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A guide to – Genital warts Genital warts – the basics Warts are a curable sexually transmitted infection (STI) caused by human papillomaviruses or HPVs. Although there are over a hundred different types of HPV, most genital warts are caused by HPV 6 and HPV 11. Warts on the fingers or soles of the feet (verrucas) are caused by different HPVs which do not spread to the genital skin. Women may notice warts on the vulva (outside the vagina) and around the anus (back passage). Sometimes warts can develop inside the vagina or on the cervix (the neck of the womb). Men may notice warts on the head or shaft of the penis or around the anus. Less commonly, warts can develop in the urethral meatus (the ‘eye’ of the penis) in the skin covered by pubic hair and in the groins. Rarely, warts can occur in and around the mouth. Warts can be diagnosed at all specialised sexual health or genitourinary medicine (GUM) clinics, family planning clinics and family doctor (general practitioner or GP) services. Doctors recommend that patients with genital warts should be tested for other STIs including chlamydia, gonorrhoea, syphilis and HIV. How common are genital warts? Genital warts are the most common STI caused by a virus. It is thought that most people who have sex will catch HPV at some time. However, only a small number of those infected with these viruses will develop genital warts. In 2016 more than 59,000 cases of genital warts were diagnosed in England. How do you get genital warts? Genital warts develop after direct skin-to-skin contact with someone who has HPV in their skin. Infection with HPV can occur – following unprotected sex (without a condom) with a person who has HPV in their skin. This can be vaginal, anal or oral sex. if HPV is passed from a mother with genital warts to her baby during childbirth. This is very uncommon. Warts cannot be caught from hugging, sharing baths, towels, sheets, toilet seats or swimming pools. What would I notice if I had genital warts? Wart virus can create small lumps on the skin. Warts can vary in size, shape and colour. Typically, they are small, flat and smooth. They are usually the same colour as the surrounding skin, but some can be light brown or red. They can occur singly or in groups. Warts can feel slightly rough to the touch. They aren’t painful but they can itch and sometimes bleed if they are damaged. Some people don’t notice that they have warts because they are very small or because they are on parts of the skin which are difficult to see. Is there a test for genital warts? Warts are usually diagnosed by a doctor or nurse examining the skin. If the doctor is not sure, a small piece of skin may be removed under local anaesthetic (a biopsy). The skin can then be examined under the microscope to make sure of the diagnosis. Is it possible to say when I caught the wart virus? It’s usually not possible to know when you caught HPV. It is quite common to develop warts within three months of being infected with the virus, but it possible to develop warts years after infection. How are genital warts treated? Most patients choose creams or lotions which they can use at home. Other treatments such as freezing or burning can only be done in sexual health clinics. You can decide which treatment will be best for you after discussing it with the nurse or doctor. How long does it take for warts to go? In some people the warts disappear after 3–4 weeks of treatment. However, it can take longer for them to go away. People who have lots of warts or who have warts around the anus (back passage) and smokers may all take longer to get rid of their warts. People who have weakened immune systems and pregnant women can also take longer to get rid of their warts. Important information about your treatment All treatments from sexual health clinics are free and are given to you in the clinic. You cannot buy treatment for genital warts ‘over the counter’ from a chemist or pharmacy. What about my partner? Wart virus is caught through skin to skin contact during sex, so if the person you caught them from has other STIs it’s possible that you may have caught them as well. This is why doctors recommend a full sexual health check-up for you and your recent sexual partners. If you prefer, your partner(s) can be contacted by the clinic without mentioning your name. When can I have sex again? You should not have sex if you have just put wart treatment creams or lotions on your skin. Having unprotected sex while you have warts makes it much more likely that you will pass on wart virus to your partner. Using condoms may help to protect your partner from infection with the virus, if the condom covers the affected skin and is put on before skin contact occurs. What happens if warts are not treated? The warts may stay the same, they may increase in number or disappear. How will I know if my warts have been cured? The warts will disappear. A nurse or doctor can make sure of this by examining your skin. Will the warts come back? It is quite common for warts to come back, usually in the first three months after they have disappeared. In most cases this happens because there is still HPV in the skin. People who smoke are more likely to see their warts come back. However, over time most people will get rid of HPV and will not develop new warts. Will I always have HPV in my skin? Most people get rid of HPV over time. Warts in pregnancy It’s not unusual for women to develop genital warts for the first time during pregnancy. Changes in the woman’s immune system and blood supply can allow warts to develop. Warts can be treated during pregnancy but it can be more difficult to get rid of them. Most women will notice that their warts go away in the weeks following the birth of their baby. Can warts affect my baby? It is rare for babies of mothers with genital warts to develop warts themselves. If this does happen, these are usually on the baby’s skin. Very rarely, warts can develop in the baby’s windpipe. Will I need a caesarean section? Having genital warts in pregnancy is not usually a reason for having a caesarean section. Most pregnant women with warts will deliver their baby in the normal way. Can warts lead to cancer? It is extremely rare for warts to become cancerous. This is because the HPVs which cause most warts (HPV 6 and 11) are ‘low risk’ viruses. Which HPVs can cause cancer? Of the hundred or so HPVs which can infect humans, 13 are known to cause cancer. The most important of these ‘high risk’ viruses are HPV 16 and 18. Can I protect myself from HPVs? Using condoms offers some protection. In the UK, girls aged 12–13 are offered vaccination to prevent infection with HPVs 6, 11, 16 and 18. Gay and bisexual men aged less than 46 years old will be offered the vaccine from April 2018. This leaflet was produced by the Clinical Effectiveness Group of the British Association for Sexual Health and HIV (BASHH). The information in the leaflet is based on the ‘UK National Guidelines on the Management of Anogenital Warts 2015’ published by BASHH. More information: BASHH: www.bashh.org/guidelines If you would like to comment on this leaflet, e-mail us at: [email protected] Please type ‘Wart PIL’ in the subject box. Copyright BASHH 2018. This leaflet was first published June 2018. Revision date June 2021.