Genital warts, caused by some types of HPV (human papilloma virus), can appear on the skin anywhere in the genital area as white or flesh-coloured, smooth, small bumps, or larger, fleshy, cauliflower-like lumps.

Not everyone infected infected with HPV will develop genital warts. Some will be infected with a strain that does not produce warts, or they will remain asymptomatic (i.e. no warts will appear) even though the virus is present in the skin or mucous membranes around the genital area or on the cervix in women. Those who do go on to develop warts will usually notice them 1 to 3 months after initial infection.

Symptoms

If symptoms do appear then the infected person may notice pinkish/white small lumps or larger cauliflower-shaped lumps on the genital area. Warts can appear on or around the penis, the scrotum, the thighs or the anus. In women warts can develop around the vulva or inside the vagina and on the cervix. If a woman has warts on her cervix, this may cause slight bleeding or, very rarely, an unusual coloured vaginal discharge.

Warts can occur singly or in groups. The warts may itch, but they are usually painless.

Occasionally, people can confuse skin problems caused by other STDs (such as genital herpes, syphilis or molluscum) with genital warts. Others may become very worried because they mistake perfectly normal and non-infectious lumps and bumps for genital warts. Conditions that may be confused with genital warts include:

• Pearly penile papules - small white or skin-coloured bumps that, when numerous, appear in a ring around the edge of the head of the penis. More rarely, similar papules may be found on the vulva.
• Angiokeratomas - bright red or purple spots that look a little like blood blisters.
• Pimples or spots - caused by blocked sebaceous glands, pimples and spots can form just as easily around the genital area as they do on the face, and may become sore and inflamed in a similar way.
• Sebaceous glands (also known as 'Fordyce spots') - hard white, yellowish or skin-coloured little bumps that may be found all over the skin of the penis and scrotum in men, and the vulva in women. Sebaceous glands produce a substance called sebum, which keeps the skin healthy.

All of the above are common, non-infectious skin manifestations that are not sexually transmitted.

Any doubt about lumps and bumps on the genitals can usually be resolved by a quick visit to a doctor or sexual health clinic.

How It’s Passed On

Genital HPV is transmitted by genital skin-to-skin contact, or through the transfer of infected genital fluids. This is usually during vaginal or anal sex, but it is also possible to pass it on through non-penetrative sexual activity.

Getting Help

If you have any symptoms or you are worried you may have been infected with an STD, you should discuss your worries with a doctor.

The Diagnosis

A doctor or nurse can usually tell whether you have genital warts just by looking closely at the affected area. To check for hidden warts, the doctor may carry out an internal examination of the vagina, cervix and/or anus.

If a person suspects they have been exposed to HPV, but does not yet have symptoms, their doctor may be able to take a swab to test for high-risk strains of the virus. Not everyone diagnosed with HPV will develop warts, and patients may be asked to come back for another examination at a later date if nothing is yet visible.

Treatment

There is no treatment that can completely eliminate genital warts once a person has been infected. Often outbreaks of genital warts will become less frequent over time, until the body naturally clears the virus and the warts disappear of their own accord. A doctor can give patients various treatments to clear genital warts, but they may reappear even after treatment. Genital warts are caused by a virus, not a bacterium, so antibiotics will not get rid of them.

• Cryocautery (also called cryotherapy) – uses liquid nitrogen to freeze more persistent warts every 1 to 3 weeks for a short period. It may cause some discomfort and is not recommended for young children.
• Podophyllin resin – a brown liquid which is painted on to the wart(s) by a doctor or nurse and must be washed off 4 hours later (or sooner, if the area is irritated). Podophyllin resin and podofilox lotion remove genital warts by stopping cell growth and may require several applications to work effectively.
• Podopfilox lotion/gel – can be applied to the wart(s) by the patient at home. The usual schedule is twice a day for 3 days, followed by 4 days without any lotion. This cycle is repeated for 4 weeks.
• Electrocautery – an electrical current is used to super-heat a needle which burns the wart cells and cauterises the blood vessels. A local anesthetic is used to prevent any pain and the procedure is usually carried out at a doctor's surgery. Electrocautery is used only after other treatments have failed.

Taking Care Of Yourself And Your Partner

If you have genital warts, following these suggestions will make an outbreak easier to deal with, and will help protect your partner.

• Use condoms when having sex. But remember that condoms will only prevent the transmission of genital warts if they cover the affected areas.
• Make sure that your partner has a check-up too, as they may have warts that they haven't noticed.
• Don't use scented soaps and bath oils or vaginal deodorants, as these may irritate the warts.
• Keep your genitals clean and dry.

Follow Up

It is important to return regularly for treatment until all of the genital warts have gone so that the doctor or nurse can check progress and make any necessary changes in your treatment.

The majority of people whose genital warts initially disappear will get a recurrence.

In most cases the immune system keeps the virus under control and eventually destroys it a few years after the initial infection.