What Are Genital Warts?

Genital warts are the visual sign of a common sexually transmitted infection (STI) caused by a common virus of the mucous membranes, the human papillomavirus (HPV). Although not harmful, they can cause physical discomfort and emotional distress. They are, however, treatable and may not reoccur. 

Genital warts are small, fleshy bumps that may be clustered together or appear solitarily  on or around the genital area. They can also appear around or in the mouth or throat after oral sex with someone infected. 

This article will provide an overview of genital warts, including their causes, signs and symptoms, management and treatment, diagnosis, risk factors, and complications.

Overview

Genital warts (condylomata acuminate) are the visible sign of a sexually transmitted infection caused by the human papillomavirus (HPV). HPV is a common virus that infects the skin and mucous membranes of the body.¹ Warts are a well-known visual sign of genital HPV infection; nonetheless, only about 10% of those infected will spread the virus. 

Over 100 different variants of HPV viruses have been discovered. HPV is transmitted through direct skin-to-skin contact with an infected person, most commonly during sex. While some HPV strains cause cervical and anal cancer, these are not the same strains that cause genital warts. It is possible to be infected by various HPV types simultaneously.²

Human papillomavirus (HPV) infection causes diseases ranging from benign warts to cancer. Over 180 types have been reported, with 15 high-risk variants, particularly HPV16 and 18, linked to cervical cancer and a kind of cancer of the neck and head called head and neck squamous cell carcinomas (HNSCCs).^1,3 The low-risk variant, such as HPV6 and HPV11, are linked to genital warts.

Causes of genital warts

Genital warts are primarily caused by infection by the human papillomavirus (HPV). Over 30 HPV subtypes can infect the genital mucous membrane, including HPV 2, 40, 42, 43, and 54. HPV-16 and HPV-84 are the most commonly detected types in people assigned male at birth. The most common type, which causes infections 90% of the time, are types 6 and 11 and are spread through sexual contact with someone with the virus.^1,2,3,4 

HPV can be transmitted through oral, vaginal, or anal sex with an infected partner, skin-to-skin contact with the infected area, or using an infected sex toy. Although rare, the virus can also be passed onto a baby from its mother during childbirth, leading to the early onset of persistent papillomatosis (wart-like bumps on the skin).⁴

Signs and Symptoms of genital warts

It is possible to have HPV and no visible warts, which is why regular STI testing is important. Symptomatic genital warts affect about 1% of the sexually active population.¹

Some genital warts tend to be so small that they cannot be seen. Genital warts are less common in those assigned male at birth but commonly appear on the tip of the penis, the scrotum, the thigh, the groyne, or around the anus. Warts in those assigned female at birth typically appear in or around the vagina, on the cervix, or around the anus. 

Genital warts appear as small bumps or groups of flesh-coloured or pink on or around the genital area. They can be flat, raised, or clustered together with a cauliflower-like appearance, which can also be itchy or painful and can bleed during sex or other activities that irritate the area.⁴

Soon after the initial appearance, genital warts may grow in size and number or spontaneously disappear.90% of detected infections resolve within 2 years, owing to cell-mediated immune processes.⁵  

The average time to wart development after exposure to HPV 6 or 11 types was 6-18 months, also known as a window period. A decline in the appearance of warts was common among people assigned female at birth who are HIV-positive and HIV-negative, even in the absence of treatment: In the first year after diagnosis, 60% of people with vulvas were infected with HIV/AIDS and 80% of HIV-negative people with vulvas experienced wart disappearance. Approximately 30% of all warts will go away within the first four months of infection.^1,2,6

Management and treatment for genital warts

Genital warts can be managed and treated, but there is no cure for the causative HPV infection. Current treatment options focus on taking off warty tissues rather than combating the virus, meaning that after treatment, the individual is still not cured of the virus. 

Treatment options include:^1,3,6

• Prescription creams or gels that are applied topically to the warts. Topical medications include imiquimod or podofilox
• Freezing warts with liquid nitrogen (cryotherapy)
• Burning warts with an electrical current (electrocautery)
• Surgery to remove warts

It is crucial to discuss a preferred treatment option with your healthcare provider, who can help determine the best plan depending on your  specific situation to avoid recurrence, which can occur within three months after infection, even after appropriate treatment.¹

Diagnosis of genital warts

A healthcare provider can diagnose genital warts by performing a visual exam of the affected area. They may also use a chemical solution to make the warts more visible. Sometimes, they may deem a biopsy necessary to confirm the diagnosis. They may also use tests such as a Papanicolaou-stained (Pap) smear or HPV tests for cervical screening, such as HPV DNA and HPV mRNA tests to detect the virus.⁷

Risk factors

Any sexually active individual risks contracting genital warts. However, certain factors increase the risk of infection, including

• Having multiple sexual partners or partners who have multiple sexual partners
• Engaging in unprotected sex
• Having a weakened or compromised immune system due to an underlying condition or infection such as HIV
• Having a history of STIs
• Healthcare workers who treat oral warts, genital warts, or intraepithelial neoplasias

Complications

While genital warts are not typically dangerous, they can cause emotional distress and discomfort. In rare cases, warts can grow very large and obstruct the airway or urinary tract, requiring emergency treatment. Additionally, some types of HPV can cause cancer. 

In males, infection with high-risk HPVs is linked to penile intraepithelial neoplasia (PIN), a precancerous condition of the penis, and anal and throat cancers. Cervical cancer is the fourth most common cancer in people assigned female at birth, with roughly 500,000 new cases diagnosed yearly, resulting in more than 250,000 deaths worldwide.^1,3

About 9% of anal cancer cases and virtually all cases of cervical cancer in people with vulvas appear to be caused by HPV infection, with HPV type 16 accounting for about half of these. Some cancers of the vulva have been linked to HPV infections; approximately 29% to 43%, whereas 70% of vaginal cancers are linked to HPV infections with types 16 and 18.^1,5

Regular STI testing and cancer screenings can help detect potential complications early on.

FAQs

How can I prevent genital warts

To prevent genital warts, practise safe sex by using condoms correctly during sexual activity and limiting your number of sexual partners. Wash toys properly before and after use and avoid sharing them with others. In uninfected people, the HPV vaccine can also help prevent genital warts. How common is genital warts

Genital warts are quite common, because HPV is the most common STI. They affect one in every 100 sexually active adults.

Are genital warts contagious

Yes, genital warts are highly contagious and are transmitted through skin-to-skin contact during sexual activity and sharing sex toys.

When should I see a doctor

If you have been exposed to or suspect you have genital warts, you should see your doctor as soon as possible. Early detection and treatment can help keep the infection from spreading and prevent further complications.

Summary

Genital warts are a sexually transmitted infection caused by the human papillomavirus (HPV). They appear as small, flesh-coloured bumps that can be flat or raised and grow on the genital area, anus, or surrounding skin. Although HPV has no cure, treatment options include prescription creams or gels, freezing, burning, or surgery to remove warts. 

While not typically dangerous, regular STI testing and cancer screenings, including pap smear, can help detect and prevent potential complications early on. Taking the HPV vaccine, and practising safe sex, are ways to prevent HPV  infection.