Genital warts: symptoms and treatments

Genital warts are benign skin tumours caused by members of the human papilloma virus (HPV) family, of which at least 60 different types exist. The wart virus gains entry through the tiny cuts or splits in your skin during skin-to-skin contact - most usually during sex with an infected person.

Most carriers of the wart virus do not have active warts, so lack of visible warts on a sexual partner does not mean they're free from infection. Using male condoms helps to prevent transmission of wart virus but may not give total protection, as they may not cover all affected areas (for example, warts may be present on the scrotum).

What symptoms will you notice?
Wart viruses stimulate overgrowth of skin cells to form warts that can vary from small, multiple, finger-like projections to single, large growths. They can occur anywhere on the male and female genitals and anus.

Once you're infected, the virus lies dormant in cells and the warts may appear from several weeks to 20 months afterwards. Some people are naturally immune and never show signs of infection and, as genital HPV is so common, it is thought that the majority of sexually active people have been exposed to HPV infection at some time. This is because even when warts are treated and disappear, the wart virus can still be found lying dormant in skin cells, so that recurrences and transmission to others are common.

Genital warts occasionally appear in people who have never been sexually active, which suggests that wart virus may be passed on in non-sexual ways (for example, via the fingers) or during non-penetrative sex.

How are genital warts diagnosed?
This relies on seeing the typical warty growths. Sometimes structures such as skin tags or remnants of the hymen may be mistaken for genital warts.

How are genital warts treated?
The latest treatment: Imiquimod. The drug is known as an immune response modifier as it stimulates the body's own immune system to attack the viruses that cause genital warts. Unlike podophyllotoxin, it does not have any anti-viral action. Imiquimod cream is applied three times a week to the wart area before you go to sleep and is then washed off six to ten hours later (i.e. next morning) with mild soap and water. While the cream is in place, you should avoid showering, bathing or sexual contact. Treatment continues until the warts clear or for a maximum of 16 weeks. It is only available on prescription and may be reserved until other, cheaper treatments have failed.

The quickest results: When warts are destroyed by heat under local anaesthetic. This leaves a shallow burn, which heals over the following week to produce instant results. This is usually the best method for treating larger or multiple genital warts. Extensive warts can also be surgically removed under general anaesthetic.