Genital Warts

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Introduction

What are genital warts?

Genital warts are flesh-colored or grayish bumps caused by the human papillomavirus, or HPV, that occur in the genital area. They can be big or small, flat or raised, and solitary or clustered. In men, they can be found on the scrotum or penis; in women, they can appear on the cervix, in the vagina, or on the vulva. They can also occur near or inside the anus and urethra.

Genital warts can appear weeks to months after an infection, or may not appear despite an infection with HPV. They can also be spread by a partner who has no symptoms. Furthermore, more than 150 types of HPV exist, including many types that do not infect the genital area or produce warts. Genital HPV is the most common sexually transmitted infection, affecting at least 50% of all sexually active adults in their lifetimes (Source: CDC).

Although some HPV types increase the risk of developing cervical, penile or anal cancer, the types that cause genital warts do not increase that risk. Left untreated, genital warts may go away with time, remain unchanged, or increase in number. Although the viral infection cannot be cured, genital warts can be treated with topical medications or with such procedures as cryotherapy (freezing), electrocautery, laser therapy, or surgery. After treatment, genital warts may recur or may never return.

HPV is spread by skin-to-skin contact, so direct contact with visible genital warts should be avoided. Since you cannot always tell who is infected with HPV, the best way to avoid genital warts is abstinence from sexual relations. The risk of infection is increased with multiple sexual partners and with sexual activity at an early age. A vaccine that protects against most types of HPV that cause genital warts or cervical cancer is available.

Whether to accept treatment for genital warts is a personal choice; however, some complications of genital warts may require treatment. Seek immediate medical care (call 911) if the genital warts block the urethra and you are unable to urinate, if they block the anus and you are unable to have a bowel movement, or if you develop bleeding during pregnancy.

Seek prompt medical care if you have bleeding that you cannot control.

Symptoms

What are the symptoms of genital warts?

Genital warts can involve the anus, cervix, penis, scrotum, urethra, vagina or vulva. They can occasionally be found in the groin or on the thigh. Sometimes they cannot be seen without magnification. Sometimes they form large clusters. They may be flat or raised and cauliflower-like.

Common symptoms of genital warts

Common symptoms of genital warts include:

  • Bleeding from the urethra or vagina

  • Flesh-colored, white, grayish, or dark bumps in the genital area

  • Itching

Serious symptoms that might indicate a life-threatening condition

Some complications of genital warts are rare but require prompt treatment. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bleeding during pregnancy

  • Inability to have a bowel movement

  • Inability to urinate because genital warts block the urethra

Causes

What causes genital warts?

Genital warts are a type of sexually transmitted infection caused by certain types of human papillomavirus (HPV). While genital warts are spread by direct contact, they do not have to be visible to be contagious and may not develop until weeks or months after the infection occurs.

What are the risk factors for genital warts?

A number of factors increase the risk of developing genital warts. Not all people with risk factors will get genital warts. Risk factors for genital warts include:

  • Alcohol use

  • Compromised immune system due to such conditions as HIV/AIDS, taking corticosteroids, organ transplant medications, or cancer and cancer treatment

  • High-risk sexual behavior

  • Multiple sexual partners

  • Personal history of a sexually transmitted infection

  • Pregnancy

  • Presence of other sexually transmitted infections

  • Sexual contact with someone who engages in high-risk sexual behavior or who has had a sexually transmitted infection

  • Tobacco use

  • Young age at first sexual intercourse

Reducing your risk of genital warts

You may be able to lower your risk of genital warts by:

  • Avoiding contact with visible genital warts

  • Avoiding sexual intercourse

  • Engaging in sexual intercourse with a single, monogamous partner

  • Getting vaccinated against HPV

  • Using condoms during sexual intercourse, although condoms may not protect against all infected areas of skin

Treatments

How are genital warts treated?

Genital warts do not always require treatment. For many people, the decision of whether to get treated is a personal choice.

Common treatments for genital warts

Treatment of genital warts is aimed at removal or destruction of the warts, relieving symptoms, and preventing or reducing disfigurement or other complications. The type of treatment is typically based on patient preference, provider experience, and the extent and location of the warts. Common treatments include:

  • Cryotherapy to freeze away the warts

  • Electrocautery to destroy the warts (loop electrosurgical excision procedure, or LEEP)

  • Laser treatment to destroy and remove the warts

  • Surgical therapy to remove the warts

  • Topical medications and treatments, such as bichloroacetic acid (BCA), imiquimod cream (Aldara), podofilox solution or gel (Condylox), podophyllin resin (Podocon-25, Podofilm), sinecatechins ointment (Veregen), and trichloroacetic acid (TCA) to destroy the warts

What are the potential complications of genital warts?

In some people, especially people with weakened immune systems, complications of untreated or poorly controlled genital warts can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of genital warts include:

  • Bleeding or pain with sexual intercourse

  • Disfigurement

  • Obstruction of the birth canal during delivery

  • Spread to a newborn during labor and delivery

  • Spread to a sexual partner

  • Susceptibility to additional sexually transmitted infections

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Genital HPV infection - fact sheet. Centers for Disease Control and Prevention. http://www.cdc.gov/STD/HPV/STDFact-HPV.htm.
  2. Sexually transmitted diseases (STDs). National Institute of Allergy and Infectious Diseases. http://www.niaid.nih.gov/topics/std/Pages/default.aspx.
  3. Sexually transmitted diseases (STDs). National Institute of Child Health & Human Development. http://www.nichd.nih.gov/health/topics/sexually_transmitted_diseases.cfm.
  4. Understanding HPV and genital warts. National Institute of Allergy and Infectious Diseases. http://www.niaid.nih.gov/topics/genitalwarts/Pages/default.aspx.
  5. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009.
  6. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy.Philadelphia: Saunders, 2013.
  7. Jemal A, Simard EP, Dorell C, et al. Annual Report to the Nation on the Status of Cancer, 1975-2009, featuring the burden and trends in human papillomavirus(HPV)-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst 2013; 105:175.
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