Genital warts - Causes, Symptoms and Treatments

Genital warts are a sexually transmitted disease. They typically appear in areas covered by clothing, in delicate areas that can cause irritation, and may spread to other regions as larger lesions. Pregnant women with genital warts can transmit the condition to their babies.This disease can affect people of all genders and ages,

but is most commonly found among teenagers, as many engage in premarital sex without adequate knowledge or understanding of how to protect themselves.

Once infected, symptoms often do not appear. Some individuals may unknowingly carry and transmit the disease. If left untreated, the condition may worsen, making it more difficult to treat.

Things to know about genital warts:

What are genital warts?

Genital warts (Genital warts, Condyloma acuminata) are a sexually transmitted disease caused by infection with the human papillomavirus (HPV).

They appear as small bumps or raised patches that are soft and resemble cauliflower. They may be pink or the same color as the skin, and protrude around the genitals or nearby areas. Genital warts are also commonly referred to as venereal warts.

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Causes of genital warts

Caused by infection with HPV (Human Papillomavirus)

What is HPV ?

There are currently over 200 known strains of the virus, with more than 40 strains transmissible through sexual contact.
90% of genital wart cases are caused by HPV types 6 and 11, which are low-risk strains that do not increase the risk of cancer. However, some other strains of this virus can increase the risk of developing cervical cancer.

HPV is categorized by its cancer-causing potential into:

High-risk (oncogenic) HPV types, which are associated with a higher risk of cancer, include types: 16, 18, 31, 33, 35, 39, 41–45, 51, 52, 56, and 59.
Low-risk (non-oncogenic) HPV types, which do not increase cancer risk, include types: 6, 11, 42, 43, and 44.

2. The virus is transmitted through direct contact with infected skin or mucous membranes.

3. HPV enters the body through microscopic abrasions, which is why it is most commonly spread through sexual contact. Condoms cannot provide complete protection against transmission.

4. The person transmitting the virus does not need to have visible lesions (although those with visible lesions are more likely to transmit the virus due to a higher virus).

5. The incubation period for the virus ranges from about 3 weeks to 8 months (with an average of 2.9 months).

Symptoms of genital warts

Genital warts have soft, raised bumps or cauliflower-like lesions that are pink or the same color as the skin. They protrude in the genital area and nearby regions.
Common locations (they may appear in multiple locations at once) include around the vaginal opening, beneath the foreskin of the penis, on the circumcised part of the penis, the cervix, the vagina, the urethra, the perineum, around the anus, the anal opening, and the scrotum.
Normally, there are no other associated symptoms. However, depending on the size of the lesions, large warts may cause itching, irritation, blockage of the urethra or vagina, and can lead to wounds or infections in the wart tissue.

See examples of genital warts symptoms.

Side effects of genital warts

A common complication of genital warts is recurrence, which can happen due to ineffective treatment, unprotected sex, or having multiple sexual partners.

There is also a risk of cervical cancer. This is because HPV infection often involves multiple strains simultaneously, some of which can cause cervical cancer.

For pregnant women, there is a possibility that the newborn may develop warts in the throat or larynx, which can obstruct the airway and may require surgical removal.

How doctors diagnose genital warts?

Genital warts can usually be diagnosed immediately by examining the appearance of the lesions.
A biopsy for pathological examination may be considered in cases where the lesion has atypical features such as being unusually dark, firm, fixed to underlying tissue, or unresponsive to standard treatment—in order to distinguish it from cancerous lesions.

Precautions for genital warts

Inform your sexual partner so they can monitor for symptoms of HPV infection. Note that partners may not have visible lesions or any symptoms at all.
Both the patient and their partner should be screened for other sexually transmitted infections (STIs).
Consult a physician for appropriate diagnosis and treatment of genital warts.
Take care of yourself when infected to prevent spreading the disease to others.

Treatment methods for genital warts

For small or asymptomatic lesions, monitoring may be considered. If the warts do not resolve within one year, treatment can begin.
Treatments include both medication and surgical procedures.
The cure rate for warts is between 35–100% within 3–15 weeks.
About 20–30% of patients may experience recurrence (at the same or different sites) within 2–3 weeks.
Treating genital warts does not reduce the future risk of cancer. Patients need to understand the treatment process, undergo regular monitoring, and be consistently vigilant. However, it may take time.
The choice of treatment depends on the size, number, and location of the lesions, as well as the side effects of the treatment.

Self-Applied Treatments

Some patients may use topical medications such as Podophyllin or Imiquimod.

The advantage is that it offers privacy, as patients can take the medication home and apply it themselves, then return for follow-up within 2–3 weeks.

However, the disadvantages include common irritation, burning, and redness at the application site,and the treatment tends to be less effective compared to other methods.

Medical treatment by a doctor

Application of 80–90% Trichloroacetic Acid (TCA) to the lesions
Electrocautery (electric burning)
Cryotherapy (freezing with liquid nitrogen)
Treatment using cauterization or surgical removal has a higher chance of success, although the recurrence rate is about the same. Possible side effects include permanent skin darkening or lightening, or the formation of depressed or raised scars at the lesion site.

How to protect yourself from genital warts

Have only one sexual partner, or as few as possible
Condoms cannot completely prevent the transmission of HPV because the virus can be present in areas such as the perineum, pubic area, and around the anus. (However, using condoms significantly reduces the risk of transmission compared to not using them. They also help prevent other sexually transmitted infections such as HIV, gonorrhea, chlamydia, and herpes.)
Male circumcision helps reduce the risk of HPV accumulation
HPV vaccination

The vaccine requires 3 doses and should ideally be administered before the onset of sexual activity. It is recommended for individuals aged 9–26.
It can be given to both males and females.
The vaccine should not be administered during pregnancy.

HPV Vaccination

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Reference documents

Anogenital Wart, Dr. Paweena Pangsuwan, Faculty of Medicine, Chiang Mai University
Genital Warts… Not Fatal but Destroys Confidence, Dr. Janjit Chayajinda, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital

Interesting Article

Jittiwat Amnouypon ,M.D.
General Practitioner

Latest edit : 13/05/2025

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