Causes and symptoms of genital warts
What are genital warts?
Genital warts are small, fleshy, bump-like growths on the genitals. They can appear anywhere on the penis or vagina, groin, perineum, anus and even in the mouth.
Genital warts are the second most common STI in the UK, with more than 70,612 new people diagnosed with the infection in 2014. While they do not usually cause harm, they can be embarrassing to look at, and to avoid infecting others, treatment is often advisable.
Causes of genital warts
Genital warts are caused by the human papillomavirus (HPV). While the HPV virus has over 100 different strains, type 11 and type 6 cause approximately 90% of all cases of genital warts. Moreover, not all strains of HPV cause genital warts.
While HPV is commonly transmitted through sexual intercourse, it is contagious through any form of skin-on-skin contact. That means that genital warts can be caught through anal, oral, vaginal, and any other form of penetrative sex, as well as by non-penetrative genital contact. It is also possible, although rare, for HPV to be passed on from a mother to a child during birth.
Only 1-5% of those people infected with HPV develop genital warts. However, these people still act as carriers for the virus and can still infect others.
It is important to understand that the HPV strains that cause genital warts are not the same as those strains generally associated with increased risks of genital or anal cancers.
HPV is contagious and it is estimated that unprotected sex has a 70% chance of passing on the infection to a partner. Even using condoms and other barrier methods of contraception will not totally eliminate the risk as there will still be direct skin-to-skin contact.
Symptoms of genital warts
Genital warts can be tiny, or can grow into large masses. They often occur in clusters or groups. In some cases they can appear to be like small stalks.
In women, genital warts may appear either inside or outside of the vagina or anus. They may also occur on the opening of the womb (the cervix). In general, the symptoms tend to be less noticeable than on men, mainly because they often occur internally.
For men, they are usually found on the tip of the penis. Genital warts may also be found occasionally on the shaft, in the groin, and on the scrotum, as well as in or around the anus.
In very rare cases, it is possible (for people of either sex) for the infection to develop inside the throat or mouth of someone who has had oral sex with a carrier of the virus.
Tests for genital warts
In general, genital warts can be easily diagnosed by inspection. This means that they will normally be examined by a medical professional who may use a magnifying lens to be sure of their diagnosis. For women, if the inside of the vagina is to be examined, then a speculum will be used to allow appropriate observation of the cervix and inside the vagina.
Warts do not cause pain unless they become irritated by friction or trauma. While many STIs can be identified by symptoms of discomfort, on the whole, warts are diagnosed simply through observation.
Treatment of genital warts
The method of treating genital warts is likely to be dependent on the severity of the infection. This will include the size, volume and texture of the warts.
We have two medicine treatments for genital warts available from our online doctor service:
- Warticon (podophyllotoxin) is used to treat small fleshy warts. It physically burns off the wart. The warts take around one month to disappear (sometimes longer) but do often return.
- Aldara (imiquimod) is a cream that works best on larger warts. It works by assisting your body's immune system in fighting the warts, as well as HPV itself. It may take several weeks or months before the treatment is complete. Warts treated with Aldara are less likely to recur.
In more severe cases, you may want to consider physically removing the warts:
- Cryotherapy: This involves freezing the warts with liquid nitrogen or dry ice. This causes the outer membranes of the wart(s) to split, killing the cells of the growth. It can take up to three weeks for the skin to heal after cryotherapy and it's a good idea to abstain from sex until it's fully healed.
- Excision: The wart is essentially cut off with a scalpel whilst under local anaesthetic. The wound will then be stitched afterwards. Excision is normally used on smaller or larger warts that have become hard to the touch, to avoid scarring.
- Electrosurgery: This is an option for large warts that have not responded to medicinal treatment. A metal loop is run round the wart and a current is passed through it which burns away the wart. As the treatment can be painful, it is normal for a regional anaesthetic to be given to numb your whole body below the waist or even a general anaesthetic.
- Laser surgery: This is used to treat larger warts that may be difficult to access with other methods. For example, those that are deep inside the anus or urethra. It may also be used for pregnant women who have failed to respond to medicinal treatments. In this instance the warts are literally burned away with a laser. Depending on the severity of the surgery it may require either a local or general anaesthetic.
As with all forms of wart treatment, you should not have sexual intercourse until you are fully healed. This may take up to four weeks after excision or laser surgery.
Unfortunately, none of the physical treatments for warts eradicate HPV which is the underlying cause of warts, so there is always a chance of recurrence.