Genital Warts (HPV): What You Need to Know

Genital warts (condylomata acuminata) are caused mainly by low-risk HPV types 6 and 11 and appear as flesh-colored bumps on the genital or anal skin. Diagnosis is usually clinical. Condoms reduce but don't eliminate transmission. The 9-valent HPV vaccine prevents most wart-causing and cancer-causing HPV types; routine vaccination begins at 11-12 years with catch-up through 26 and shared decision-making for 27-45. Treatments (imiquimod, podofilox, cryotherapy, TCA, excision, laser) remove visible warts but do not cure HPV; recurrences are common. Cervical screening remains important for people with a cervix.

What genital warts are

Genital warts are skin growths on the genital or anal area caused by certain types of human papillomavirus (HPV). They are also called condylomata acuminata or venereal warts. Most genital warts are caused by low-risk HPV types 6 and 11.

Warts can appear on the penis, scrotum, vulva, vagina, cervix, urethra, or around the anus. Some people have visible bumps; others have no symptoms but can still spread the virus.

Symptoms and diagnosis

Typical findings include flesh-colored or pink bumps that may be flat, raised, single, or clustered in a cauliflower-like mass. They can itch, bleed with friction, or produce local moisture. Many infections are asymptomatic and are found during a cervical screening or pelvic exam.

Clinicians usually diagnose genital warts by visual inspection. Applying a dilute acetic acid (vinegar) solution can make warts whiten and become easier to see. A biopsy is rare but used when the lesion looks unusual.

How HPV spreads and risk factors

HPV spreads by skin-to-skin sexual contact. Having multiple sexual partners or a partner with HPV increases risk. Smoking and immune suppression (for example, HIV) increase the chance of persistent or recurrent warts. In rare cases, a newborn can develop respiratory papillomatosis after exposure during birth.

Condoms reduce but do not eliminate HPV risk because they do not cover all infected skin. Spermicides and foams do not prevent HPV infection.

Prevention

Vaccination against HPV is the most effective prevention. The 9-valent HPV vaccine (Gardasil 9) protects against the HPV types that cause most genital warts and many HPV-related cancers. Routine vaccination is recommended starting at ages 11-12 (can start at 9). Catch-up vaccination is recommended through age 26; adults 27-45 may consider vaccination after discussion with their clinician.

Regular cervical screening (Pap test and HPV testing) remains important for people with a cervix, because HPV can cause precancerous changes.

Treatment and outlook

Treatments remove visible warts but do not eliminate the virus. Common options include patient-applied topicals (imiquimod, podofilox, or sinecatechins for external warts) and office procedures (cryotherapy, trichloroacetic acid, surgical excision, or laser). Choice depends on wart size, location, and patient preference.

Warts often recur because HPV can persist in skin cells. Treatments aim to relieve symptoms and reduce visible disease. Long-term monitoring and follow-up are important when the cervix is involved.

When to see a clinician

Seek evaluation for new genital lesions, persistent or rapidly growing warts, abnormal vaginal bleeding, or if you or your partner are immunosuppressed. Pregnant people with large or symptomatic warts should discuss management with their provider.