Genital warts
What are genital warts?
Genital warts are growths on the skin’s surface or mucous membrane that occur in the genital area.
What causes genital warts?
A virus called human papillomavirus (HPV) causes genital warts. HPV is a group of viruses that are common in humans and nearly all sexually active people will be exposed to it at some point in their lives. There are over 100 types of HPV that can infect humans, and around 40 types can infect the genital area. Some HPV types cause genital warts, while other HPV types cause warts on the hands, feet, or other areas.
There are different types of HPV that do not cause warts or other apparent symptoms and most people with HPV will not be aware that they have it. The body’s immune system usually clears the HPV virus over time.
How do I know if I have genital warts?
Genital warts are not always noticeable. If they are noticeable, they look like flesh-coloured lumps or bumps on the skin. They can be small or large, raised, or flat, single, or multiple, or cluster in groups and look a bit like tiny cauliflowers. They can occur on the vulva, vaginal area, cervix, penis, scrotum, anal area, or the groin.
They are usually painless, although sometimes they may be slightly itchy or sore. Genital warts can also be inside the vagina or anus or on the cervix, and in that case, people may not be aware they have them.
Warts may appear a few weeks after infection or may take many months, or even years, to appear after you were first infected. There is usually no way of knowing when you were infected.
Some types of HPV cause infection of the cervix where there are no obvious signs or symptoms. These HPV types can cause changes that, if left undetected and untreated, may eventually lead to cancer of the cervix.
The Cervical Screening Test screens for these types of HPV, and if you have a cervix, it is important to have regular cervical screening from the ages of 25 to 74. (See SHFPACT factsheets on Human Papilloma Virus (HPV) and The Cervical Screening Test for more information). The HPV types which cause genital warts do not cause cancer of the cervix.
How do you get genital warts?
HPV and genital warts are transmitted by skin-to-skin contact during vaginal or anal sex. It is possible but rare for spread to occur with oral sex.
How are genital warts diagnosed?
Genital warts are diagnosed by looking at them. No swab or blood test can diagnose them. If you think you may have genital warts, you need to see a doctor to be diagnosed and discuss treatment.
How are genital warts treated?
For many people genital warts go away without treatment over 1 to 2 years.
If they don’t go away, or you want them treated, several treatments are available. Most of these treatments take some time to be effective. It is essential to see a doctor or nurse for a correct diagnosis and to discuss the treatments available and which one will work best for you.
Do not use over-the-counter treatments for other warts to treat genital warts.
The doctor may sometimes recommend a combination of treatments. Treatment can have side effects such as skin irritation, ulceration, pain, and discomfort. You can use paracetamol or other oral analgesia and warm salt baths to help relieve these side effects.
Treatment does not get rid of the virus, just the visible warts. The virus usually goes away by itself over time, although occasionally, warts can keep recurring.
Treatments
Treatment you can apply yourself
PODOPHYLLOTOXIN PAINT (CONDYLINE)
Podophyllotoxin paint is a liquid that is applied directly to the warts. Several treatments are usually necessary, and treatment is applied in cycles. Podophyllotoxin must not be used inside vagina, urethra, or anus, and must not be used in pregnancy. It requires a prescription from your doctor.
IMIQUIMOD CREAM
This cream helps stimulate the immune system to destroy the cells infected with the wart virus. It also cannot be used in pregnancy. It is applied directly to the warts. It needs a doctor’s prescription and is relatively expensive, although some private health insurance funds may cover it.
Treatment by a doctor or nurse
CRYOTHERAPY (FREEZING)
This treatment is applied by a doctor or nurse and uses liquid nitrogen to freeze the warts. Several treatments are often needed.
LASER TREATMENT OR SURGICAL REMOVAL
This is sometimes used for warts that are extensive, difficult to reach, or are resistant to other treatment. It is done under sedation.
Can genital warts recur?
Treatment for genital warts treats the visible genital warts by destroying the cells that contain the virus but does not get rid of the wart virus in the body. Therefore, the virus can persist, and warts may recur, needing further treatment. In most people, the body’s own immune system will get rid of the virus over time and genital warts do eventually resolve and stop recurring.
Reducing transmission of the wart virus
The wart virus is most easily transmitted when there are visible warts present. However, transmission is also increased just before they appear and just after treatment. It can also occur with no visible warts present.
You may have the wart virus long before any warts appear.
To reduce the risk of transmission, it is best to avoid skin-to-skin contact with the affected area until the warts have been treated, and for a short time afterwards.
It is important not to shave or wax the area where the warts are; this can spread the virus and cause more warts.
Can genital warts be prevented?
The HPV vaccine (Gardasil 9®) is a vaccine that is available in Australia and can prevent infection with several HPV types including 2 of the HPV types, which cause over 90% of genital warts, and 7 of the HPV types, which cause 90% of cervical cancers.
The vaccine is most effective when it is given before someone has engaged in any sexual activity. It is provided as a single-dose vaccine through the National Immunisation Program for all children aged 12-13 through the school vaccination program.
The HPV vaccine is also available free as part of the National Immunisation Program for people 14 to 25 years old through a GP.
For those 26 years and older, the HPV vaccine is available as a course of 3 vaccines through a GP, although a cost is involved. If you did not receive this vaccine through the National Immunisation Program, and you are interested in having it, discuss this with your doctor.
Condoms
Condoms and dams can help to protect you, but they do not cover all areas of your genital skin.
Dealing with a diagnosis of genital warts?
People can feel upset, embarrassed, or ashamed when they are diagnosed with genital warts, or any sexually transmissible infection. These feelings are common and normal. Remember though that wart viruses are just viruses like the ones that causes colds.
They are common, easy to catch, and it does not reflect on you as a person in any way. If you do feel that you need support or would like to talk to someone, mention this to your doctor or make an appointment to see a doctor or nurse at a sexual health centre such as SHFPACT or Canberra Sexual Health Centre.
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References
- Australian STI Management Guidelines
- Victorian Sexual Health Network.
- Family Planning Australia. Healthdirect.
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