Genital Warts: Signs, Testing and Treatment

Genital warts are skin growths caused by certain human papillomavirus types and can be treated, although they may return.

They can develop on or around the genitals and anus. The HPV types that commonly cause visible warts are different from the types most closely associated with cancer. Having warts can feel worrying, but they are manageable and do not reveal when or from whom HPV was acquired.

Genital warts commonly present as small, flesh-coloured, pale or darker bumps. They may be flat, raised, smooth or clustered with an uneven surface. A single lesion or several growths can occur on the vulva, vagina, cervix, penis, scrotum, groin, perineum or around the anus.

Many cause no discomfort. Others itch, feel irritated or bleed after friction. Not every genital lump or skin change is a wart; harmless skin tags, normal glands and other infections may look similar. Painful ulcers, rapidly changing pigment, unexplained bleeding or difficulty passing urine warrant prompt clinical assessment.

Genital warts result from HPV infecting cells near the skin surface. Transmission occurs mainly through close genital skin contact, including contact when no wart is visible. Penetrative sex is not required. Condoms reduce exposed skin but do not cover every area where HPV can be present.

Warts may appear long after exposure because HPV can remain unnoticed. Their timing cannot reliably identify when transmission happened, and a diagnosis does not by itself indicate infidelity.

Untreated warts may stay similar, increase, spread locally or clear as the immune system controls the virus. Treatment removes or shrinks visible lesions but does not instantly eliminate HPV from nearby skin. Warts can therefore recur after apparently successful treatment, particularly in the period after therapy.

A return does not necessarily mean a new exposure. Follow-up is useful when lesions persist, multiply, change in appearance or do not respond as expected.

Close sexual skin contact creates an opportunity for HPV transmission. A weakened immune system, including from some illnesses or medicines, can make warts more persistent or extensive. Smoking may also impair local immune control. Anyone who is sexually active can acquire HPV, even with a single partner.

Diagnosis is usually made by examining the skin in good light. The clinician may ask about symptoms, immune health, pregnancy possibility and previous treatments, then check nearby genital or anal areas with consent. Internal examination is offered only when the location or symptoms make it relevant.

A biopsy may be needed if a lesion has an unusual colour, is firm, ulcerated, bleeding without friction or has not responded to treatment. Routine cervical screening follows the local programme and is separate from diagnosing external warts; visible warts do not make HPV tests useful for confirming the lesion.

Choice depends on wart size, number and location, as well as skin sensitivity, immune health, pregnancy and personal preference. Imiquimod is a prescribed cream that stimulates a local immune response and is applied according to a clinician's directions. Clinic treatments include freezing with cryotherapy or removing tissue with electrosurgery.

More than one session or method may be needed. Temporary soreness, swelling, crusting or colour change can follow treatment. Do not use ordinary pharmacy wart removers on genital skin because their ingredients are too harsh for this area.

Avoid picking or shaving directly over warts, which can irritate the skin and spread viral particles locally. Keep treated areas clean and follow instructions about bathing, exercise and sexual contact while skin heals. If a topical medicine causes severe pain, open sores or intense swelling, wash it off if directed and contact the prescriber.

Partners can share HPV without either person having visible lesions. A calm conversation about the diagnosis, barrier protection and vaccination is more useful than trying to determine the timing of infection. Sexual health support can help if disclosure or anxiety feels difficult.

Warts may become irritated, bleed with friction or obstruct a small opening when extensive. Treatment can inflame delicate skin, and altered skin colour or a scar may remain. People with reduced immunity may develop larger or more persistent lesions. Seek urgent help for heavy bleeding, severe swelling, spreading redness with fever or inability to pass urine.

HPV vaccination can protect against HPV types responsible for many genital warts and other HPV-related diseases, but it does not treat an existing wart. Eligibility and scheduling depend on age, health history and local recommendations. Condoms and other barriers lower exposure during sexual contact, though uncovered skin can still transmit HPV.

Stopping smoking supports immune health. Avoid sexual contact while a treated area is raw or painful, and do not share sex toys unless they are cleaned and covered appropriately between users.

A dermatologist, sexual health clinician, gynaecologist or urologist can assess a genital lesion confidentially. Book a visit for a new or uncertain lump, persistent vulval skin change, anal lesion, recurrence after treatment or symptoms during pregnancy. Mention immune-suppressing medicines and any recent cervical screening, but do not delay care if those records are unavailable.