’t use treatments meant for warts that grow on the hands.
Warts are treated by:
- putting on a special cream or acid, at a clinic or at home
- freezing with liquid nitrogen
- cutting with laser treatment or surgery under local anaesthetic in hard-to-treat cases.
It can take several treatments to get rid of warts and they might come back. Don’t have sex (oral, vaginal or anal) until treatment has finished or you could pass on the infection.
Regular testing
The more people you have sex with (especially unprotected sex), the bigger your chance of getting infections like genital warts.
As you can have them without knowing, regular check-ups are a good idea. This is especially the case if you are starting a new relationship or want to stop using condoms with your partner.
Most people get tested and treated for infections such as warts at sexual health (or ‘GUM’) clinics. It is free and confidential, which means no one else, including your GP, will be know about your visit. Some GP surgeries also test for and treat these infections.
The HPV vaccine
Girls and boys aged 12-13 in the UK are offered the HPV vaccine Gardasil. The second dose is offered 6 to 24 months after the first dose. It’s important to have both doses of the vaccine to be properly protected.
From September 2023, the HPV vaccination will move from two doses to one, following updated advice from the Joint Committee on Vaccination and Immunisation (JCVI) that a single dose will offer the same protection against HPV as two doses.
Gardasil protects against:
- HPV types 6 and 11m, which cause the majority of cases of genital warts.
- HPV types 16 and 18, which cause 70% of cervical cancer cases, and are linked to cancers of the anus, vulva, vagina and penis.
People who’ve missed the HPV vaccine at school can still get it for free on the NHS up until age 25 if you’re a girl born after 1 September 1991 or boy born after 1 September 2006.
Men who have sex with men (MSM) can also get the vaccine at sexual health clinics, up to the age of 45.
Some trans women and trans men are eligible for the HPV vaccine if they have sex with MSM and are aged 45 or under.
Our HPV vaccine campaign
Vaccination of boys and MSM follows a successful campaign by the HPV Coalition, which includes us.
The coalition is campaigning for a catch-up programme for all secondary-school aged boys.
Genital warts
Condylomata acuminate; 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
- 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:
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 cervical cancer women age 30 or older
- 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. Human papillomavirus (HPV). HPV vaccination.
. Updated July 9, 2024. Accessed July 24, 2024.
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. 5th ed. Philadelphia, PA: Elsevier; 2025:chap 79.
