Genital Warts Prevention, Diagnosis, and Treatment of This Common STI

Genital warts may be uncomfortable to talk about, but they’re very common. If you have genital warts, you’re not alone. In fact, there are up to 1 million new cases each year in the U.S. That’s likely in part because genital warts can be passed easily — even if you’re using condoms.

What causes genital warts?

The human papillomavirus (HPV) causes genital warts. There are many strains of HPV. Some strains can cause other conditions like cervical cancer. The specific strains responsible for 90% of genital warts are HPV types 6 and 11. 

The virus is spread during sexual intercourse. You’re at risk if you have skin-to-skin contact with someone who has genital warts. They can spread from:

• Penis to vagina, cervix, or anus
• Vagina to penis, vagina, or vulva
• Penis or vagina to the skin surrounding the genital areas
• Mother to child during childbirth
• Penis or vagina to the larynx or mouth 

It’s also possible to have warts spread within the same person. You can spread warts from one part of your body to your genitals.

Who is at higher risk for genital warts?

If you’re exposed to the virus that causes genital warts, it doesn’t mean you will develop them. In fact, 90% of those exposed to the virus never develop genital warts. But there are certain factors that can put you at higher risk for getting it. These risk factors include:

• Smoking 
• Younger age
• Poor immune status
• Multiple sexual partners
• History of other sexually transmitted infections (STIs)

After exposure to the HPV virus, it takes an average of 2 to 3 months for the warts to appear. But it can take longer. Genital warts appear as one or more flesh-colored growths. They can be flat, raised, or attached to a stalk (like a mushroom). 

Genital warts can be separate lesions or clustered in groups in a cauliflower shape. They can grow to a size of 5 mm (as small as a pencil eraser) or a mass of several inches if many are joined together. These growths most commonly occur in these locations:

• Vagina
• Cervix
• Skin around the anus
• Inside the anus
• Scrotum
• Area between the genitals and anus

Genital warts less commonly affect the:

• Mouth
• Throat
• Nose
• Lining of the eyelid

Genital warts are usually painless. But, depending on where they’re located, your warts may be painful or itchy. Genital warts can also cause other symptoms, including:

•  Bleeding after intercourse
•  Blockage of urine flow
•  Bleeding while urinating
•  Vaginal discharge

How do you diagnose genital warts?

The diagnosis of genital warts is usually easy and straightforward. Healthcare providers diagnose them in two main ways:

1. Visual inspection: Your healthcare provider can often make the diagnosis after examining you and looking at the warts.
2. Biopsy: Sometimes it’s not clear from the exam if you have genital warts. Your provider may take a sample of the growths to send to the lab for a closer look.

How do you treat genital warts?

There are many different treatments for genital warts. Your healthcare provider may recommend treatments they can apply in their office. There are also treatments you can apply at home. Some treatments need multiple applications to clear the warts.

Treatment options that your provider applies include:

• Fluorouracil
• Trichloroacetic acid (TCA)
• Cryotherapy: cold treatment with liquid nitrogen
• Electrocautery: use of heat to destroy the warts
• Scissor excision: physical cutting off of the warts
• Carbon dioxide (CO2 laser): use of infrared light to vaporize the warts

Treatments that you can apply yourself include:

• Imiquimod  
• Podofilox
• Veregen

The goal of treatment is to remove the warts, but they don’t get rid of the virus that causes them. There’s no cure for HPV infection. So genital warts can recur after treatment. Recurrence is typically within 3 months, even with proper treatment. 

The likelihood of recurrence usually depends on:

• General health and immunity 
• Prior HPV vaccination 
• HPV strain 
• Sexual frequency with an infected partner 
• Condom use (although it may not be protective)

What happens if you don’t treat genital warts?

Even if you don’t treat genital warts, there’s a good chance they may go away. When you have a healthy immune system, your body will try to clear the HPV infection on its own. In 90% of cases, the HPV will go away within 2 years. And about 30% of genital warts that have developed will disappear within 4 months. 

But, without treatment, genital warts may also stay the same or grow larger. In severe cases that are left untreated, genital warts can lead to: 

• Disfigurement of the affected area 
• Worsening of symptoms like pain and itching
• Emotional distress

How can you prevent the spread of genital warts?

HPV is very contagious. So preventing the spread of the virus is key. Unlike other STIs, condoms may not be as effective. That’s because the warts spread through skin-to-skin contact, and they may be in an area that condoms don’t cover. All the same, healthcare professionals still recommend condom use for all sexual intercourse — vaginal, oral, or anal. 

Gardasil is a vaccine that protects against human papillomavirus types 6, 11, 16, and 18. Since 6 and 11 cause an estimated 90% of genital warts, the Gardasil vaccine is recommended and approved by the FDA for people as young as 9 years old. That’s because the vaccine works best before exposure to the virus. In fact, it works almost 100% of the time to prevent genital warts before you have been exposed to the virus.

If you have a vagina, experts recommend the vaccine for people ages 9 to 26. For those with a penis, you can begin at age 11. In certain cases, your healthcare provider can administer the vaccine up to age 45. 

If you’ve already been infected with HPV, it’s still a good idea to get the vaccine. While it doesn’t treat HPV infection, it may prevent you from getting another HPV strain.