Brief overview
- Symptoms: Usually no symptoms, rarely burning, itching, pain, genital warts (genital warts) in men and women, infants, children, condyloma.
- Treatment: Depending on the clinical picture, icing, laser therapy, electrocautery, medication, surgical procedures, home remedies
- Causes and risk factors: Infection with HPV: mainly via direct skin or mucous membrane contact, unprotected sexual intercourse, smoking, suppressed immune system, many births, other infections
- Prevention: safer sex (condoms), vaccination, regular preventive examinations recommended, treat sexual partners as well
- Diagnosis and examination: medical history, physical examination, cell smear (Pap test), colposcopy (dilated examination of the vagina), examination of the urethra, anus, HPV test, fine tissue analysis, exclusion of other STDs
What are genital warts?
Genital warts are benign growths of the skin or mucous membrane caused by infection with human papillomavirus (HPV). Mostly these warts are found in the genital area (more rarely in other parts of the body). Therefore, they are also called genital warts. Other names are “pointed condyloma” or “condylomata acuminata”.
In most cases, genital warts are not dangerous.
When they develop, the upper (mucous) layer of skin (epidermis) grows pointedly upward, and warts the size of a pinhead to several centimeters in size form. The soft, warty structures are reddish, grayish-brownish or whitish in color. They usually occur in clusters and may develop into larger papillomatous nodules or plate-like formations (“cock’s comb”).
In addition, in rare cases, the genital warts develop into so-called “giant condylomas” (Buschke-Löwenstein tumors or condylomata gigantea). These large, cauliflower-like tumors destroy the tissue and in some cases transform into a cancerous growth (verrucous squamous cell carcinoma).
More information about HPV can be found here: Human papillomavirus (HPV).
What are the characteristics of genital warts in men, women and children?
Genital warts usually do not cause any symptoms, so they are asymptomatic. For many of those affected, genital warts are then a purely cosmetic problem, which, however, causes psychological problems for some people, for example due to feelings of shame.
Sometimes genital warts cause pain during sex (dyspareunia). This is often psychologically very stressful. Some patients also suffer from the fear that they themselves (or their partner) will develop cancer or become infertile due to genital warts. Do not be afraid to see a doctor about genital warts and tell him about your worries and fears!
Genital warts in men
Most often, the warts are located on the penis – preferably on the foreskin frenulum, on the penile furrow (ring-shaped depression behind the glans) and on the inner leaf of the foreskin. Circumcised men no longer have a foreskin and are less prone to genital warts. However, even in them, it is possible for genital warts to colonize the penile trunk and root.
It is also possible for genital warts to form in the urethra, anal canal, anus, and scrotum. Especially people who frequently practice (unprotected) anal sex are susceptible to such warts on the anus.
Genital warts in women
Genital warts in infants and children
If pregnant women suffer from genital warts, it is possible that they transmit the causative viruses to the child during birth. This increases the risk that the newborn will contract what is known as juvenile laryngeal papillomatosis. This is a condition in which there are nodules similar to genital warts in the area of the larynx and vocal cords. Possible symptoms include hoarseness, coughing, difficulty swallowing and audible breathing sounds.
If genital warts occur in children, it is important to rule out sexual abuse. If the child behaves conspicuously or if traces of violence are visible, this suspicion is reinforced. In such cases, a visit to a pediatrician and a child psychologist is advisable in addition to treatment of genital warts by a specialist.
Other body parts
Genital warts love warm and humid conditions. They find these mainly in the genital and anal area, which is why they almost always develop here. Only rarely do they grow in other parts of the body. For example, HP viruses from the genital area reach the mouth and throat area (also tongue, lips) through oral sex and sometimes lead to the formation of warts here. However, this happens very rarely. Genital warts are also rarely found, for example, in the navel, under the female breasts or in the armpits.
Warts on the face, hands or feet are usually caused by other HP viruses, so they are not usually genital warts.
How are genital warts treated?
There are several options for the treatment of genital warts. The doctor and the patient will decide together on the therapy plan. When choosing the therapy measures, it is recommended to especially consider the following factors:
- Size, number and location of the genital warts
- Possible underlying and concomitant diseases (HIV, Chlamydia, etc.)
- Wishes of the patient
- Experience of the treating physician
It is advisable that the sexual partner also be examined for genital warts and that the doctor treat him or her if necessary. This prevents partners from infecting each other over and over again.
Treatment with medication
The means used to treat genital warts include medications that can be applied externally (topically). The preparations are available as a cream/ointment or liquid (solution, acid) and are applied directly to the warts. Depending on the active ingredient, either the doctor or the patient himself treats the genital warts. In any case, careful and regular application of the medication is crucial for the success of the therapy.
If the treatment is not carried out regularly, the genital warts may keep coming back.
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Drug |
User |
Notes |
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Podophyllotoxin-0.5% solution Second choice: Podophyllotoxin-0.15% cream |
Patient |
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Imiquimod 5% cream |
Patient |
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Sinecatechine 10% ointment |
Patient |
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Trichloroacetic acid |
Physician |
Icing genital warts
The technical term for this treatment of genital warts is cryotherapy. It is performed by a specialist. The doctor applies liquid nitrogen to the wart with the help of a spray or a stick (absorbent cotton, metal), whereby the tissue “freezes” or dies and the warts fall off. The doctor repeats the application once a week.
This method of genital wart treatment is easy to perform, inexpensive and can also be used during pregnancy. Possible side effects are burning and pain in the treated area. It is also possible that pigment disorders and superficial scars may appear. The HP viruses are not killed by the treatment, so many patients develop new genital warts later.
Surgical treatment
An electrocautery can be used to remove genital warts by heating and destroying the tissue with an electric current. Doctors use this method especially for large-area, bed-shaped as well as recurrent genital warts. During the procedure, smoke containing potentially contagious viral particles may develop. Therefore, a suction device, face masks and protective goggles are necessary.
The doctor also often removes genital warts using laser therapy. The laser uses carbon dioxide or dye (Nd:YAG). The method, like electrocautery, is particularly suitable for large-area, beet-shaped as well as recurrent genital warts. In addition, there is also a risk of smoke development with the potential spread of infectious HP viruses.
Especially if the doctor removes genital warts from the cervix (e.g. by laser), it is advisable to perform a histological examination of a tissue sample. It is possible that malignant cell changes in the tissue (or precursors thereof) can be found. Then the doctor often extends the surgical intervention.
There are currently no approved drugs for the treatment of genital warts in the urethra. If necessary, the specialist removes them surgically during a urethral endoscopy. There is a risk of damage and scarring of the tissue. Possible consequences are discomfort, pain and narrowing of the urethra.
The doctor also usually removes genital warts in the anal canal surgically. Here, too, scarring and narrowing are possible.
Under no circumstances should you cut off genital warts (or other warts) yourself! This causes injuries, which then cause unnecessary pain and the wart is usually not completely removed.
Pregnant
Children
The specialist treats genital warts in children by cryotherapy, laser or electrocautery (see above).
Home remedy
Some people use tea tree oil in the treatment of genital warts. The essential oil from the leaves of the Australian tea tree (Melaleuca alternifolia) has a reputation for inhibiting the multiplication of viruses. Whether tea tree oil actually fights genital warts successfully has not been proven. There are also other over-the-counter medications available for purchase at pharmacies for the treatment of genital warts. In any case, consult your doctor or pharmacist before using them!
Home remedies have their limits. If the symptoms persist for a long time, do not get better or even get worse, you should always consult a doctor.
How to get genital warts
Harmless HP viruses only very rarely cause malignant diseases, which is why they are also called low-risk types. The best-known types are HPV 6 and HPV 11, which are detectable in most cases of genital warts. In some cases, other low-risk HPV also cause genital wart symptoms. In total, there are about 40 HPV types that infect the genital/anal area.
High-risk HPV rare in genital warts
If low-risk types only very rarely lead to degenerations, infections with so-called high-risk HPV (high-risk HPV) are significantly more often associated with cancer diseases in the intimate area. Thus, in almost all cases of cervical cancer (cervical carcinoma), the involvement of high-risk HPV types can be detected. Infection with high-risk HPV may also be involved in the development of other intimate cancers such as penile cancer or vaginal cancer.
How do you get infected with genital warts?
Genital warts are among the most common sexually transmitted diseases. People usually become infected through direct contact with the skin or mucous membrane, i.e. most frequently through unprotected sexual intercourse. Particularly if you change sexual partners frequently, there is a risk of infection. Condoms reduce the risk, but not 100 percent. This is because they do not cover all areas of the skin that may be infected by the HP virus.
A genital wart infection is also possible via contaminated objects such as sex toys. Infection via shared contaminated towels or bath sponges, as well as bathing together, is also not ruled out.
Oral intercourse sometimes increases the risk of HPV infection in the mouth and throat area – and thus also the risk of developing skin thickenings similar to genital warts at this site.
If children with common warts on their fingers scratch their genital or anal area, they may develop genital warts. This is usually triggered by HPV type 2, but sometimes also by type 27 or 57, in which case experts call it self-infection.
Caution: If children have warts in the genital or anal area, clarification is always necessary because there is a suspicion of sexual abuse!
Many affected persons wonder when the genital warts are no longer contagious. The warts must first be completely healed and even after that the viruses are still viable for some time, so that sometimes a new outbreak occurs. Only when the immune system has fought off all the viruses is one cured.
Risk factors
Several factors increase the risk of contracting genital HP viruses, which can potentially lead to genital warts or cervical cancer. These include:
- First sexual contact before the age of 16
- Smoking (weakens the protective and barrier function of the mucosa).
- Childbirth at a young age and multiple births (pregnancies change the uterine mucosa, making it more susceptible to infection)
- Weakened immune system
- Other genital infections such as chlamydia or genital herpes
Prevention
There is no definitive protection against HPV infections and consequently genital warts. However, some measures help to reduce the risk of genital warts. The advantage is that these steps also prevent other, more serious consequences of HPV. These include, first and foremost, malignancies such as cervical cancer or penile cancer.
Practice safe sex!
It is also strongly advised to use condoms or dental dams during oral sex. They also reduce the risk of infection.
Go to preventive examinations!
In this way, the doctor often detects and treats genital warts and other HPV-related mucosal changes at an early stage. As with almost all diseases, the same applies here: The earlier the diagnosis and treatment, the better the prognosis!
Always think about your sexual partners, too!
As with all sexually transmitted diseases, it is advisable that in the case of genital warts, the sexual partner also goes to the doctor for clarification. If the doctor diagnoses you with genital warts, it makes sense that you inform your sexual partner(s) about it. This is the only way to prevent them from spreading. You certainly want to protect your partner from potentially serious diseases (including cancer)!
Get yourself and your children vaccinated!
You can find all the important information here: HPV vaccination
Examinations and diagnosis
Genital warts do not cause any problems in many cases. Nevertheless, it is advisable to always show warts in the genital area to a specialist. It may be a malignant disease process. Even harmless genital warts sometimes cause discomfort, especially if they increase in size. In addition, the risk is increased that high-risk HPV infects the skin or mucous membrane in the intimate area elsewhere and leads to barely visible changes there.
In case you are wondering which doctor you should see with genital warts: Necessary examinations in the clarification of genital warts are performed by specialists. Possible contacts are gynecologists (“women’s doctors”), urologists (“men’s doctors”), dermatologists (dermatologists) and venereologists (specialists in venereal diseases).
Medical history (anamnesis)
- Where exactly do you have complaints?
- Where and which skin changes have you noticed? Are these possibly clear warts in the genital area?
- Have you noticed genital bleeding outside the menstrual cycle, for example after sexual intercourse?
- Have you frequently changed your sexual partner? Do you use condoms during sex?
- Are you aware of any previous medical conditions?
- Have you had a sexually transmitted disease in the genital area in the past, such as genital warts, chlamydia or syphilis?
Examinations for genital warts
The doctor clarifies genital warts in men in more detail during a physical examination. He examines above all the penis acorn, the urethral outlet and its extension located there. Under certain circumstances, the urethral opening may be spread open in order to examine the last few centimeters of the urethra (meatoscopy).
Genital warts in women often appear in the area of the labia or also on the anus and are then usually easily recognizable. In order to detect all warts in the intimate area, further examinations are necessary. The gynecologist will palpate the vagina as part of a gynecological examination and then examine it with a speculum (“mirror”). Palpation is important because sometimes specula cover deep-seated genital warts or other growths.
The doctor also takes a swab from the mucous membrane at the cervix and cervix. He then stains the smear and examines it under a microscope. This “Pap test” often reveals malignant cell changes at an early stage, such as those caused by HPV infection in rare cases.
In the initial stage, genital warts are sometimes not visible to the naked eye, then the doctor uses further examination methods.
Further examinations
In the case of warts on the anus, the doctor will palpate the anus and the anal canal with his finger (digital-rectal examination). If necessary, he will also perform a reflection of the anal canal (anoscopy): In this case, he examines it with the help of a rigid endoscope (anoscope).
Alternatively, a proctoscopy is also possible: Here, too, a rigid endoscope is used, the proctoscope. With its help, the doctor not only sees the inside of the anal canal, but also the lower section of the rectum.
If the other examinations for genital warts have produced unclear findings, the physician may perform an acetic acid test. This involves dabbing the suspicious areas of skin/mucous membrane with three to five percent acetic acid (in women, for example, as part of a colposcopy). Barely detectable genital warts turn whitish in the process. However, the test result is not very reliable, which is why the method is not routinely recommended.
Fine tissue examination of removed warts
The doctor usually diagnoses genital warts with the naked eye. However, if he has doubts, he removes the wart in its entirety and has it examined in the laboratory for fine tissue (histological). A genital wart is also removed and examined in the laboratory in the following situations:
- The treatment does not work.
- After successful treatment, new genital warts form quickly.
- The genital warts have a diameter of more than one centimeter.
- Giant condylomas (Buschke-Löwenstein tumors) are suspected.
- The patient exhibits immunodeficiency.
HPV detection
The genetic material of the HP viruses does not usually need to be detected in the case of genital warts. Exceptions are giant condylomas: here it is useful to detect the viruses by molecular biology and to identify the virus type.
An HPV test (including virus typing) may also be useful for children with warts in the genital area. If, for example, HPV 2 is identified as the cause of the warts, this suggests transmission of common skin warts rather than sexual abuse as the cause of genital warts (the latter are usually caused by HPV 6 or 11).
Exclusion of other STDs
Genital warts increase the risk that other STDs are present. Therefore, the physician may also screen patients for syphilis, gonorrhea, HIV, chlamydia, and hepatitis B and C.
Differentiation of genital warts from other skin changes
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Disease |
Properties |
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Condylomata lata |
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Hair follicle inflammation (folliculitis) |
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Dell warts (Mollusca contagiosa) |
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Seborrheic warts |
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Soft fibromas |
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Free sebaceous glands |
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Mariscs |
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Hirsuties papillaris vulvae (woman) Hirsuties papillaris penis (man) |
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Lichen nitidus |
In addition, the physician must distinguish genital warts from possible malignant changes in the skin (precancerous or cancerous lesions).
Course of the disease and prognosis
The course of the disease in genital warts varies. In some cases, genital warts regress on their own without therapy. Sometimes, however, they spread if left untreated. Sometimes they even grow into large growths, in which case they cause increasingly severe symptoms. Therefore, it makes sense to always treat genital warts consistently – also because they are very contagious.
With all treatment methods, the trigger HPV is rarely completely eliminated. Therefore, relapses (recurrences) often occur.
HIV patients and people with organ transplants must take special care. Their immune system is extremely weakened (organ transplants by the long intake of defense-suppressing drugs, so-called immune suppressants). The risk of genital warts degenerating into cancer (especially squamous cell carcinoma) is significantly increased.