Genital warts

Genital warts are skin growths that you can see and feel. They are usually 1 to 5 millimeters in diameter. Some are flat and others hang from the skin on little stalk-like structures. They may occur alone or in clusters. Genital warts are often the same color as the healthy skin around them. Sometimes they’re a bit darker.

Typically, genital warts develop on the outer sex organs and the anus. In women, it’s mostly the entrance to the vagina that’s affected; in men, particularly the area between the head and shaft of the penis and around the base of the penis. In both men and women, the skin and mucous membrane of the anus and the rectum may also be affected. In rare cases, genital warts develop into larger clusters with a rough, lumpy surface. Then they look a bit like cauliflower.

The warts are sometimes itchy. Although they don’t usually hurt, the affected area can be painful if sexual partners rub against it. Even if there’s no soreness or irritation, a lot of people don’t like having them. They can have a negative impact on people’s sex life and quality of life.

Genital warts are caused by an infection with certain kinds of human papillomavirus (HPV), typically HPV 6 and 11. The viruses enter the skin, where they may lead to the growth of too many skin cells. The resulting growths can be seen as warts. It is thought that genital warts don't generally develop into cancer. Other kinds of human papillomavirus can eventually lead to cancer in skin or mucous membranes, though.

Not everyone who gets infected with HPV 6 or 11 develops warts. A lot of them don’t have any visible changes in their skin but they are still capable of infecting other people.

The viruses are mainly passed on through sex. The infection occurs due to intimate skin and mucous membrane contact, especially when someone touches a sexual partner’s genital warts. The viruses can be found in normal-looking skin too but there are a lot more of them in the actual warts. They can also be passed on when people share sex toys like dildos, but that is rare.

It is possible – but not very common – for babies to be infected during birth.

Condoms and femidoms (condoms for women) don’t provide 100% protection because the infection doesn’t only affect the penis and vagina. The risk is higher for people who have unprotected sex with many different partners. The risk of infection or re-infection after treatment is also greater if you have a weak immune system or if you smoke.

Genital warts are one of the most common sexually transmitted infections (STIs) in Germany. Around 170 out of 100,000 people get them every year.

Most people don’t even realize they’ve been infected with human papillomaviruses. Often, they have the viruses for weeks or months without developing any warts. Others do get warts eventually. The time it takes for an infected person to develop warts (the incubation period) can differ greatly. On average, it’s about three months for women and eleven months for men. So, if you notice you’ve got genital warts, you might actually have been infected quite some time ago and not necessarily by recent sexual partners.

Genital warts generally don't go away without treatment. But some may go away on their own.

Doctors can usually identify genital warts by their appearance. They sometimes use a magnifying glass to examine the affected areas. If the warts are inside the vagina, they might have to use a special instrument called a colposcope to see them. If the doctor thinks you might have genital warts in your rectum, they’ll feel inside your bottom and insert something called a proctoscope to look at the mucous membrane.

If it’s not possible to distinguish the growths from other diseases, like non-melanoma skin cancer, it can be helpful to examine the tissue more closely. The doctor then removes the wart or takes a sample (biopsy), and the tissue is examined under a microscope to find out exactly what it is.

If you’re diagnosed with genital warts, the doctor will usually offer to do additional tests for other sexually transmitted infections (STIs) like syphilis or gonorrhea too.

If you want to learn how to prevent genital warts, a good place to start is by finding out about the infection that causes them and how it is passed on. Doctors such as dermatologists and specialists in sexual health or your local health department can tell you more about warts and other STIs and how you can prevent them.

HPV vaccination provides effective, safe protection against genital warts and other tissue growths caused by HPVs.

Using condoms or femidoms doesn’t prevent infection completely, but it does reduce the risk.

There are various treatments to get rid of genital warts. The treatments are generally thought to be helpful and well-tolerated. But there isn’t enough good-quality research to assess and compare exactly how effective they are.

One way to treat the warts is using creams or solutions that your doctor has to prescribe. You apply them regularly at home over several weeks. They contain active ingredients like podophyllotoxin, green tea extract or imiquimod.

The warts can also be removed surgically instead. Then the doctor cuts them out with a scalpel, for example, or uses an electric current to destroy (cauterize) them. Other options include freezing (cryotherapy) and laser treatment. The different surgical procedures can also be combined with using a cream.