How hard is it to get rid of genital warts?

Genital warts are a common sexually transmitted infection caused by a virus called Human Papilloma Virus (HPV).

This virus is passed on through direct skin-to-skin contact with someone who has HPV on their skin. It can be passed from person to person during vaginal and anal sex. It's also rarely passed on through oral sex.

How do you get genital warts?

You get genital warts by touching your genitals with someone else’s genitals who carries the HPV virus. The virus may be present on the skin but no actual warts can be seen.

You can get warts even if you use condoms or don’t have penetrative sex, as a condom does not cover all of the genital skin.

Symptoms of genital warts

If you have genital warts, you may notice lumps or growths around your vagina, penis or anus that were not there before. However, you can carry the virus without developing actual warts.

You may develop symptoms years after you have been in contact with the virus so it isn’t possible to know when you came in contact with HPV.

It's common for warts to appear or re-appear during pregnancy due to a change in how the immune system manages the virus.

Testing for genital warts

A healthy immune system is usually able to clear the virus, or suppress it, over time. This means that eventually the warts would be cured.

If you think you may have genital warts you should make an appointment with your GP or contact your local sexual health services.

It’s important that warts are diagnosed by a doctor or nurse.

Online appointment booking

You may be able to book an appointment for an STI test online using the online booking system. This varies for different NHS board areas.

Treating genital warts

Treatment for genital warts needs to be prescribed by a doctor or nurse.

The type of treatment you'll be offered depends on what your warts are like. The doctor or nurse will discuss this with you. Treatment options include:

• cream or liquid
• freezing
• surgery

Cream or liquid

You can usually apply this to the warts yourself a few times a week for several weeks.

Freezing

A doctor or nurse freezes the warts with liquid nitrogen, usually every week for 4 weeks.

Surgery

A doctor or nurse can cut, burn or laser the warts off. This is usually only recommended if the warts are not responding or are too large for cream or freezing. Side effects of these treatments include:

• bleeding
• wound infection
• scarring

Recurring genital warts

Warts can come back after you have managed to get rid of them. This may happen weeks, months or years after they first appeared.

You can try and prevent this by keeping yourself and your immune system as healthy as possible by eating well and exercising.

Smoking reduces your chances of clearing the virus, so it is advised you stop smoking.

In some people the treatment doesn't work. There's no cure for genital warts but it's possible for your body to clear the virus over time.

Avoiding passing on genital warts to a partner

Using a condom every time you have vaginal, anal or oral sex is the best way to avoid passing on genital warts to a partner. However, if the virus is present on skin not protected by a condom, it can still be passed on.

Your doctor or nurse may advise you to avoid sex while you're having treatment for genital warts.

Reducing the risk of genital warts

To reduce your risk of getting genital warts you should use a condom for vaginal, anal and oral sex.

You can get warts even if you use condoms, as a condom does not cover the whole genital area.

The HPV vaccination will reduce your risk of getting HPV virus which causes warts.

HPV and cancer

Genital warts are not cancer and don't cause cancer. They're caused by a different strain of HPV.

The HPV vaccine offered to girls and boys in the UK to protect against cervical cancer also protects against genital warts.

The HPV vaccine is also offered to men who have sex with men (MSM) and trans people aged up to 45 years.

If you didn't have the vaccine at school and don’t fulfil the above eligibility criteria, you can purchase the vaccine privately.

If you’ve noticed soft pink or flesh-colored bumps around your genital area, you may be going through a genital warts outbreak.

Genital warts are cauliflower-like growths caused by certain types of the human papillomavirus (HPV). HPV is themost commonviral sexually transmitted disease in the United States.

Will the warts go away?

Although HPV isn’t curable in all cases, genital warts are treatable. You can also go extended periods of time without an outbreak, but it may not be possible to get rid of the warts forever.

That’s because genital warts are only a symptom of HPV, which may become a chronic, lifelong infection for some.

For those who clear the HPV infection, there is a chance of contracting an infection from the same strain or a different one. You could even contract an infection of multiple strains at the same time, though this is less common.

So even with treatment, genital warts may come back in the future. This depends on whether you’ve been vaccinated, how well your immune system is functioning, the strain of HPV you have, and the amount of virus you have (viral load).

Some strains are high risk and associated with later formation of squamous cell carcinoma (cancer), and you may not even know if you have a high-risk HPV strain until precancerous or cancerous lesions form.

What does the research tell us?

Some research shows that HPV infections persist latently in10 to 20 percentof those who contract them, as opposed to the 80 to 90 percent who clear the virus within two years of infection. According to the World Health Organization (WHO), about90 percentof HPV infections clear within two years.

However, certain factors increase the risk of the infection not going away. These include having sex without protection, contracting other sexually transmitted infections (STIs), alcohol use, smoking tobacco, and having a suppressed immune system.

A recent study published in December 2017 noted that over 200 genetically distinct strains of HPV exist. The study looked at HPV infection in unvaccinated men between the ages of 18 and 70. Researchers tracked over 4,100 subjects over five years.

What the study found was that HPV infection strongly increases the risk of future infection by the same strain.

The researchers focused on strain 16, which is responsible for most HPV-related cancers. They noted that an initial infection increases the one year probability of reinfection by a factor of 20, and the probability of reinfection remains 14 times higher two years later.

The researchers found that this increased risk occurs in men regardless of whether they are sexually active. This suggests reinfection arises from the virus spreading to different parts of the body, reactivation of latent virus (that is, virus that’s still inside the body), or both.

There are ways to decrease the risk of contracting HPV, however.

According to the Centers for Disease Control and Prevention (CDC), the most reliable way to prevent HPV infection is to abstain from sexual activity. The CDC also suggests condom use and limiting the number of sexual partners as ways to lower risk of contracting an HPV infection. As well, the organization recommends vaccination at a younger age to help protect against the strains that cause the majority of warts and cancer.

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HPV symptoms take a while to show, so warts may not appear until weeks or months after infection. In some cases, genital warts can take years to develop.

Outbreaks can happen in or around the vagina or anus, on the cervix, in the groin or thigh area, or on the penis or scrotum. HPV can also cause warts on your throat, tongue, mouth, or lips.

For some people, genital warts may clear up on their own within two years, but treatment helps speed up the process.

Treatment can also prevent possible health complications caused by HPV, as well as:

• ease pain, itching, and irritation
• potentially lower the risk of spreading HPV
• get rid of warts that are hard to keep clean

How genital warts are treated

Genital warts can be treated by a doctor in a number of ways. Topical treatments, prescription medications, and minor procedures can help clear up an outbreak.

Topicals

Over-the-counter wart removers won’t work on genital warts and may cause more discomfort. Genital warts require a special type of topical treatment that your doctor can. Those creams include:

Podofilox

Podofilox is a plant-based cream used to treat external genital warts and stop wart cells from growing. You should apply podofilox to the wart tissue at least twice daily for three days, then let the area rest for the remainder of the week.

You may need to repeat this treatment cycle four times.

Podofilox is one of the more effective topical creams in clearing warts. According to onestudy, outbreaks in nearly half of the people using the cream improved by 50 percent or more. Twenty-nine percent of participants saw their warts clear completely.

But like all medication, podofilox does come with side effects, including:

• burning
• pain
• inflammation
• itching
• sores
• blistering, crusting, or scabbing

Imiquimod

Imiquimod is a prescription cream that’s used to destroy external genital warts, as well as certain skin cancers. You should apply the ointment directly to the warts at least three days a week for about four months.

Although imiquimod may not be effective for everyone, onestudydid show that warts cleared in 37 to 50 percent of people using the cream. The medicine can also boost your immune system to fight HPV.

Side effects of imiquimod include:

• redness
• swelling
• burning
• itching
• tenderness
• scabbing and flaking

Sinecatechins

Sinecatechins is a cream made from green tea extract that’s used to clear up external genital and anal warts. You should apply the ointment three times per day for up to four months.

Sinecatechins may be the most effective topical for getting rid of warts. According to onestudy, the ointment cleared up warts in 56 to 57 percent of participants.

Side effects of sinecatechins are similar to other topical treatments. They include:

• burning
• pain
• discomfort
• itching
• redness

Cryotherapy

With cryotherapy, your doctor will remove the warts by freezing them with liquid nitrogen. A blister will form around each wart, which will shed once it heals.

Cryotherapy is effective in clearing outbreaks temporarily, butmultiple treatmentsmay be necessary to achieve long-term results.

You can go right back to your normal activities after the procedure, but expect a lot of watery discharge for up to three weeks as the area heals.

Side effects of cryotherapy include:

• pain
• swelling
• mild burning

Electrodessication

Electrodessication is a treatment that needs to be performed by a specialist. Your surgeon will use an electrical current to burn and destroy external genital warts, and then scrape away the dried tissue.

It’s considered to be a painful procedure, so you may be given a local anesthetic or go under general anesthesia.

Research has found the surgery to be highly effective. Onestudyfound that 94 percent of people who had six weekly sessions of electrodessication were clear of genital warts. Healing time takes four to six weeks.

Side effects include:

• bleeding
• infection
• scarring
• skin color changes of treated area

Laser surgery

Laser surgery is also a specialist procedure. Your surgeon uses a laser light to burn away wart tissue. You may require local or general anesthesia depending on the size and number of warts.

Laser surgery can be used to destroy large genital warts or hard-to-access warts that can’t be treated by other procedures. Recovery should take a few weeks.

Side effects include:

• pain
• soreness
• irritation
• bleeding
• scarring

What happens if genital warts are left untreated?

Most HPV infections that cause genital warts will go away on their own, taking anywhere from a few months to two years. But even if your genital warts disappear without treatment, you may still have the virus.

When left untreated, genital warts can grow very large and in big clusters. They are also more likely to return.

How to prevent transmission

You should wait to have sex at least two weeks after your warts have cleared. You should also talk to your sexual partners about your HPV status before engaging in sexual activity.

Even if you aren’t dealing with an outbreak, you can still spread HPV through skin-to-skin contact. Wearing a condom will reduce your risk of transmitting HPV. This includes dental dams and male or female condoms.

The bottom line

Although genital warts may clear on their own, HPV may still be in your body. Treatment will help get rid of warts and reduce future outbreaks, though you may have to repeat treatments to clear warts completely.

It may take a few months to treat the warts, and you could go years without an outbreak. Make sure to wear a condom every time you have sex, as HPV can spread without warts present.

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