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Genital Warts Explained: Causes, Treatments and Support

Genital Warts Explained

Genital warts – or anogenital warts, to give them their full name – are a common sexually transmitted infection.

As their name suggests, genital warts are small fleshy lumps that develop around the genitals. They are found in several areas:

  • In women, genital warts can develop on the cervix (the neck of the uterus or womb), in the vagina and on the vulva (the opening to the vagina).

  • In men, they can develop on the penis, scrotum and urethra (the tube that carries urine out of the body from the bladder).

  • In both sexes they can also be found on the upper thighs and around or inside the anus.

  • Genital warts can develop in the mouth, throat or on the lips too – though this is very rare.


Genital warts can be skin coloured, like the warts some people get on their hands, or they may be red, pink, grey or white. The number of warts that develop varies from one person to another. Some people have one or two tiny warts that are barely noticeable, while others may have many bigger ones. Sometimes several warts can also join together to form one larger area.

Genital warts can be flat and smooth or they can be raised and cauliflower-like in texture. They can also be firm or soft – those that develop on moist, hairless skin tend to be softer than those that appear on skin that’s drier and hairy.

While they may be generally painless, genital warts can be embarrassing, and you may find them interfering with your sex life. They can also sometimes be uncomfortable, causing itching and soreness, particularly if you have some that have developed around your anus. If they become inflamed they can bleed sometimes too, and in men they can change the stream of urine if they develop inside the urethra. In women, on the other hand, warts that develop inside the vagina can sometimes cause pain during sex.

The good news, however, is that it’s rare for genital warts to cause any long-term health problems. They aren’t linked to cancer, and they don’t affect your fertility.


What causes genital warts?

Most genital warts are caused by a viral infection, which means that they can’t be treated with antibiotics (antibiotics are only effective against bacterial infections). The virus in question is the human papilloma virus (HPV), of which there are more than 100 different types.

Around 30 of these HPV types can live in and around the genital and anal areas, but the majority of genital warts – about nine out of 10 – are caused by HPV types 6 and 11. Other types of HPV are responsible for common warts, which most often develop on the hands or knees, and verrucas (warts on the soles of your feet).

However, most people infected with a HPV that causes genital warts don’t go on to develop visible warts, and the virus can go away on its own (that is, without any treatment). If you do go on to develop genital warts, they may not appear for weeks, months or even years after you first came into contact with the virus. In either case, you probably won’t know you have the virus for some time, if at all. And even if they do develop, the warts can be so small, you may not even notice them.


How common are they?

It’s difficult to tell how many people are affected by the HPV that causes genital warts because many don’t realise they’ve been infected since they have no symptoms – in other words, they are carriers of the virus. In fact, it’s thought that most of us have a high chance of having a HPV infection at some point or other during our lifetime, though only a relative few will actually develop warts.

According to the online sexual health service SH:24, experts estimate that more than 50 per cent of sexually active people aged 15 - 49 have been infected with a genital wart virus. The sexual health service charity Brook, meanwhile, claims genital warts are the second most common type of sexually transmitted infection in people under 25 in the UK after chlamydia. And Patient suggests around one in 10 sexually active people develop genital warts at some point in their lives.


How are genital warts spread?

The virus that causes genital warts is most commonly passed on through skin-to-skin contact with an infected person. This usually happens during sexual activity. But you don’t have to have sexual intercourse to become infected, as you can pick up the virus by sharing sex toys and through non-penetrative genital-to-genital contact. It’s very rare, but genital warts can be spread via hand warts too.

It’s most likely the virus will spread when someone infected with HPV has gone on to develop genital warts (that is, they aren’t simply carriers). Even if you are a carrier – which means you probably won’t know you have the virus – you can pass the virus on to others without realising. You can also have treatment for warts and still pass on the virus to a sexual partner after they’ve disappeared.

You can’t, however, spread the virus by kissing, hugging, sharing towels or clothing or using swimming pools or toilet seats.


Genital warts during pregnancy

If you get genital warts when you’re pregnant, the virus can be passed on to your baby if you have a vaginal birth. Though rare, this can cause an infection in your baby’s throat.

This means it’s important to get advice about having your genital warts treated if you’re pregnant or trying to get pregnant. Warts can often grow bigger or multiply during pregnancy too, and if you’ve had them before and they went away of their own accord or you had them treated, they can come back while you’re expecting.

If the warts grow and become very big, your doctor may advise you to have treatment, so that the warts don’t cause any problems during the birth. The good news is in most cases it’s safe to have genital warts treated while you’re pregnant.
 

What treatments are available?

If you think you could have genital warts you can usually have them diagnosed by your GP. If you don’t want your GP involved you can see a doctor or nurse at a sexual health or genitourinary medicine (GUM) clinic (to find a clinic, visit NHS Choices). Going to a clinic means all information about your visit is confidential, and it’s only shared with your GP with your permission.

There’s no test for genital warts as they can be diagnosed visually. However, some people also have an internal examination of their vagina or anus to check for warts that could have developed inside. Very occasionally doctors take a biopsy of a genital wart to have it analysed (a biopsy involves taking a small sample of tissue for examination under a microscope).

If your doctor or nurse confirms you have genital warts you’ll have to decide whether or not to have them treated. Even if they’re not treated, most warts will disappear eventually – it’s thought that around a third of visible warts disappear without treatment within six months. However, they can grow larger and multiply before they finally go away.

There are treatments available, but they only remove visible warts – this means they don’t clear the infection completely. In other words, you’ll still be infected with HPV, so you could still pass on the virus to someone else and your warts may even come back.

How effective the treatment is can depend on how many warts you have; how big they are and how effectively your immune system fights the virus.

There are two main types of treatment – chemical and physical:


Chemical treatments

Chemical treatments work by burning or destroying the wart tissue. They come in the form of a cream or lotion that you put on the warts yourself at home. Some treatments have to be used longer than others, and you may have to apply some more frequently too. However, chemical treatments aren’t suitable if you’re pregnant and they may be a little uncomfortable and cause irritation and soreness for a few days – though they’re not usually painful.

You should also avoid having sex soon after using a cream or lotion for genital warts, as it could cause irritation for your partner. If these treatments have little effect, your doctor may recommend using another type of chemical treatment that’s applied while you’re at the clinic or at your GP’s surgery, rather than at home.

  • If you use barrier contraception methods (e.g. condoms, diaphragms or caps), it’s important to make sure any cream or lotion you use won’t reduce their effectiveness. If you’re unsure, ask your doctor or nurse for advice.

 

Physical treatments

There are several techniques used to destroy genital warts, including freezing them (cryotherapy), having them surgically removed, burning them using a procedure called electrocautery or by using a laser. These techniques are thought to be more successful at treating genital warts than using chemical treatments, but they’re not suitable for everyone.

Whichever treatment is used, your warts may still come back at some point. That’s because the virus may still be living in your skin cells for a while, sometimes for years, and may cause warts to develop again. You may also need several treatments before your warts go away. There again if you do get more genital warts after being treated successfully, it’s impossible to say whether or not they were triggered by the original infection or a new infection.

Meanwhile, if you’re a smoker, you may find treating genital warts takes longer than someone who doesn’t smoke. According to the sexual health charity FPA, smokers respond less well to treatment than non-smokers.


Genital warts and other STIs

If you have genital warts it’s possible you have another sexually transmitted infection (STI) at the same time. If any of the following apply to you, it’s advisable to have a check-up for other infections:

  • You or your partner have just been diagnosed with genital warts.

  • You’ve had recent unprotected sex with a new partner.

  • Your partner has had recent unprotected sex with someone else.

  • You’ve been told someone you’ve had sex with has a STI.

  • You’re pregnant or are planning to get pregnant.

 

Can you prevent genital warts?

There are two things that help protect against genital warts.


Condoms

Using male or female condoms can help prevent the spread of genital warts if you use them when warts are present and for three months after they have disappeared. However, as they don’t cover the entire genital area, they can’t prevent infection if you come into contact with parts of the genitals or anus that are left uncovered. They do, however, also offer protection against most other STIs, including chlamydia, gonorrhoea and HIV.


Washing and covering sex toys with a new condom before each use can also help prevent the virus being spread if you share sex toys with other people.


HPV vaccine

All girls in the UK aged 12 - 13 are offered the HPV vaccine as part of the national vaccination programme. This vaccine protects against HPV 16 and 18, strains that are thought to cause cell changes that can lead to cervical cancer, as well as HPV 6 and 11, which cause genital warts. The vaccine is believed to offer protection against the virus for at least 10 years.

However, only girls are currently covered by the vaccination programme. Despite this, experts think vaccinating teenage girls before they are infected with HPV may help reduce the number of people with genital warts in years to come.


Natural support for genital warts

There aren’t any natural products proven to get rid of genital warts. But since genital warts are triggered by a virus, finding natural ways to support your immune system may be useful.

According to FPA, warts may take a long time to go away without treatment if you have an illness that affects the way your immune system works, as it makes it difficult for your body to fight off the infection. The charity also suggests that treatments for genital warts can vary depending on a number of factors, including how good your immune system is at fighting the virus. 

Things you can do to support your immune system include eating healthily, taking regular exercise, reducing the amount you drink and giving up smoking. There are also several supplements that may help support your immune system to work effectively, including the following:


Live bacteria

Experts believe live bacteria – also called ‘friendly’ bacteria – may help regulate and support the immune system (i). These live bacteria are thought to help restore the natural balance of bacteria in your gut.


High-strength multivitamin and mineral

As well as having a healthy diet, taking a high-strength multivitamin and mineral supplement may help make sure your immune system is getting all the nutrients it needs to stay as strong and effective as possible, especially when dealing with infections. For the best results, a multivitamin and mineral supplement should include good levels of zinc, which is thought to be important for immune function (ii) as well as vitamin D (iii).


Vitamins B and C

Both of these vitamins support the normal functioning of the immune system. But despite the fact that they’re found in a wide range of everyday foods, many of us may be running short. To make sure you’re getting the level of the B and C vitamins your immune system needs, you may want to consider taking a high-quality B complex supplement as well as a high-quality vitamin C supplement. You can also get both nutrients in good levels in a quality multivitamin and mineral formulation.


Elderberry juice

Another supplement that may be useful for immune health is elderberry extractt as it contains powerful antioxidants called anthocyanins. There is also evidence to suggest black elderberry extract increases the body’s production of chemical messengers within the immune system called cytokines, suggesting it has an immune-supporting function (iv).



References:

  1. , Probiotics and immune health. Curr Opin Gastroenterol. ;27(6): 496–501. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006993

    , , , et al. Enhancing immunity by dietary consumption of a probiotic lactic acid bacterium (Bifidobacterium lactis HN019): optimization and definition of cellular immune responses. Eur J Clin Nutr. ;54:849-8551. Available online: https://www.ncbi.nlm.nih.gov/pubmed/11114680

  2. Trace element regulation of immunity and infection. J Am Coll Nutr. ;4:5-16.

    , , , et al. Interrelationships between zinc and immune function. Fed Proc. ;45:1474-1479. Available online: https://www.sciencedirect.com/science/article/pii/S0271531782801164

  3. Vitamin D and the Immune System. J Investig Med. ;59(6):881-886. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406

  4. , , The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. ;12(2):290-6. Available online: https://www.ncbi.nlm.nih.gov/pubmed/11399518