Genital Warts (Human Papillomavirus)

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
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Is this topic for you?

This topic provides information about genital warts, which are caused by the human papillomavirus (HPV). If you are looking for information about cervical cell changes or cervical cancer caused by HPV, see the topics Abnormal Pap Test or Cervical Cancer.

What are genital warts?

Genital warts are skin growths in the groin, genital, or anal areas. They can be different sizes and shapes. Some look like flat white patches, and others are bumpy, like tiny bunches of cauliflower. Sometimes you can't see the warts at all.

Genital warts are spread by skin-to-skin contact. The virus is usually spread through sexual activity. Genital warts are a common sexually transmitted disease (STD).

What causes genital warts?

Genital warts are caused by the human papillomavirus, or HPV. Some types of HPV cause genital warts. But these are not the same types of HPV that cause abnormal cervical cell changes and cervical cancer.

You are more likely to get genital warts if you:

• Do not use condoms every time you have sex or genital contact.
• Have more than one sex partner or have a high-risk partner(s) who has had multiple sex partners or HPV-infected sex partners.
• Start sexual activity before age 18.
• Have an impaired immune system that makes it hard for your body to fight infection.

What are the symptoms?

Most people infected with the virus that causes genital warts don't have symptoms. But if they do, the symptoms may be so mild that they may not know they are infected. The symptoms may include pain, itching, and bleeding.

If you have symptoms, they will probably occur 2 to 3 months after infection. But you can have symptoms from 3 weeks to many years after infection.

Visible genital warts appear only during active infection. But it is possible to spread the virus even if you can't see the warts.

How are genital warts diagnosed?

A doctor can often tell if you have genital warts by looking closely at your genital and anal areas. He or she may ask you questions about your symptoms and your risk factors. Risk factors are things that make you more likely to get a disease.

Sometimes the doctor takes a sample of tissue from the wart for testing.

How are they treated?

Talk to your doctor about whether you should treat genital warts. They usually go away with no treatment, but they may also spread. Most people decide to treat them because of the symptoms or how the warts look. But if you don't have symptoms and are not worried about how the warts look, you can wait and see if the warts go away.

If you do decide to treat genital warts, talk to your doctor about the best treatment for you. There are prescription medicines you or your doctor can put on the warts. Or your doctor can remove them with lasers, surgery, or by freezing them off.

Even if you treat visible warts or your warts go away without treatment, the HPV infection can stay in your body's cells. It is possible to spread genital warts to your partner even if you have no signs of them.

Finding out that you have genital warts may make you feel bad about yourself or about sex. Counseling or a support group may help you feel better.

Can genital warts be prevented?

The best way to keep from getting genital warts—or any other STD—is to not have sex. If you do have sex, practice safe sex.

• Before you start a sexual relationship, talk with your partner about STDs. Find out whether he or she is at risk for them. Remember that a person can be infected without knowing it.
• If you have symptoms of an STD, don't have sex.
• Do not have sex with anyone who has symptoms or who may have been exposed to an STD.
• Do not have more than one sex partner at a time. Having several sex partners increases your risk for disease.
• Use condoms. Condoms may help reduce the risk of spreading genital warts, but they do not protect the entire genital area against skin-to-skin contact.

A new vaccine called Gardasil protects against four types of HPV, which together cause most cases of cervical cancer and genital warts. You get three shots over 6 months. The vaccine is recommended for girls 11 to 12 years old. It is also recommended for females 13 to 26 years old who did not get it when they were younger.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should my daughter get the HPV vaccine?

The human papillomavirus (HPV) causes genital warts. More than 100 types of HPV have been identified. Types 6 and 11 cause the most visible genital warts.

How the disease is spread (transmission)

HPV is spread by direct contact.

• The virus can be spread to or from the genitals, anus, mouth, or throat during sexual activities. However, warts in the mouth or throat are extremely rare. Condoms can lower your risk of getting genital warts. You can prevent infection when you use them every time you have sex.
• After the infection occurs, it may spread to other areas of the genitals or to the anal area.
• You can spread the virus even if you do not have any symptoms of infection or any visible warts.
• A pregnant woman can infect her child during vaginal delivery, although this is very rare. An infection rarely causes growths on the baby's larynx (laryngeal papillomas), which is in the throat. The presence of genital warts does not mean that the mother should have a cesarean delivery, unless a vaginal delivery would cause the warts to bleed excessively.¹

Human papillomavirus (HPV) infection

Infection with the human papillomavirus (HPV) usually does not cause any symptoms and does not always produce visible genital warts.

When symptoms do develop, they usually occur 2 to 3 months after infection. However, symptoms have been known to develop from 3 weeks to many years after infection.

Symptoms that may occur with genital warts include:

• Irritation.
• Itching.
• Bleeding.

Genital warts

Genital warts can be different sizes and shapes.

• They may be large, or they may be too small to be seen with the naked eye. They may appear individually or in groups.
• Warts may look like tiny bunches of cauliflower or like flat, white areas that are very difficult to see.
• In women and men, warts may appear in the groin, on and around the genitals, in the urethra, or in the rectum or anus.
• In women:
  • Genital warts may appear on the vulva, vagina, or cervix.
  • Women are often unaware of warts inside the vagina or on the cervix until a health professional finds them.
• In men:
  • Genital warts may occur on the outside of the penis and scrotum.
  • Men are often unaware they have genital warts, even when they can be seen, until the warts are identified by a health professional.

Symptoms of genital warts may be similar to those of other conditions.

Genital warts may or may not be visible, depending on the type of human papillomavirus (HPV).

• Common HPV types 6 and 11 produce visible warts that may disappear without treatment.
• Other HPV types, such as 16 and 18, do not produce visible genital warts. These types, which may be found with a Pap test, are associated with precancerous cervical cell changes and cervical cancer.

HPV infection and cervical cell changes

In women, most precancerous or cancerous cell changes associated with HPV infection occur on the cervix. This is because the cells of the cervix naturally undergo changes in an area called the transformation zone. This process can cause cervical cells to become abnormal when infected with HPV.

High-risk factors and infection with high-risk types of HPV increase the chance that a woman with HPV will develop abnormal cervical cell changes. This type of infection is more likely if your partner or you have multiple sex partners.

HPV infection during pregnancy

A pregnant woman infected with HPV may have more complicated warts than a woman who is not pregnant. Genital warts may increase in size, bleed, or become infected with bacteria. Your health professional may recommend treatment. Warts may be passed onto the newborn, but this is rare.

HPV infection and cancer in men

It is not clear whether men who are infected with HPV on the penis are more likely to have precancerous or cancerous changes on the penis than men who are not infected. Because HPV does cause cell changes, more research is being done to determine whether HPV increases the risk of penile cancer. In the United States, cancer of the penis is extremely rare (fewer than 1 case in 100,000 occurs each year). Studies have shown that the risk of penile cancer is extremely low in circumcised men.

Among men who receive anal sex, HPV infection of the anal canal is associated with an increased risk of anal cancer; this risk may be especially high in men who also have HIV infection.²

Factors that increase the risk of becoming infected with a sexually transmitted disease, such as genital warts, include:

• Having multiple sex partners.
• Having high-risk partner(s) (partner has multiple sex partners or HPV-infected sex partners).
• Having unprotected sexual contact (not using condoms).
• Starting sexual activity at a young age (before age 18).
• Having an impaired immune system.

What to think about

Research has not clearly determined whether using birth control pills increases your risk of HPV infection and an abnormal Pap test. Condoms can lower your risk of getting genital warts. You can help prevent infection when you use them every time you have sex.

Men who are circumcised may be less likely to transmit HPV than men who are not circumcised.³

Call your health professional if you have not been diagnosed with genital warts and you have any of the following symptoms:

• Sores, bumps, rashes, blisters, or warts on or around your genitals or anus
• Burning, pain, or severe itching while urinating
• You suspect you have been exposed to a sexually transmitted disease (STD).
• For women, an abnormal vaginal discharge that smells bad
• For men, an abnormal discharge from your penis

Avoid sexual contact until you have been examined by a health professional.

Children

A child can get genital warts in several ways. Any child with genital warts needs to be evaluated by a health professional to determine the cause and to assess for possible sexual abuse.

Rarely, infants may develop warts in the larynx (laryngeal papillomas), which is in the throat, from exposure to HPV during birth.

Watchful Waiting

A health professional should evaluate any warts or other symptoms that suggest infection with the human papillomavirus (HPV) or another sexually transmitted disease (STD). Avoid sexual contact until you have been examined. If you have an STD, avoid sexual contact to prevent spreading the virus.

After you are diagnosed with genital warts, if you do not have symptoms or cosmetic concerns, you and your health professional may observe your condition without using medical treatment. This is called watchful waiting. This period may vary from a few days to weeks or possibly months.

Who To See

Generally, your family doctor or any of the following health professionals can determine whether you have genital warts:

• Nurse practitioner
• Physician assistant
• Family medicine doctor
• Internist

Treatment may require a specialist, such as a:

• Gynecologist.
• Urologist.
• Dermatologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment

A health professional usually can diagnose genital warts using your medical history and a physical examination. Your health professional may ask you the following questions.

• Do you think you were exposed to genital warts or any sexually transmitted diseases (STDs)? How do you know? Did your partner tell you?
• What are your symptoms? If you have discharge from the vagina or penis, it is important to note any smell or color.
• What method of birth control do you use? Did you use condoms to protect against STDs?
• Which sexual behaviors do you or your partner engage in, including high-risk behaviors such as sex with multiple partners?
• Have you had an STD in the past? How was it treated?
• Have you ever had an abnormal Pap test (for women)?

For women

After your health professional takes your medical history, you will have a gynecological exam, which usually includes a Pap test.

If your health professional finds areas of abnormal tissue on the cervix (which may be related to HPV infection), he or she may recommend treatment.

For men

After the medical history, you will have a physical examination for genital warts.

For men and women

When your health professional finds abnormal tissue but cannot make a definite diagnosis, you may have a biopsy for lab tissue studies.

Testing for the type of HPV that is causing warts is not useful for diagnosis. This test is not routinely done for diagnosis or treatment of genital warts.

Early Detection

For women

A Pap test screens for abnormal cells on the cervix. Women over 30 can get a test for HPV types at the same time as the Pap test. Results of the Pap test may indicate an HPV infection even though you have no visible warts. Not all HPV infections cause visible warts. A Pap test or cervical test for HPV types will not find HPV infections or warts in other locations of the body.

For men

There is no screening test for HPV infection in men. However, although there are no formal guidelines, some experts believe that men who receive anal sex should have a routine anal Pap test, especially if they also have HIV infection. Ask your health professional whether and how often you should be tested.

Genital warts caused by the most common types of human papillomavirus (HPV) may go away on their own without treatment. For this and other reasons, experts sometimes have different approaches to treating genital warts.

• Genital warts may disappear without treatment. This is the natural course of many genital warts.
• Destroying large areas of warts is difficult and may cause scarring.
• Treatment for genital warts does not eliminate the HPV infection. You may still be able to spread the infection. Condoms can help reduce the risk of HPV infection.⁴
• Treatment of genital warts can be painful, and warts return after treatment in between 20% and 50% of people.² Warts that return after being treated usually are not treated again unless you want to be retreated. If you do, you would usually choose a different form of treatment.
• Some health professionals believe that treatment for genital warts will help prevent the spread of HPV infections and keep genital warts from returning.

Watchful waiting

After you are diagnosed with genital warts, if you do not have symptoms or cosmetic concerns, you and your health professional may observe your condition without using medical treatment. This is called watchful waiting. This period may vary from a few weeks to a few months. The length of the watchful waiting period is determined by:

• The severity of your symptoms.
• The progression of the problem if not treated.
• The risks and benefits of waiting.
• Your age and medical history.

If symptoms or cosmetic concerns develop, your health professional may recommend treatment.

Watchful waiting is usually recommended for children with warts, because most warts in children go away without treatment. Also, current treatments for warts are too painful and traumatic for children. Any child with genital warts needs to be evaluated by a health professional to determine the cause and to assess for possible sexual abuse.

Types of treatment

Treatments for genital warts include medicines, freezing, laser, or surgery.

The type of medical treatment for genital warts will depend on:

• The number, size, and location of warts.
• The side effects of treatment.
• The skill of the health professional for each treatment option.
• The cost of treatment, which varies depending on:
  • The cost of medicine.
  • Any specialized equipment used.
  • The number of treatments needed.
• The problems caused by the warts (such as blockage of the urethra).
• Your preference.

Medicines

Health professionals often recommend medicine applied to warts (topical drug treatment) as the first choice of treatment. A health professional will apply the medicines that have a high risk of causing damage to the skin around the warts; you can apply others at home.

Topical medicines applied by a health professional include:

• Podophyllin resin (Podofin).
• Trichloroacetic acid (TCA) or bichloroacetic acid (BCA).
• Intralesional (injected into wart lesion) interferon.
• Fluorouracil (Efudex, Fluoroplex).

Topical medicines that are available by prescription but can be applied at home include:

• Imiquimod (Aldara).
• Podofilox lotion or gel (Condylox).

Caution: Do not use nonprescription wart removal products to treat genital warts. These products are not intended to be used in the genital area and may cause serious burning.

Surgery and other treatment

Surgery to remove genital warts may be done when:

• Medicine treatment has failed and the removal of warts is considered necessary.
• Warts are widespread.

Surgical methods that may be used include:

• Cryotherapy
• Electrocautery.
• Laser surgery.
• Surgical excision.
• Loop electrosurgical excision procedure (LEEP).

Treatment considerations

Without treatment, external genital warts may remain unchanged, increase in size or number, or go away. Studies show that no one treatment is completely successful because there is no cure for genital warts. All treatments have advantages and disadvantages. The benefits and effectiveness of each treatment need to be compared with the side effects and cost.

Recurrence rates vary from method to method. Recurrence is most frequent in the first 3 months after treatment. People with an impaired immune system may have more frequent recurrences after treatment than other people.¹ It is difficult to know whether a recurrence of genital warts is a new infection or an unsuccessfully treated infection.

For women, an HPV infection that causes an abnormal Pap test will be treated differently than HPV that causes visible genital warts. For more information, see the topic Abnormal Pap Test.

Several choices of treatment for pregnant women have been found to be effective and safe, including trichloroacetic acid (TCA), cryotherapy, and surgery.

What To Think About

There is no standard method of treating genital warts. Very few studies have evaluated the effectiveness of combining more than one treatment.

• Treatment of warts usually requires a series of applications rather than a single treatment.
• Warts in moist areas usually respond better to treatments applied to the area, such as creams or acids.
• Warts on dry skin may respond best to freezing (cryotherapy) or surgical removal.
• Cryotherapy may be done when genital warts are visible and bothersome and are growing in a small area. Repeat treatments may be needed to remove all wart tissue.
• The success of surgery is related to the number of warts. The success rate is higher and additional treatments are less likely to be required when surgery is performed on fewer and smaller warts. However, surgery is less likely to be needed for a few small areas of warts. Surgery may require anesthesia.
• Small areas of warts can be quickly treated with removal methods, such as cryotherapy or surgical excision.
• Self-applied medicines may be used for larger areas of warts that need longer or repeated treatments.

A biopsy of warts on the vulva or penis that do not go away on their own or after treatment is often done to rule out precancerous or cancerous conditions.

You can reduce your risk of becoming infected with the human papillomavirus (HPV) or another sexually transmitted disease (STD). You also can reduce the risk of spreading HPV to your sex partner(s).

Practice safe sex

Preventing a sexually transmitted disease (STD) is easier than treating an infection after it occurs.

• Talk with your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for an STD. Remember that it is possible to be infected with an STD without knowing it. Some STDs, such as HIV, may be in your blood for 3 to 6 months before they can be detected.
• Be responsible.
  • Avoid sexual contact if you have symptoms of an STD or are being treated for an STD.
  • Avoid sexual contact with anyone who has symptoms of an STD or who may have been exposed to an STD.
• Don't have more than one sex partner at a time. Having several sex partners increases your risk of getting an STD.

Male condom use

Condom use can reduce the risk of becoming infected with HPV. You can help prevent infection if you use them every time you have sex.⁴ Condoms must be put on before beginning any sexual contact.

Female condom use

Even if you are using another birth control method, you may wish to use condoms to reduce your risk of getting an STD. Female condoms are available for women whose partners do not have or will not use a male condom. Female condoms may lower the risk of HPV infection of the cervix. But these condoms are more effective at lowering the risk of other STDs.

Vaccines

In 2006, the U.S. Food and Drug Administration (FDA) approved the HPV vaccine(What is a PDF document?) (Gardasil) that protects against four types of HPV, which together cause most cases of cervical cancer and genital warts. Three shots are given over 6 months. Gardasil is recommended for girls 11 to 12 years old. The immunization is also recommended for females 13 to 26 years old who did not receive it when they were younger. It can be given to girls as young as 9 years old. Studies show that the vaccine is safe and works well to prevent cervical cancer and genital warts.^{5, 6}

For more information see:

Should my daughter get the HPV vaccine?

The HPV vaccine is not useful for treating women who already are infected with HPV.⁷ But it may protect a woman against types of the HPV virus other than the one causing her infection.

Home treatments may not cure genital warts. However, a health professional may prescribe medicine that you can use at home, such as podofilox lotion or gel or imiquimod cream.

Caution: Do not use nonprescription wart removal products to treat genital warts. These products are not intended for the genital area and may cause serious burning.

You can use at-home care to feel more comfortable.⁸

• Take sitz baths. Fill a tub with a few inches of warm water and sit in it for 10 or 15 minutes every day.
• Squeeze warm water from a bottle over your genital area to provide comfort and cleansing.
• Use a heat lamp or a hair dryer several times a day to dry your genital area. Make sure to hold the lamp or dryer at least 18 inches from your skin.

Finding out that you have genital warts may cause you to have negative thoughts or feelings about yourself or about sex. Some of these include:

• Feeling ashamed or embarrassed.
• Being afraid of the consequences of the infection.
• Being angry at the person who infected you.
• Feeling frustrated with treatment or the recurrence of warts.
• Feeling scared to have sexual intercourse.

It is important to remember that most infections are minor, without serious complications. Some cases of genital warts disappear without treatment, although human papillomavirus (HPV) will still be present in your body's cells.

Most male sex partners of women with genital warts also are infected with warts. Many men are unaware they have genital warts because the warts are so small. Warts are often treated if they are large or cause pain or bleeding. There is no evidence that treating an infected male partner lowers the risk of a woman developing genital warts after her warts are treated.

Medicine may be used to destroy bothersome genital warts, relieve your symptoms, and reduce the amount of area affected by warts, particularly when the warts are:

• Visible, bothersome, and growing in a small area.
• A cosmetic concern and you want them removed. Warts that are growing around the anus or on external genitals, such as on the penis or vulva, may be removed because they are unsightly. Some treatments that remove genital warts are more likely to leave scars. Therefore, cosmetic concerns about scarring may help guide the choice of treatment.

Topical medicine often is the first treatment. For safety, a health professional will apply the topical medicines that could damage the skin around the warts; you can apply other medicines at home. If warts return after one course of treatment with topical medicine, they are treated again only if there are clear reasons for retreatment.

Medication Choices

Treatment applied at home

The following medicines can be applied to the affected area (topical treatment) at home:

Imiquimod (Aldara)

Podofilox lotion or gel (Condylox)

Do not use these medicines during pregnancy.

Imiquimod and podofilox appear to be the most effective medicine options that can be applied at home. Read the instructions carefully before using these medicines.

Treatment applied by a health professional

Treatment by a health professional can:

• Treat areas that you cannot reach easily.
• Treat a large area.
• Remove the warts quickly.
• Be expensive.
• Be painful.
• Have side effects.

Medicines applied by your health professional include:

• Trichloroacetic acid (TCA) or bichloroacetic acid (BCA).
• Podophyllin resin (Podofin).
• Intralesional (injected into wart lesion) interferon.
• Fluorouracil (Efudex, Fluoroplex).

Treatment during pregnancy

Treatment for pregnant women includes trichloroacetic acid (TCA) and bichloroacetic acid (BCA), which have been found to be both effective and safe. Podophyllin resin, interferon, and fluorouracil should not be used during pregnancy because they can harm the fetus.

What To Think About

Avoid sexual contact in the treated area until the area is completely healed.

Some medicine may be more expensive than others.

Warts on the vulva or penis that do not go away on their own or after treatment often are biopsied to rule out precancerous or cancerous conditions.

Recurrence

Removing genital warts does not cure an HPV infection. Although warts may go away with topical treatment, they may return because the HPV virus may still be in the body's cells.

Even if genital warts have been removed or destroyed:

• You may still be able to infect sex partners with HPV.
• You should continue to use condoms during sexual intercourse if you have multiple sex partners.
• You may choose to discontinue condom use if you are in a long-term, single-partner (monogamous) relationship.

You may have surgery to remove genital warts if they are widespread and medicine or freezing (cryotherapy) fails to remove them.

Surgery Choices

Surgical methods that may be used include:

• Cryotherapy (cryosurgery).
• Electrocautery.
• Surgical excision.
• Laser surgery.
• Loop electrosurgical excision procedure (LEEP).

Surgical treatment for pregnant women

Surgical choices for pregnant women with genital warts include electrocautery, surgical excision, loop electrosurgical excision (LEEP), and laser surgery.

What To Think About

The success of surgery is related to the number of warts present. The success rate is higher and additional treatments are less likely to be required when surgery is performed on fewer and smaller warts. However, surgery is less likely to be needed for a few small areas of warts.

Surgery may be more expensive than some other treatment choices.

There is no other treatment for genital warts.

Organizations

• Abnormal Pap Test
• Exposure to Sexually Transmitted Diseases

Citations

1. U.S. Department of Health and Human Services (2002). Sexually Transmitted Diseases Treatment Guidelines 2002 (CDC Publication Vol. 51, No. RR-6), pp. 53–57. Atlanta: U.S. Department of Health and Human Services.

2. Douglas J, Moreland A (2003). Genital papillomavirus infections. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 3rd ed., pp. 261–278. Edinburgh: Mosby.

3. Castellsagué X, et al. (2002). Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. New England Journal of Medicine, 346(15): 1105–1112.

4. Winer RL, et al. (2006). Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354(25): 2645–2654.

5. FUTURE II Study group (2007). Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. New England Journal of Medicine, 356(19): 1915–1927.

6. Garland SM, et al. (2007). Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. New England Journal of Medicine, 356(19): 1928–1943.

7. Hildesheim A, et al. (2007). Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection. JAMA, 298(7): 743–753.

8. Wiley DJ, et al. (2002). External genital warts: Diagnosis, treatment, and prevention. Clinical Infectious Diseases, 35(Suppl 2): S210–S224.

Other Works Consulted

• American College of Obstetricians and Gynecologists (2005). Human papillomavirus. ACOG Practice Bulletin No. 61. Obstetrics and Gynecology, 105(4): 905–918.

• Bonnez W, Reichman RC (2005). Papillomaviruses. In GL Mandell et al., eds., Principles and Practice of Infectious Diseases, 6th ed., vol. 2, pp. 1841–1856. Philadelphia: Elsevier Churchill Livingstone.