Genital Warts: Symptoms, Causes, and Effective Treatment in the UK

Genital warts are small, fleshy growths, bumps, or skin changes that appear on or around the genital or anal areas. They are caused by certain low-risk strains of the Human Papillomavirus (HPV), specifically types 6 and 11. Unlike the 'high-risk' strains of HPV associated with cervical cancer, the strains that cause visible warts do not typically lead to cancer.

In the UK, genital warts represent one of the most common reasons for visits to sexual health clinics. While they can be distressing to look at, they are generally harmless physically. However, because they are highly contagious and spread through skin-to-skin contact, they require professional diagnosis to ensure effective management and to prevent transmission to partners.

Genital warts do not always look the same; their appearance can vary significantly between individuals. In some cases, the warts are so small they are barely visible, while in others, they may grow into larger clusters. Key characteristics often include:

• Texture: They may be small and smooth or have a rough, 'cauliflower-like' surface.
• Colour: Warts are usually skin-coloured, white, or slightly darker than the surrounding skin.
• Location: In men, they often appear on the penis, scrotum, or around the anus. In women, they may appear on the vulva, cervix, or inside the vagina.
• Sensation: Most warts are painless, but some individuals may experience itching, redness, or occasionally bleeding, especially if the warts are irritated by clothing or sexual activity.

It is important to note that the virus can remain dormant in the body for weeks, months, or even years before a visible wart appears. This means you may have been infected long before noticing any symptoms.

The primary cause of genital warts is the transmission of HPV through skin-to-skin contact during sexual activity. This includes vaginal, anal, and sometimes oral sex. Because the virus lives in the skin cells, it can be passed on even if a condom is used, as the condom may not cover all affected areas.

You are more likely to develop visible warts if you have a weakened immune system. It is also possible to pass the virus to a partner even when no visible warts are present, though transmission is much more likely when a breakout is active. Sharing sex toys can also spread the virus if they are not washed or covered with a new condom between uses.

If you suspect you have genital warts, it is essential to seek a professional diagnosis. In the UK, this is typically done through a physical examination by a GP or at a sexual health (GUM) clinic. There is no routine 'blood test' for the HPV strains that cause warts; the diagnosis is based on the appearance of the growths.

A clinician may use a magnifying lamp to look closely at the area. In some cases, they may examine the inside of the vagina or anus if symptoms suggest internal warts. It is often recommended that you undergo a full STI screening at the same time to check for other infections like chlamydia or gonorrhoea, as having one STI can increase the likelihood of another.

While the body’s immune system may eventually clear HPV on its own, many people choose treatment to remove visible warts for comfort or aesthetic reasons. The type of treatment recommended depends on the texture and location of the warts.

Topical Treatments (Home Application)

If the warts are soft, you may be prescribed a cream or liquid that you apply at home for several weeks. Common treatments include Podophyllotoxin or Imiquimod. These work by either being toxic to the wart cells or by stimulating your immune system to attack the virus in the skin.

Physical Removal (Clinical Setting)

For harder or more persistent warts, physical removal may be necessary. These procedures are performed by a healthcare professional and include:

• Cryotherapy: Freezing the warts with liquid nitrogen, usually performed weekly.
• Excision: Cutting the warts away under local anaesthetic.
• Electrosurgery or Laser: Using heat or light to destroy the wart tissue.

It is important to remember that treating the visible warts does not necessarily remove the underlying HPV virus immediately. Therefore, warts can sometimes return after treatment.

If you notice any unusual lumps, bumps, or skin changes in your genital or anal area, you should consult a healthcare professional. An online GP consultation can be a discreet and convenient first step to discuss your symptoms, understand your options, and receive guidance on necessary next steps.

You should consult a GP if:

• You have found a new growth and are unsure what it is.
• Your partner has been diagnosed with genital warts.
• Existing warts are causing discomfort, itching, or bleeding.
• You have completed a course of treatment but the warts have returned or are not healing.

A GP can provide advice on managing the condition, prescribe suitable topical treatments where appropriate, or refer you to a local specialist clinic for physical removal procedures.