Genital Warts: Types, Treatment and Why They Come Back

Finding genital warts is upsetting, but they are common, treatable and not a judgement on you. The main thing to know is that treatment removes the warts, not the virus behind them. That is why they sometimes return.

What do genital warts look like, and where do they appear?

Genital warts usually show up as a small bump or a group of bumps. They can be small or large, raised or flat, and some are shaped like a cauliflower. They may be soft or firm, and white, red, skin-coloured or darker than the skin around them.

Most are caused by HPV types 6 and 11, which the CDC says account for about 90% of cases. These are different from the HPV types linked to cancer.

They can appear:

• around the vaginal opening, on the penis or scrotum, or around the anus
• on the skin between the genitals and anus
• less often inside the body, such as in the vagina, on the cervix, in the urethra or inside the anus

Warts usually cause no symptoms, though some are itchy, painful or bleed.

Do genital warts need treatment?

Not always. Warts may clear on their own, stay the same, or grow in size or number. Because some clear within a year, waiting is an acceptable choice for some people. Treatment is mainly to remove the warts, ease symptoms and take away the distress they can cause.

How are genital warts treated?

There are two broad routes, and a clinician will choose with you based on the size, number and location of the warts, your preferences and your health.

• Treatments you apply yourself. These are prescription creams, solutions or ointments. A clinician should show you how to use them. Some can weaken condoms and diaphragms, so ask about that.
• Treatments done in a clinic. These include freezing (cryotherapy), a strong acid applied by a clinician, and minor surgery such as cutting out, scraping or using a laser or heat to remove the wart.

Warts inside the vagina, on the cervix or inside the anus are treated by a clinician, sometimes with a specialist. No single method is best for everyone, and clinicians sometimes combine two.

Side effects can include pain, irritation or burning, and, uncommonly, lasting changes in skin colour or scarring. If you are pregnant or hoping to be, tell the clinician, because some treatments are not suitable. The NHS also notes that many treatments work better if you don’t smoke.

Can I treat genital warts at home with a wart remover?

No. Treatments sold in pharmacies for warts elsewhere, such as on the hands and feet, are not made for genital warts, and the NHS advises against using them. Only use a treatment a clinician has prescribed for this area, and keep it off healthy skin and open wounds.

Why do my genital warts keep coming back?

Treatment can remove warts, but it does not cure the virus itself. The CDC says warts often return after treatment, especially in the first three months. Warts can take weeks or months to respond to treatment, and sometimes it does not work and another method is needed.

Recurrences are more common, and warts may be larger or more numerous, if your immune system is weakened.

A return of warts does not tell you when or from whom you got HPV. Warts can appear months or years after the virus is acquired.

Can I have sex with genital warts?

The CDC advises stopping sex until the warts are gone. HPV can still be passed on when no warts are visible, and nobody knows how long it can be spread after warts clear. The NHS says to avoid sex until the warts have gone, and to use a condom if you do have sex.

Condoms may lower the chance of passing on HPV, but they only cover part of the skin. The CDC suggests telling current partners, who may already have HPV without visible warts. It does not recommend HPV testing for partners, though they may benefit from an exam by a doctor or clinician and an online test for other STIs.

Does the HPV vaccine help with genital warts?

The vaccine can prevent most genital warts in people who haven’t yet been exposed to the wart-causing types. It does not treat existing HPV or warts.