About genital warts
Genital warts are one of the most common sexually transmissible infections (STIs). They are caused by the human papillomavirus (HPV). There are more than 100 strains of HPV, but only certain types affect the genitals and not all cause visible warts. Genital warts can appear around the genitals and anus or, sometimes, inside the vagina, rectum or urethra.
Appearance of genital warts
Genital warts appear as painless growths and may be:
- flat or raised
- single or multiple
- clustered together with a cauliflower-like appearance.
Genital warts can be invisible
In many cases, HPV is a ‘subclinical’ infection. This means that you may be carrying HPV on your skin, even though you do not have any visible warts. Subclinical HPV infection is common in both women and men, but is detected more often in women through a cervical screening test.
Risk factors for genital warts
HPV is spread by direct skin-to-skin contact during vaginal or anal sex. It is also possible, but rare, to transmit HPV to the mouth by oral sex. Infection may occur after direct contact with a visible wart or contact with genital skin where the virus is present.
Warts may appear within a few weeks after sex with a person who has HPV, or they may take months to appear, or they may never appear. This can make it hard to know when or from whom you got the virus.
Treatment for genital warts
It is important to remember that treatment does not get rid of the virus. It only treats the visible warts. For most people, the body’s natural immunity will get rid of the virus over time.
Treatment aims to remove visible warts so that the area looks more cosmetically acceptable. Always consult your doctor about any treatments. Over-the-counter wart treatments are not suitable for genital warts.
Treatment options include:
- cryotherapy – the warts are frozen off with liquid nitrogen. Several treatments may be required
- podophyllotoxin – this lotion can be applied at home. It is most effective on multiple warts that are easily accessible. Pregnant women should not use podophyllotoxin. You need to be careful to protect the unaffected skin
- imiquimod cream – this is applied once a day, three times a week for up to three months. This treatment is not recommended for use in pregnancy
- laser or diathermy treatment – this is used for larger numbers of warts or when other treatment options have not been effective. Laser or diathermy treatment is administered in hospital under general anaesthetic. Remember, this procedure does not get rid of the virus, it helps to get rid of the visible warts.
Genital warts can reappear after treatment
After treatment for warts:
- The virus may persist on the skin, even though the visible wart has gone. This means that warts may reappear.
- If the wart reappears, it does not necessarily mean that you have caught the infection again.
- In most cases, the wart will eventually disappear for good. This is due to the body’s natural immune response clearing the virus from the body.
HPV and cervical cancer
Certain types of HPV can infect the cervix and cause cell changes that may, over many years, increase your risk of cervical cancer if the body is not successful in clearing the virus naturally. The types of HPV that cause visible genital warts do not progress to cervical cancer.
The cervical screening test is a screening tool used to detect HPV on the cervix that may lead to cervical cancer.
Most HPV found on the cervix will clear naturally without treatment. However, some high-risk types require closer monitoring and may need treatment to remove them. Your doctor will advise you about this if necessary.
Genital warts and HPV vaccines
There are two HPV vaccine brands available in Australia to help prevent cervical cancer: Cervarix® and Gardasil®9. Both vaccines work by preventing infection with two types of HPV -- types 16 and 18. These two types have been shown to cause 70% of cervical cancers.
Gardasil®9 provides protection against nine types of HPV. In addition to types 16 and 18, it also protects against HPV types 6 and 11, which cause almost all genital warts, and types 31, 33, 45, 52 and 58, which cause an additional 15% of all cervical cancers. Gardasil®9 replaces the Gardasil® vaccine (which protected against the four types of HPV -- types 6, 11, 16 and 18).
Immunisation with Gardasil®9 vaccine involves a course of two injections a minimum of six months apart for children aged 12 to 13 years to under 15 years of age as part of the Year 7 secondary school vaccine program, or three injections over a six month period for people from 15 years of age.
Immunocompromised individuals require three doses of the HPV vaccine to attain adequate protection regardless of their age. The doses should be given with a minimum interval of two months between doses one and two and a minimum of four months between doses two and three.
In Victoria, the HPV vaccine is available free of charge under the National Immunisation Program for all adolescents in Year 7 of secondary school (aged 12 to13 years). The two-dose course of the vaccine is given at school, or can also be given by a local doctor or at a council immunisation session.
The vaccine provides best protection if it’s completed before a person becomes sexually active.
The benefit of the vaccine may be reduced for older men and women who have already had sex, as they may have been already exposed to the HPV types providing protection in the vaccine. Talk to your doctor about whether or not the vaccine may be beneficial for you and whether you are age eligible for the free vaccine or require a prescription to purchase the vaccine for administration.
Preventing the spread of genital warts
You can help reduce the risk of spreading genital warts by using condoms during sex. However, because condoms don’t cover all the genital skin that is exposed during sexual contact, you may still acquire HPV through skin to skin contact.
Remember that transmission of genital warts can occur when a wart is present, but may also occur even if there are no genital symptoms.
Genital warts and sexual relationships
The benefits of condoms are less clear if you are in a regular sexual relationship, especially if you and your partner already have warts. Discuss this issue with your doctor or with a nurse at an STI clinic.