HPV and genital warts

Genital warts are small skin-coloured lumps in the genital or anal area. They can be flat or raised. They are caused by the human papillomavirus (HPV), which is a very common skin virus that most sexually active people carry at some stage in their lives, but they usually don't have any symptoms.

Genital warts are not dangerous, are not cancer, and often go away on their own.

HPV is spread through direct skin-to-skin contact, often during intimate sexual activity.

HPV is really common, and most people who have sexual contact will come across it at some point. There are many types of HPV, but most genital and anal warts are caused by types 6 and 11. These are different from the types that usually cause warts on your hands or feet, so those warts do not usually spread to your genitals. Warts can show up weeks or months after contact with HPV, or they may never appear, so it is usually not possible to know exactly when HPV was passed on or who it came from.

Rarely, warts can be passed from a mother during childbirth causing warts on the baby's skin or, very rarely, in the larynx (windpipe). It is a good idea to tell your antenatal team if you have anogenital warts while you are pregnant. Usually, having warts does not affect how you should deliver your baby and is not usually a reason to need a caesarean section.

Genital warts are small growths or bumps that can appear:

• On the vulva
• In or around the vagina or anus
• On the cervix
• On the penis, scrotum, groin, or thigh.

They may be raised or flat, single or multiple, small or large. Sometimes they cluster together and can look a bit like cauliflower.

They are often rough, flesh-coloured and painless. Sometimes they may itch, bleed, or feel uncomfortable, but many people have no symptoms. Some people do not notice warts because they are inside the vagina, on the cervix, or in the anus.

Genital warts is not a serious infection, is easily treated, and usually disappears on its own. However, HPV can cause changes to skin cells that, if not found and managed, can lead to cancer in some people.

In most people, HPV is harmless and causes no symptoms.

However, in some people, genital HPV that you can't see can cause changes to skin cells that, if not found and treated, can lead to cancer including cervical, vaginal, vulvar, anal, throat and penile cancers.

The HPV vaccine is highly effective at preventing the cancer-causing strains of HPV. The vaccine works best if you have it before becoming sexually active.

Genital warts are usually diagnosed by looking at them. Sometimes it can be hard to tell the difference between a wart and other skin changes, so it is a good idea to get it checked if you are unsure.

There is no routine test for genital warts in people without symptoms. If you think you have warts, or if you are worried about HPV, visit your doctor, nurse, or sexual health clinic for advice.

Cervical screening (previously called smears) checked for HPV in people with a cervix aged 25-69. This can help detect HPV types linked to risk of cervical cancer, but it does not test for genital warts.

Treatment is optional. Genital warts often go away on their own, but some people choose treatment if the warts are uncomfortable, upsetting, or persistent.

Treatment options may include:

• Freezing the warts (cryotherapy)
• Creams or solutions
• Surgical removal, depending on where the warts are and how many there are.

No one treatment is right for everyone. The choice of treatment depends on the size, number, and location of the warts, as well as your preference, cost, convenience, possible side effects, and the experience of the clinician.

Important to know:

• It is best to talk with a doctor or nurse before starting treatment
• Make sure you understand how the treatment works, how much it may cost, and what follow-up is needed
• Treatment may take more than one visit, and sometimes more than one approach is needed
• Treatment removes the visible warts, but it does not cure HPV
• If you are pregnant or might be pregnant, tell your doctor or nurse so they can choose a safe treatment
• Do not use treatments made for hand or foot warts on the genital area
• Avoid sex involving the treated area while it is healing.

Even after visible warts have been treated, HPV may still be present in the skin for a time and can still sometimes be passed on. HPV is very common, and this is not something you can fully control, so the focus is on treatment, vaccination, and looking after your sexual health rather than worry or blame.

Get vaccinated. The HPV vaccine, Gardasil 9, protects against the HPV types that cause most genital warts and many HPV-related cancers.

In Aotearoa New Zealand, Gardasil 9 is free for everyone aged 9 up until their 27th birthday. It works best when given before a person becomes sexually active, but it can still offer protection later by protecting against HPV types a person hasnot yet been exposed to.

Condoms reduce the risk of HPV, but they do not fully prevent it because HPV can live on skin not covered by a condom. Cleaning sex toys and changing condoms on shared toys may also help reduce risk.

To reduce the risk of a recurrence keep your immune system strong, reduce stress, sleep well, eat well, and keep active. Reduce or stop using cigarettes/vapes, alcohol and other drugs.

Having HPV at some point is very common and is a normal part of being sexually active. The focus should be on looking after your health, rather than blame.

You do not need to tell every past partner. It can be helpful to talk with a current partner, especially if you want to discuss symptoms, treatment, or vaccination. Most people exposed to HPV will not have symptoms and will clear the virus naturally. A partner can see a doctor, nurse, or sexual health clinic if they have symptoms, concerns, or want to talk about HPV vaccination.

Genital warts are passed on through skin-to-skin contact, and the risk is highest when warts are present. Waiting until the warts have cleared after treatment can help lower the chance of passing them on. Condoms can also reduce the risk, especially when they cover the area of skin affected by warts and are put on before any skin-to-skin contact. Avoid having sex straight after applying wart treatment creams or ointments to the skin.