Genital warts are the most common sexually transmitted infection (STI) caused by human papilloma viruses (HPV), usually subtypes HPV6 and HPV 11. Until the introduction of HPV vaccination to all children in Year 8, it was thought that most sexually active individuals would come into contact with HPV at some time. For most individuals it is a ‘silent’ infection with only a small number of those infected gettinggenital warts. Warts usually develop within 3 months of being infected with HPV but sometimes years later.

HPV is transmitted through direct skin-to-skin contact with someone who has HPV in their skin following unprotected vaginal, anal or oral sex. HPV can very rarely pass from a mother with genital warts to her baby during childbirth.

Warts appear as small lumps on the genital skin and vary in size, shape and colour. Women develop warts externally on the vulva and around the anus and sometimes warts internally in the vagina or on the cervix (the neck of the womb). Men develop warts on the head or shaft of the penis or around the anus. They are not painful but they can itch and sometimes bleed if they are damaged.

Warts are usually diagnosed by clinical examination. If there is uncertainty about the diagnosis, a skin biopsy under local anaesthetic may be required.

Warts are usually treated with a combination of cryotherapy (freezing) or hyfrecation (burning) in combination with self-administered treatment with topical creams or lotions. On average, warts disappear after 3–4 weeks of treatment. Warts around the anus (back passage), in smokers, in pregnant women and in individuals with a weakened immune systemsmay take longer to clear.

You should not have sex if you have just put wart treatment creams or lotions on your skin. Having unprotected sex while you have warts makes it much more likely that you will infectyour partner. Using condoms may help to protect your partnerif the condom covers the affected skin and is put on before any skin to skin contact.

If the warts clear and do not reappear for a period of six months, it is unlikely they will ever recur. Recurrence occurswhen there is residual HPV in the skin. This is less likely to occur if the warts are treated with immunomodulatory treatment.

Genital warts are largely a cosmetic nuisance. It is extremely rare for warts to become cancerous because HPV 6 and 11 are ‘low risk’ virus subtypes. Thirteen ‘high risk’ subtypes are known to cause cancer; the most important of which are HPV 16 and 18. In the UK, boys and girls aged 12–13 and gay and bisexual men aged less than 46 year are offered vaccination to prevent infection with HPVs 6, 11, 16 and 18.