The labia may increase during sexual intercourse

Genital warts

What are genital warts?

Genital warts, also called condylomata acuminata, genital or anogenital warts, are the most common sexually transmitted disease (STD). They are caused by certain subtypes of the highly contagious human papillomavirus (HPV).

While there are around 200 different HPV subtypes, 90 percent of all genital warts cases are caused by subtypes 6 and 11. Often there are co-infections with two different HPV subtypes at the same time. About 60% of those affected who have become infected with HPV-6 or HPV-11 develop warts in the course of the disease. The virus spreads when it comes into contact with an infected person's infected skin or mucous membrane.

The warts often go away on their own after a few months, and there are effective treatment options. However, wart formation can occur again and again. Warts in the genital area can lead to a high level of internal distress, as they are generally perceived as unsightly and can thus cause psychological problems. Complications such as cancer development are rare but depend on the HPV subtype.[1],[2][3],[4]

What are the symptoms of genital warts?

Whether or not there are visible symptoms after an HPV infection depends on the subtype. Most infections remain symptom-free. However, if there is an infection with HPV-6 or HPV-11, genital warts develop in around 60% of those affected. These usually occur three weeks to eight months after the infection.[1],[2],[3]

Genital warts:

  • can occur individually or in groups.
  • can be flat or raised and sometimes resemble a small cauliflower in groups.
  • can be white, skin-colored, reddish or brownish.
  • are usually soft.
  • vary in size from 1 millimeter to several centimeters in diameter.
  • usually do not cause any discomfort, but itching can occur.
  • can lead to mental health problems such as stigma, social isolation, anxiety, depression, and feelings of guilt.
  • usually form on the outside of the genital or anal area, typically on the vulva, penis, groin, perineum, and around the anus.
  • more rarely, they can also occur in the anus, vagina, urethra or cervix.
  • In rare cases, there may be problems with bowel movements, bleeding from the urethra and sexual intercourse, and problems with urination.
  • Especially in women, vaginal discharge, an obstruction or blockage of the vagina and a sexual dysfunction (dyspareunia) are possible.[3],[5],[6],[7]

After the first appearance, warts can appear in the genital area increase in number and size or regress spontaneously without treatment. The latter happens about a third of the time and usually within four months.[1],[2],[3]

Even after the genital warts have receded, the human papillomavirus (HPV) infection can persist. This can lead to a recurrence of the genital warts, which happens 20-30% of the time.

Possible triggers for recurrence include:[3],[5]

  • Mechanical irritation
  • Wounds
  • Weakened immune system
  • Inflammation

If you are unsure whether these symptoms apply to you, start a symptom analysis.

What are the causes of genital warts

Genital warts are caused by the human papillomavirus (HPV). HPV infection affects a person's skin or lining. There are around 200 different HPV subtypes, affecting different parts of the body.

More than 40 of these subtypes can be transmitted through sexual contact and infect the so-called anogenital region, the area around the anus and genital organs. About 90% and thus the majority of warts in the genital area are caused by the two subtypes HPV-6 and HPV-11.

Both men and women can become infected with the virus and pass it on to others. Half of all people will be infected with HPV in the course of their life, often without noticing the consequences of the disease.

HPV is mainly transmitted during oral, vaginal or anal intercourse. The sexual partner does not have to have genital warts. Sexually active people in particular have with changing sexual partners an increased risk of becoming infected. However, penetrative sex is not absolutely necessary for infection with HPV. Close genital contact between the two partners is sufficient.

However, hugs or kisses, but also contact with a person's clothing or towel, are not enough for infection with the virus.[3],[6],[8],[9]

How is the diagnosis of genital warts made?

Visible warts in the genital area are usually with the help of a precise questioning, the so-called anamnesis, and a physical examination of the affected person diagnosed by a doctor. A specific test for the human papillomavirus (HPV) usually has no influence on the diagnosis and treatment of genital warts and is therefore not routinely recommended. The physical exam should also consider other sexually transmitted diseases and be accompanied by appropriate testing.[1],[2],[3],[6],[10]

A tissue sample, also known as a biopsy, is usually only necessary:

  • when there is uncertainty about the diagnosis;
  • for genital warts that do not respond to treatment;
  • if another skin disease is suspected, e.g. malignant degeneration;
  • in people with a weakened immune system;
  • with induration, bleeding and other atypical features;[3]

If the urethra, vagina, cervix, or anus is affected, further tests may be needed:

  • Urethral involvement - those affected with genital warts at this point should be referred to a urologist for further evaluation, who will perform a so-called cystoscopy.
  • Involvement of the vagina and / or cervix - a pelvic exam is used to make a diagnosis.
  • Involvement of the anus - A referral to a proctologist for a so-called anoscopy, with which the anal canal can be inspected, is advisable if genital warts are present in the anal area that is visible from the outside.[3]

Good to know:

Those affected may have acquired the HPV infection that caused it years before a genital wart appeared. A new genital wart can also be a relapse instead of a new infection. Thus, an initial diagnosis of genital warts does not mean that the person affected or his / her partner must have had sex outside of the relationship.

HPV is so common that most people will have acquired an HPV infection at some point in their life but are unaware of the infection because it is usually asymptomatic.

Acquiring immunity to a single HPV subtype does not ensure immunity to other subtypes, so further infections can occur.[5]

What is the treatment of genital warts

The warts often disappear in the genital area by itself after a few months. In addition there is effective treatment options, aimed at eliminating genital warts. The virus that caused it cannot be removed by treatment and remains in the body. This can lead to a recurrence of the warts in 20-30% of cases.[1],[2],[3],[6]

Whether treatment is recommended differs depending on gender, location of the genital warts, and other factors.[5]

Treatment of genital warts around the vagina or vulva:

Genital warts do not pose an increased risk to health or fertility; therefore one can first wait to see whether the genital warts will disappear on their own.[5]

The reason for treatment are unpleasant or annoying complaints such as:

  • itching
  • Bleeding
  • Burn
  • Vaginal discharge
  • Pain
  • Relocation or blockage of the vagina
  • sexual dysfunction (dyspareunia)

Good to know:

  • Treating genital warts does not affect a woman's future risk of cancer.
  • The HPV subtypes that cause genital warts are usually different from the potentially cancerous HPV subtypes.
  • The treatment and the associated elimination of warts in the genital area does not remove the potential infectiousness.[5]

Treatment of genital warts in men:

Treatment should be offered to all affected persons. Whether or not to wait can be discussed with a doctor on a case-by-case basis. Treatment is advisable, especially in the case of high psychological distress and symptoms such as itching, pain, bleeding, urination disorders, bowel movements or sexual function.[11]

Treatment methods (regardless of gender):

If treatment is given, it usually takes a long time and requires regular follow-up care. There are both drug and surgical treatment options. The most typical are:[1],[2],[11],[5],[12]

Using antiviral ointments or creams:

  • Those affected can apply these themselves over several days or weeks.
  • Side effects can include itching and slight scarring.[11],[5]

Use of acidic solutions:

  • Usually carried out by a doctor.
  • The method requires a few sessions.

Cryotherapy (freezing):

  • Liquid nitrogen is used to freeze the affected area for a short time. This can lead to a mild burning sensation.
  • This procedure is usually used on small warts around the penis or vulva.

Excision (surgical removal):

  • The genital warts are surgically removed while the person concerned is under local anesthesia.
  • Typically used for large genital warts.

Electrosurgery:

  • Typically used on larger groups of warts that have not responded to other treatments.
  • With the help of an electric current, the affected area is deserted.

Laser surgery:

  • Typically used for large or multi-site warts.
  • A doctor obliterates the affected area with a laser while the affected person is under regional or general anesthesia.

Can you prevent genital warts?

Sexual activity is the main risk factor for acquiring HPV infection and the resulting development of genital warts. To reduce risk, the following can be taken into account: [1],[2],[11],[5],[13]

Vaccination:

  • most effective option to reduce the risk of genital warts,
  • but should be done before starting sexual activity,
  • there are different vaccines, none of which can protect against all HPV subtypes.

Number of lifelong sexual partners:

  • with each additional sexual partner, the risk of contracting other HPV subtypes increases.

Age at first intercourse:

  • statistically speaking, the risk is reduced if the first sexual intercourse occurs later.

Condoms:

  • using condoms can help reduce the risk of contracting HPV.
  • however, HPV infection can still be transmitted through contact with infected skin that is not covered by a condom.

What is the prognosis for genital warts

After the first appearance, genital warts can increase in number and size or regress spontaneously without treatment. The latter happens about a third of the time and usually within four months.

Even after the genital warts have receded, the human papillomavirus (HPV) infection can persist. This can lead to a recurrence of the genital warts, which happens in 20-30% of cases. Any treatment carried out has no influence on the future course of an HPV infection.[1],[2],[3]

What are complications of genital warts

As a rule, genital warts have no or only mild health consequences.

Consequences of surgical treatment can be:

  • Bleeding
  • Infections with other pathogens
  • Scarring
  • Persistent hypo- or hyperpigmentation of the skin

Apart from hypo- or hyperpigmentation, these complications are no more common than with other surgical procedures.[2]

Malignant degeneration:

  • Certain HPV subtypes increase the risk of certain types of cancer.
  • BUT: The treatment of the genital warts itself has no influence on the future risk of cancer. The HPV subtypes that cause genital warts are usually different from the potentially cancerous HPV subtypes.[2],[5]

If you are unsure whether these symptoms apply to you, start a symptom analysis.


  1. Medscape. "Genital Warts." - As of July 31, 2019 ↩↩↩↩↩↩↩↩

  2. BMJ. "Genital warts." - As of July 27, 2019 ↩↩↩↩↩↩↩↩↩↩

  3. UpToDate. "Condylomata acuminata (anogenital warts) in adults: Epidemiology, pathogenesis, clinical features, and diagnosis." - As of July 30, 2019 ↩↩↩↩↩↩↩↩↩↩↩

  4. NHS Choices. "Genital Warts - Symptoms." - As of July 31, 2019 ↩

  5. UpToDate. "Condylomata acuminata (anogenital warts): Treatment of vulvar and vaginal warts." - As of July 31, 2019 ↩↩↩↩↩↩↩↩↩↩

  6. Anvil. "Human papillomavirus infection." - As of July 30, 2019 ↩↩↩↩

  7. DrEd. "Early Signs of Genital Warts." - As of July 31, 2019 ↩

  8. In the know ZONE. "[How are genital warts spread.] (Http://www.intheknowzone.com/sexual-health-topics/genital-warts/how-are-genital-warts-spread.html" "How are genital warts spread." ) "- As of July 31, 2019 ↩

  9. NCBI. "Genital HPV infection and related lessons in men." - As of July 31, 2019 ↩

  10. WebMD. "Genital Warts." - As of July 31, 2019 ↩

  11. UpToDate. "Condylomata acuminata (anogenital warts): Management of external condylomata acuminata in men." - As of July 31, 2019 ↩↩↩↩

  12. fpa. "Genital Warts." - As of July 31, 2019 ↩

  13. CDC. "HPV Vaccination Information for Young Women." - As of July 31, 2019 ↩