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 membranes lining 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 warts don't cause any of these symptoms, a lot of people find them unpleasant. 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) – almost always 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. They have the viruses for weeks or months but don't develop 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 3 months for women and 11 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 soft tissue lining the area.

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 tests for other sexually transmitted infections (STIs) like syphilis or gonorrhea too.

If you want 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 skin specialists (dermatologists) and specialists in sexual health, your local health department and (in Germany) the Deutsche Aidshilfe organization can tell you more about warts and other STIs and how you can prevent them.

HPV vaccines provide effective, safe protection against genital warts and other changes in your tissue that can be 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 help and be 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 have to be prescribed by a doctor. 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.

The German Federal Institute of Public Health (BIÖG) (previously known as the Federal Centre for Health Education, or BZgA) has a website called liebesleben.de that includes information on STIs like genital warts and practical tips on how to prevent them. They also have an online and telephone advice service, and can help you find somewhere nearby if you have more questions.

The Deutsche Aidshilfe organization offers information about genital warts and also has its own online and telephone advice service. They can help you find out where else to get advice, too.