Your Ultimate Guide to Treating Genital Warts

Genital warts are soft growths that develop around the genitals or anus, and are passed on predominantly by vaginal or anal sex. The condition is one of the most common viral STIs (Sexually Transmitted Infections) in the UK with 51,000 individuals diagnosed in 2019; heterosexual males in the 20-24 age group account for the most cases of any particular demographic^[1]. Thankfully, genital warts can be easily treated with a topical cream, clearing the warts and preventing them from returning. In this ultimate guide, we’ll explain what causes genital warts, how to spot the symptoms and what you can do to treat them.

What are Genital Warts and What Are the Symptoms?

Also known as venereal warts or condylomata acuminata, genital warts are small growths that appear on the genitals or sometimes the anus. They aren’t always visible to the naked eye, usually under 5mm in size, but can range to several centimetres. They are typically the same or a slightly darker shade than your skin colour, and can appear either separately or in clusters.

In women, genital warts can appear:

• On the vulva
• Inside or outside of the vagina
• On the cervix
• Inside the urethra
• Inside or outside the anus

In men, genital warts can appear:

• On the penis (on the shaft, on or under the foreskin)
• On the scrotum
• Inside the urethra
• Inside or outside the anus

It is also possible, but unlikely, for genital warts to appear on the lips, tongue, mouth or throat if you’ve had oral sex with someone with the condition.

Genital warts do not usually cause symptoms, although they can occasionally be painful, cause itching and redness, and may bleed. Since the warts can be difficult to spot externally, or internally on the urethra or cervix, it’s important you visit a sexual health clinic if you experience any of the following:

• 1 or more painless lump or growth around the penis, vagina or anus
• An itching or burning sensation, or bleeding from the genital or anus areas
• A change to the normal flow of urine, such as pointing sideways, that does not go away
• A bloody, brown, or watery vaginal discharge with an unpleasant odour
• A sexual partner has genital warts, regardless of whether you’re experiencing symptoms

What Causes Genital Warts?

Genital warts are a skin infection in the genital or anal area caused by HPV (human papilloma virus). HPV is responsible for causing warts all over the body, with more than 100 different strains of the virus. Between 30 and 40 strains appear in the genital and anal areas, although most cases of genital warts are caused by just one of two types of HPV, type 6 and type 11, which are responsible for 90% of genital warts cases and cannot cause cancer. However types 16 and 18 cause the majority of HPV-related cancers, causing 70% of cervical cancers for example, although these do not produce genital warts^[2].

The infection is transmitted through sexual contact, typically through penetrative vaginal or anal sex with a partner who has genital warts. HPV can also be passed on by close skin-to-skin contact of the genital area, and very rarely pass to the lips, throat or mouth area by performing oral sex on an infected partner. Additionally, sharing sex toys with an infected partner may pass on the infection, however kissing, hugging, sharing towels or drinking from the same cups etc. cannot spread genital warts. When warts are present, it is more likely that the virus infection will be passed on, but it can still be given to a partner after the warts have disappeared. It’s also possible, but very unlikely, for a pregnant mother to pass the virus to their baby at birth if they have genital warts at the time^[3].

What are the Risk Factors?

If you are sexually active with someone who may have genital warts then there is naturally a risk of infection. However, the condition is more common in people who:

• Are under 30 years of age
• Smoke
• Have a weakened immune system
• Are children of mothers who have had the infection during childbirth

How Do I Treat Genital Warts?

Sometimes your body will clear a genital warts outbreak without treatment. However, it’s not uncommon for the infection to multiply and get worse without intervention. Whilst an outbreak of genital warts may return in future, treatment can eliminate the warts over time which in turn will greatly reduce the risk of transmission.

A word of caution: treatments designed to combat warts on other parts of the body such as on the hands or feet should NOT be applied to the genital or anus areas, as they will not be effective. Additionally, antibiotics won’t help to get rid of the infection as genital warts are caused by a virus rather than bacteria.

The most appropriate treatment for you will depend on the size, location, and quantity of your genital warts.

Topical Creams

Podophyllin

Podophyllin contains a powerful antiviral plant extract called podophyllotoxin that not only prevents the virus from developing and spreading further, but will also clear the genital warts within around four weeks. Warticon is a popular branded version of podophyllin, available in both solution and cream form, that is both effective and fast-acting.

Imiquimod

Another topical prescription treatment, Imiquimod, supports the body’s immune system to fight the HPV virus responsible for the outburst and clears gential warts. As an immune response modifier, Imiquimod treatments like the popular Aldara cream stimulate the body’s immune system to activate it’s natural defence mechanisms, allowing the body to clear HPV quicker. Whilst slightly more expensive and with a slower average recovery time compared to Warticon’s treatments, Aldara has been found to more effectively prevent genital warts from recurring in the long term.

All three of these topical treatments share the same common side-effects, which can include:

• Wearing away of the top layers of the skin
• Skin irritation including redness, itching, burning sensation
• Skin ulcers, scabs, dry skin or skin discolouration
• Minor pain or swelling

If any of the above symptoms become severe, stop using the solution immediately and seek medical attention.

For application instructions, please refer to each of our genital warts treatments. Always read the patient information leaflet before use.

Cryotherapy

Cryotherapy is where liquid nitrogen is applied to the affected area by a healthcare professional, blistering the warts and causing them to eventually fall off. Up to three treatments could be necessary, and healing usually takes one to three weeks. Cryotherapy is appropriate for external genital warts and has a very high success rate of 79%-88%^[4], although there is a slight risk of scarring, with irritation and mild pain often occurring as a more commonly experienced side-effect.

Laser Surgery

Laser surgery is often considered as a last resort when it comes to treating genital warts when other treatments have been unsuccessful. Laser surgery may also be used if the infection is particularly widespread or if the infection needs to be treated during pregnancy. The efficacy of laser surgery ranges from approximately 20% to 40%, and as with Cryotherapy, it does not prevent further warts from forming in the future. Furthermore, like Cryotherapy, similar side effects may be experienced (mild pain, itching, shedding of dead skin, potentially scarring), and the recovery time is usually between two and four weeks.

How Do I Prevent Genital Warts?

There are a number of protections you can take to reduce your chances of catching the HPV virus and developing genital warts. These include the following:

• Use a condom every time you have sex. As a sexually transmitted infection, placing a physical barrier between you and a potentially infected partner will drastically lower the likelihood of you contracting the infection. However, genital warts can be caught from affected areas of skin around the genitals, so avoiding sexual intercourse (even protected sex) with someone that has the infection will eliminate this risk altogether.
• Check that your potential sexual partners are clear of STI’s before you have sex.
• In the UK, both girls and boys are offered a vaccination against HPV when they’re aged 12 to 13, as part of an NHS programme. The vaccine is called Gardasil, and protects against types HPV types 6 and 11 that cause genital warts, and types 16 and 18 that cause cervical cancer. It is also free to all men aged 45 of younger who have sex with men, and is available privately to other age groups. It is also important to know that the cervical cancer-prevention vaccine Cervarix does not protect against genital warts.
• There is little evidence to support various home remedies for genital warts, and it is vital not to use generic wart treatment for genital warts as they are not effective and can result in undesired side-effects.