Genital Warts
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Genital Warts
Causes (HPV), symptoms, diagnosis and UK treatment options including Warticon and cryotherapy.
Key fact: Genital warts are the most commonly diagnosed viral sexually transmitted infection (STI) in the UK, caused by the human papillomavirus (HPV). The wart-causing strains (HPV 6 and 11) are “low-risk” types that do not cause cancer. Genital warts are treatable — though not curable, as HPV remains latent — and recurrence is common. The HPV vaccine protects against the strains that cause 90% of cases.
What Are Genital Warts?
Genital warts are soft, skin-coloured growths that appear on and around the genitals, anus and upper thighs. They are caused by infection with the human papillomavirus (HPV) and are spread through skin-to-skin sexual contact. Genital warts are benign — they do not cause cancer — though they can cause significant distress, itching and discomfort.
Genital warts are the most commonly diagnosed viral STI in UK sexual health clinics. Many people who carry the causative HPV strains never develop visible warts; others develop them weeks, months or even years after initial infection, making it impossible to determine the source of infection from timing alone.
Understanding HPV: Low-Risk vs High-Risk Strains
HPV is a large family of viruses with over 200 strains. They are classified by cancer risk:
| HPV Type | Risk Category | What It Causes | Vaccine Coverage |
|---|---|---|---|
| HPV 6 and 11 | Low-risk | Genital warts (~90% of cases); respiratory papillomatosis | Yes — Gardasil 9 |
| HPV 16 and 18 | High-risk | ~70% of cervical cancers; anal, vulval, vaginal, penile, oropharyngeal cancers | Yes — Gardasil 9 |
| HPV 31, 33, 45, 52, 58 | High-risk | Remaining ~30% of HPV-related cancers | Yes — Gardasil 9 |
| Other low-risk types | Low-risk | Common skin warts (e.g. HPV 1, 2, 4); plantar warts | Partial or no coverage |
Important distinction: The HPV strains that cause genital warts (HPV 6 and 11) are completely different from the high-risk strains that cause cervical and other cancers. Having genital warts does not mean you are at increased risk of cervical cancer. However, a person can be co-infected with both low-risk and high-risk strains simultaneously — which is why cervical screening remains important regardless of wart history.
How Genital Warts Are Transmitted
HPV is transmitted primarily through skin-to-skin contact during sexual activity. Key facts about transmission:
- Transmitted through vaginal, anal and oral sex, and through non-penetrative genital contact
- Condoms reduce — but do not eliminate — the risk of HPV transmission, as the virus can be present on areas not covered by a condom
- HPV can be transmitted even when no warts are visible — the virus can shed asymptomatically from skin
- The incubation period from infection to visible warts ranges from 3 weeks to several months (occasionally longer)
- HPV cannot be transmitted through toilet seats, towels, swimming pools or casual non-sexual contact
- A new partner developing warts does not necessarily mean the other partner has been recently unfaithful — latent HPV can remain dormant for years before causing warts
Symptoms and Appearance
Genital warts vary widely in appearance and may be so small they are not noticed. Common presentations include:
- Soft, fleshy, skin-coloured or slightly pink bumps, either flat or raised
- Cauliflower-like clusters of multiple small warts
- Single warts or multiple warts in the same area
- Itching, soreness or mild bleeding from warts
- In women: warts on the vulva, vaginal walls, cervix or around the anus
- In men: warts on the shaft, glans or foreskin of the penis, or around the anus
- Anal warts in men who have sex with men and in women who have anal sex
Do not attempt to treat suspected warts without clinical confirmation, particularly for the first episode. Skin conditions including molluscum contagiosum, normal anatomical variants (e.g. pearly penile papules, Fordyce spots), and sebaceous cysts can all resemble genital warts but require different management — or no treatment at all.
Diagnosis
Genital warts are usually diagnosed clinically on the basis of their characteristic appearance. For a first episode, a sexual health clinic assessment is recommended to confirm the diagnosis, exclude other STIs, and counsel the patient on HPV, recurrence and partner notification.
No routine HPV typing is performed for genital warts in UK clinical practice — the result does not change management. A cervical smear test is not indicated specifically because of genital warts, but women should remain up to date with routine cervical screening.
Treatment Options
Treatment aims to clear visible warts, reduce symptoms and reduce (but not eliminate) the risk of transmission. No treatment eliminates latent HPV infection — recurrence after treatment is common and does not indicate treatment failure.
| Treatment | How It Works | Application | Evidence & Notes |
|---|---|---|---|
| Warticon (podophyllotoxin 0.5% solution or 0.15% cream) | Cytotoxic antiproliferative agent; disrupts wart cell division | Patient-applied; twice daily for 3 consecutive days, followed by 4 days rest; repeat for up to 4 cycles | Clearance rates 45–80%; suitable for external genital and perianal warts; not for internal or cervical warts; not in pregnancy |
| Imiquimod 5% cream | Immunomodulator; stimulates local interferon-alpha production to enhance immune clearance of HPV | Patient-applied; 3 times per week at night, washed off after 6–10 hours; up to 16 weeks | Clearance rates 35–75%; particularly useful for recurrent warts; slower response but lower recurrence vs podophyllotoxin; not in pregnancy |
| Cryotherapy (liquid nitrogen) | Rapid freeze-thaw cycle destroys wart tissue | Clinician-applied; typically repeated every 1–2 weeks until clearance | Clearance rates 60–90%; useful for keratinised or large warts; most accessible clinic-based treatment; can be used in pregnancy with caution |
| Electrosurgery / laser | Cauterisation or vaporisation of wart tissue under local anaesthetic | Clinician-applied; usually single session; sexual health or GUM clinic | High single-session clearance; useful for multiple or large warts; requires local anaesthetic; not affected by HPV type |
| Trichloroacetic acid (TCA) | Chemical coagulation of wart proteins | Clinician-applied; weekly sessions | Suitable for small warts; usable in pregnancy; lower clearance rates than cryotherapy for larger warts |
Choosing a treatment
| Situation | Preferred Approach |
|---|---|
| External warts, first episode, confirmed diagnosis | Warticon or imiquimod patient-applied; or cryotherapy at GUM clinic |
| Internal warts (vaginal, urethral, anal, cervical) | Must be managed in a GUM/sexual health clinic — not suitable for home treatment |
| Pregnancy | Cryotherapy or TCA; podophyllotoxin and imiquimod are contraindicated |
| Recurrent warts not responding to Warticon | Switch to imiquimod; or escalate to clinic-based cryotherapy/electrosurgery |
| Large or keratinised warts | Cryotherapy or electrosurgery preferred over topical agents |
Get Warticon for Genital Warts Online
Access Doctor provides prescription Warticon (podophyllotoxin) for external genital and perianal warts following a confidential online consultation with our GPhC-registered pharmacist independent prescribers. No GP appointment required.
View Genital Warts Treatment →Recurrence and Latent HPV
HPV cannot be permanently cleared from the body in the way bacteria can. After initial infection, the virus establishes a latent reservoir in the basal layer of the epithelium. This explains why warts recur after treatment — not because the treatment failed, but because residual HPV reactivates.
- Recurrence occurs in approximately 20–30% of people within 3 months of successful treatment
- The immune system suppresses HPV over time; most people clear detectable HPV within 1–2 years
- Factors increasing recurrence risk: immunosuppression, smoking, stress, concurrent STIs
- Recurrent warts in the same location are most commonly due to latent HPV, not reinfection
- Most people with HPV 6/11 will not develop warts at all — visible warts represent a minority of those infected
Partner Notification
Partner notification for genital warts is recommended but complicated by the long incubation period and the prevalence of asymptomatic HPV. BASHH recommends:
- Current partner(s) should be informed and encouraged to attend a sexual health clinic for examination and advice
- Because the source of infection cannot be determined, extensive tracing of past partners is not routinely recommended unless there is a specific public health indication
- Partners without visible warts cannot be diagnosed with genital warts on the basis of their partner’s diagnosis alone
- All partners benefit from advice about HPV, condom use, cervical screening (for female partners) and vaccination if not previously vaccinated
HPV Vaccination
The UK national HPV vaccination programme uses Gardasil 9, which protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58. It is offered to:
- All children aged 12–13 as part of the school vaccination programme
- Men who have sex with men (MSM) up to age 45 through sexual health clinics
- Individuals up to age 25 who missed the school programme (free on NHS)
- Adults aged 26–45 can access the vaccine privately (not routinely recommended as part of the programme)
If you already have genital warts: The vaccine does not treat existing warts or clear current HPV infection. However, it is still recommended as it protects against other HPV strains you have not yet been infected with — including the high-risk cancer-causing strains 16 and 18.
When to Seek Help
- You have noticed new or changing lumps, bumps or skin changes in the genital area
- This is your first episode of genital warts — clinical confirmation and STI screening is recommended
- Warts are internal (vaginal, urethral, anal, cervical) — these cannot be treated at home
- Warts are not responding after two full courses of Warticon
- You are pregnant and have genital warts
- You are immunocompromised (e.g. HIV, on immunosuppressive therapy)
- You want STI screening alongside genital wart treatment
Any new, rapidly growing, ulcerated or bleeding lesion in the genital area should be assessed urgently by a clinician. These features are not typical of uncomplicated genital warts and may require investigation for other conditions including squamous cell carcinoma.
Related Guides
Frequently Asked Questions
What causes genital warts?
Genital warts are caused by the human papillomavirus (HPV) — specifically the low-risk strains HPV 6 and HPV 11, which account for around 90% of cases. They are transmitted primarily through skin-to-skin sexual contact. HPV can be transmitted even when no warts are visible.
Are genital warts the same as the HPV that causes cervical cancer?
No. The HPV strains that cause genital warts (HPV 6 and 11) are low-risk types that do not cause cancer. High-risk strains (16, 18 and others) are responsible for cervical and other anogenital cancers. A person can be infected with multiple HPV strains simultaneously, which is why cervical screening remains important regardless of wart history.
What treatments are available for genital warts?
Patient-applied options include Warticon (podophyllotoxin) and imiquimod cream. Clinician-applied options include cryotherapy, electrosurgery and trichloroacetic acid. Most external warts clear with treatment; recurrence is common due to latent HPV. Internal warts must be managed in a sexual health clinic.
Do genital warts go away on their own?
Around 30% of warts clear spontaneously within 3 months as the immune system suppresses HPV. However, this can take months to years, and warts frequently recur. Treatment accelerates clearance and reduces the risk of transmission to partners.
Can I get Warticon for genital warts online in the UK?
Yes. Access Doctor provides prescription Warticon (podophyllotoxin) following a confidential online consultation with our GPhC-registered pharmacist independent prescribers. Warticon is suitable for external genital and perianal warts. Internal warts require assessment and treatment in a sexual health clinic.
Will the HPV vaccine prevent genital warts?
Yes. Gardasil 9 protects against HPV 6 and 11 — the strains causing 90% of genital warts — as well as high-risk cancer-causing strains. The vaccine is most effective before HPV exposure. If you already have warts, vaccination still protects against HPV strains you have not yet encountered.
References
- British Association for Sexual Health and HIV (BASHH). UK National Guideline on the Management of Anogenital Warts. 2023. bashh.org/guidelines
- National Institute for Health and Care Excellence (NICE). Anogenital warts: Clinical Knowledge Summary. Updated 2024. cks.nice.org.uk/topics/anogenital-warts
- NHS. Genital warts. NHS.uk, 2023. nhs.uk/conditions/genital-warts
- Electronic Medicines Compendium. Warticon 0.15% Cream: Summary of Product Characteristics. 2024.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.
