HPV and Genital Warts

Genital warts are small skin growths caused by human papillomavirus, nearly always types 6 and 11. These low-risk types do not cause cancer. They are different from the high-risk types, mainly 16 and 18, which cause no visible warts but can lead over years to cervical, anal, penile and throat cancers.

HPV is so common that most sexually active people meet it at some point. In around nine in ten people the immune system clears the virus within 2 years. Treatment removes the warts you can see; it does not remove the virus, so warts come back in roughly a third of people, mostly in the first few months.

Symptoms

• Small flesh-coloured, pink or brownish bumps on the vulva, penis, scrotum, groin or around the anus
• Single or clustered lumps, sometimes with a cauliflower-like surface
• Itching, irritation or slight bleeding, though most are painless
• Warts inside the vagina, on the cervix, in the urethral opening or in the anal canal
• Change in the direction of the urine stream with urethral warts
• Distress and worry about relationships, which are often the main burden

Causes and risk factors

HPV spreads by skin-to-skin contact during vaginal, anal or oral sex and close genital contact. Condoms lower the risk but do not cover all the skin involved. Warts can appear weeks, months or even years after infection, so their appearance in a long relationship does not prove recent infidelity. Smoking, pregnancy and a weakened immune system, for example from HIV or transplant medicines, make warts more numerous and more persistent. Vaccination before exposure prevents the large majority of genital warts and HPV-related cancers.

How it is diagnosed

• Visual examination: A clinician can usually diagnose warts by looking. Normal variants such as pearly penile papules and vestibular papillae are often mistaken for warts.
• Biopsy: For atypical, pigmented, ulcerated or treatment-resistant lesions, and in people with weak immunity.
• Anoscopy or speculum examination: To look for internal warts when symptoms or findings suggest them.
• Cervical screening: Smear and high-risk HPV testing at the usual intervals. Having warts does not mean extra smears.
• Sexual health screen: Tests for chlamydia, gonorrhoea, syphilis and HIV are offered at the same visit.

Treatment options

• Self-applied creams and solutions: Podophyllotoxin or imiquimod used at home in cycles over several weeks. Neither is used in pregnancy.
• Cryotherapy: Freezing with liquid nitrogen, repeated weekly or fortnightly. Suitable in pregnancy.
• Trichloroacetic acid: Applied by a clinician to small moist warts.
• Electrocautery or excision: Under local anaesthetic for larger or stubborn warts, clearing them in one visit.
• Laser ablation: For extensive, internal or recurrent warts, usually in an operating theatre.
• Vaccination: Does not treat existing warts but protects against types you have not met. Worth discussing at any age up to about 45.

When it is urgent

Genital warts are not dangerous. See a local doctor soon for a genital or anal lesion that bleeds, ulcerates, is hard, grows rapidly or changes colour, for rectal bleeding, or if you are pregnant and warts are enlarging quickly. People with weakened immunity should have new lesions checked early.

Travelling to Türkiye for treatment

Most treatment needs repeated short visits over weeks, which suits a local sexual health or dermatology clinic far better than a trip. A single session of cautery or laser for extensive warts can be done during a visit of about 3 to 5 days, with healing over 2 to 4 weeks, but recurrences will need someone at home to treat them. Avoid any offer that claims to eliminate HPV from the body, since no such treatment exists.

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Frequently Asked Questions