What Are They, Causes, Treatment, and More
Author: Anna Hernández, MD
Editors: Ahaana Singh, Lisa Miklush, PhD, RN, CNS
Illustrator: Jillian Dunbar
What are genital warts?
Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the world. It is estimated that between 500,000 to one million people in the United States are diagnosed with genital warts each year. In fact, HPV infection is so common that the Centers for Disease Control and Prevention (CDC) estimates that almost all sexually active people will become infected by the virus at some point in their lives. However, most infected individuals do not know they have HPV because they may never develop any symptoms or concerns since the immune system is typically able to control the infection.When symptoms do occur, they vary depending on the strain of HPV infection. Low-risk HPV strains are responsible for the majority of genital warts, while high-risk HPV strains are responsible for the development of precancerous lesions and several types of cancer, including cervical and anal cancer. Currently, there are several HPV vaccines that can help prevent genital warts, as well as decrease the risk of cervical and anal cancer.
What causes genital warts?
Genital warts are caused by certain types of human papillomavirus (HPV), a large family of DNA viruses that specifically infect human epithelial cells. These cells are found on the outer lining of body surfaces, such as the skin, urogenital system, and the digestive and respiratory tracts.
There are more than 40 types of HPV that can infect the anal and genital area, although only a few of them cause genital warts. Specifically, HPV strains 6 and 11 are responsible for the majority of genital warts. These strains are considered to be low-risk HPVs because they typically do not cause cancer. Regardless, people with HPV infection are often infected with more than one HPV type, so individuals with genital warts are more likely to be infected by a high-risk HPV strain as well.HPV is spread through direct skin-to-skin contact with an infected individual, usually during oral, genital, or anal sex. Certain risk factors that can increase the risk of infection include having multiple sexual partners, engaging in unprotected sex, smoking, or having a compromised immune system. Although the use of condoms during penetrative sex can lower the risk of getting an HPV infection, it does not fully protect against HPV since the virus can also infect areas that a condom does not cover (e.g., the vulva, scrotum, or perineal area).
What are the signs and symptoms of genital warts?
Genital warts are typically painless, though they can sometimes cause tenderness, itching, a burning sensation, local pain, or bleeding with sexual intercourse. Other symptoms -- such as vaginal discomfort, unusual vaginal bleeding between periods, or vaginal discharge with an unpleasant smell -- may be warning signs of more serious cervical lesions, which can develop into cervical cancer.
What do genital warts look like?
Genital warts are benign, skin-colored growths located in the genital area. They can develop anywhere near the vagina, cervix, genitals, or anus. It is also possible to develop warts in the mouth after engaging in oral sex. Genital warts can present in various shapes and sizes. They can be small or large, raised or flat, shaped like a dome, or have a cauliflower-like appearance. They usually appear in clusters and can become very numerous, although they can also be invisible to the naked eye. In individuals with a compromised immune system, genital warts can multiply into large clusters.
How are genital warts diagnosed?
Initially, a healthcare professional may ask about the person’s sexual history and any prior episodes of sexually transmitted diseases. In most cases, genital warts can be easily identified and diagnosed through a physical exam of the genital area. If necessary, a vinegar-like solution can be applied to the skin to make the warts more visible. Examination of the warts under magnification (i.e., colposcope) may also be needed.Since individuals with genital warts have a higher risk of being infected by a cancer-causing HPV, they may be advised to get regular HPV tests (i.e., pap smears, or pap tests) to screen for cervical cancer.
Are genital warts curable?
Genital warts are curable but have a high risk of recurrence due to the possibility of lingering infected cells. Treatment of genital warts depends on their number, size, and location. Small warts can be treated with liquid nitrogen cryotherapy or with topical medications that are applied to the skin. The most effective treatments are topical immune modifiers (e.g., imiquimod cream or sinecatechin ointment), which boost the immune system’s ability to clear the infection on its own. Larger warts may require laser therapy or surgical removal, although warts are more likely to reoccur after these methods.
How long do genital warts last?
If left untreated, gential warts can last for several months or years. In some cases, however, they can resolve on their own. Notably, gential warts that have been treated and removed can still potentially return.
What are the most important facts to know about genital warts?
Genital warts are a very common sexually transmitted infection (STI) caused by certain types of human papillomavirus (HPV). While some types of HPV can cause cervical and anal cancer, these are not the same types that cause genital warts. Most genital warts are caused by low-risk HPV strains, such as HPV strains 6 and 11, whereas most cases of cancer are caused by different strains. Diagnosis of genital warts can be accomplished through a review of medical history and physical exam of the genital area. Although they can be cured, genital warts have a high risk of recurrence after they are removed. Treatment of genital warts depends on their number, size, and location, and methods may include topical medications, cryotherapy, laser therapy, or surgical removal. Since it is possible to become infected by more than one type of HPV, individuals with genital warts may be advised to get regular HPV tests to screen for cervical cancer.
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Resources for research and reference
Kaliterna, V., & Barisic, Z. (2018). Genital human papillomavirus infections. Frontiers in Bioscience (Landmark Edition), 23: 1587–1611. DOI: 10.2741/4662
Park, I., Introcaso, C., & Dunne, E. (2015). Human papillomavirus and genital warts: A review of the evidence for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clinical Infectious Diseases, 61 (suppl_8): S849–S855. DOI: 10.1093/cid/civ813
Patel, H., Wagner, M., Singhal, P., & Kothari, S. (2013). Systematic review of the incidence and prevalence of genital warts. BMC Infectious Diseases, 13(1). DOI: 10.1186/1471-2334-13-39
Roden, R., & Stern, P. (2018). Opportunities and challenges for human papillomavirus vaccination in cancer. Nature Reviews Cancer, 18(4): 240–254. DOI: 10.1038/nrc.2018.13Yanofsky, V., Patel, R., & Goldenberg, G. (2012). Genital warts: A comprehensive review. The Journal of Clinical and Aesthetic Dermatology, 5(6): 25–36.