HPV & Genital Warts
Symptoms, Causes & Treatment
Understanding HPV and genital warts: what causes them, how they are treated, why vaccination is important, and what the difference is between low-risk and high-risk HPV.
What Is HPV?
Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. There are over 200 types of HPV, of which approximately 40 infect the genital area. Most HPV infections cause no symptoms, are cleared by the immune system within 1–2 years, and are never detected.
HPV types are classified by their clinical significance:
- Low-risk types (mainly HPV 6 and 11) -- cause genital warts (condylomata acuminata). These types do not cause cancer.
- High-risk types (mainly HPV 16 and 18) -- do not cause visible warts but can cause cellular changes that, over time, may progress to cancer of the cervix, anus, oropharynx, penis, vagina, and vulva.
Genital warts are the most visible manifestation of HPV infection. They are extremely common -- the most frequently diagnosed viral STI in sexual health clinics in the UK. An estimated 1 in 10 sexually active people will develop genital warts at some point. Rates have declined significantly since the introduction of the HPV vaccination programme.
Genital warts are not dangerous and do not cause cancer, but they can be cosmetically distressing and may take time to resolve. They are treatable and, in most cases, the immune system eventually clears the virus.
What Are the Symptoms of HPV & Genital Warts?
Most HPV infections are asymptomatic. When symptoms occur, they reflect either low-risk or high-risk strain activity.
Genital warts: soft, flesh-coloured cauliflower-like growths on penis, vulva, anus, or inside vagina · Usually painless but may itch · Can be single or multiple · Most HPV infections produce no visible warts · High-risk HPV types cause no visible symptoms but cause cervical, anal, and oropharyngeal cancers
Warts that bleed, grow very rapidly, or become necrotic · Warts in pregnancy (may require delivery planning) · Abnormal cervical screening result · Post-coital bleeding in women with known HPV infection · Anal warts with rectal bleeding
Warts that bleed, ulcerate, or grow rapidly need same-day clinical assessment to exclude malignant transformation (very rare). Any woman with HPV on cervical screening and abnormal cells (CIN 2+) should be referred for urgent colposcopy within 2 weeks.
What Causes HPV & Genital Warts?
HPV infection is almost universal — most sexually active people will acquire HPV at some point. The clinical outcome depends entirely on which HPV strain is acquired.
Over 200 HPV strains exist. Low-risk strains (HPV 6, 11) cause 90% of genital warts. High-risk strains (HPV 16, 18) cause 70% of cervical cancers and are also associated with oropharyngeal, anal, vulval, and penile cancers.
The Gardasil 9 HPV vaccine protects against HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58 — covering 90% of cervical cancer risk. It is offered to all children aged 12–13 in the UK and is available to MSM up to age 45.
STIs are transmitted through unprotected vaginal, anal, or oral sex. Some (herpes, HPV, syphilis) can spread through skin-to-skin contact even without penetration or visible symptoms.
Many STIs, particularly chlamydia, gonorrhoea, and early HIV, cause no symptoms at all. Regular testing is the only way to detect them — waiting for symptoms means delayed treatment and onward transmission.
Condoms reduce STI transmission by 85–98% when used consistently and correctly. They are less effective for infections spread by skin contact (herpes, HPV, syphilis) where lesions extend beyond the condom-covered area.
STI co-infection is common. Gonorrhoea and chlamydia frequently co-exist (15–40% co-infection rate). HIV significantly increases susceptibility to all other STIs and their complications.
Key Risk Factors
How Is HPV & Genital Warts Diagnosed?
Genital warts are diagnosed clinically by visual inspection. HPV typing is not routinely performed for warts as most are low-risk strains. High-risk HPV is detected through cervical screening (HPV primary testing). Colposcopy examines the cervix in detail when high-risk HPV is found.
How Are Genital Warts Treated?
Genital warts are treated with patient-applied topical agents or clinician-applied procedures. High-risk HPV infection itself has no specific treatment — management focuses on surveillance and treating pre-cancerous changes.
Supportive Measures
Keep the wart area clean and dry. Avoid shaving over wart areas (spreads virus to adjacent skin). Do not share towels. Genital warts do not require sexual abstinence but informing partners so they can be examined is sensible. Partner notification is recommended but not mandatory as HPV is not a notifiable infection.
Recurrent Genital Warts
Warts often recur after treatment because the underlying HPV virus may persist in local skin cells. Recurrence is not treatment failure — it reflects the biology of HPV persistence. Most recurrences respond to the same first-line treatment. If warts recur frequently, specialist referral to a sexual health clinic is appropriate for alternative treatments including electrosurgery or carbon dioxide laser ablation.
When Should You Seek Help for Genital Warts or HPV?
Warts that bleed heavily or grow very rapidly · Anal warts with rectal bleeding · Abnormal cervical screening with high-grade changes (CIN 2/3) — urgent colposcopy referral.
You have noticed new growths on your genitals · You have received an abnormal cervical screening result · A partner has been diagnosed with genital warts · Your warts have not responded to treatment · You are pregnant and have genital warts.
How to Prevent HPV & Genital Warts
HPV can be significantly prevented through vaccination and cervical screening. These two measures together have the potential to nearly eliminate cervical cancer.
HPV vaccination is most effective before sexual debut but remains beneficial up to age 25 in women. MSM can receive Gardasil 9 free on the NHS at sexual health clinics up to age 45.
Attend cervical screening (smear test) regularly. The UK now uses HPV primary screening — if high-risk HPV is detected, cytology is performed. Do not miss appointments as they detect pre-cancerous changes early.
Annual STI testing is recommended for all sexually active people. Those with multiple partners should test every 3 months. Free NHS testing is available at sexual health clinics, online via SHGM/SH:24, and from GP surgeries.
Use condoms consistently for vaginal, anal, and oral sex with new or casual partners. Dental dams reduce transmission during oral-vulval contact. Lube reduces condom breakage and anal mucosal trauma.
Notify all recent sexual partners when diagnosed with an STI so they can be tested and treated. Partner notification can be done directly or anonymously through the sexual health clinic (contact tracing service).
HPV vaccination prevents 90% of cervical cancer and most genital warts. Hepatitis B vaccine is recommended for all MSM, PWID, and sexual health clinic attendees not previously vaccinated.
Speak to a Clinician About Genital Warts
Through The GP Service, a clinician can assess genital warts, prescribe topical treatment, and refer to a specialist for cryotherapy or other clinic-based treatments.
Expert clinical advice, when you need it.
HPV & Genital Warts FAQs
HPV vaccination is highly effective before first sexual contact but still provides meaningful protection after sexual debut. The NHS offers Gardasil 9 to all children aged 12–13 regardless of gender. Catch-up vaccination is available free up to age 25 for women and men who have not been vaccinated. MSM can receive free vaccination at sexual health clinics up to age 45. For people already exposed to HPV, the vaccine still protects against strains they have not yet encountered. HPV vaccination combined with regular cervical screening has the potential to virtually eliminate cervical cancer in the UK.
Most genital warts are caused by HPV 6 or HPV 11 — low-risk strains that do not cause cancer. Having genital warts does not mean you have a cancer-causing strain of HPV. However, people with genital warts may also have been exposed to high-risk HPV strains at the same time. Women with genital warts should ensure they attend regular cervical screening. The high-risk strains (HPV 16 and 18) rarely cause warts — they cause cervical changes detected by smear tests. Anal cancer risk from high-risk HPV is higher in MSM and HIV-positive individuals, who should discuss screening with their clinician.
STI testing is recommended annually for all sexually active people. Those with new or multiple partners should test every 3 months. Testing is free at NHS sexual health clinics and from online services (SH:24, SHGM). You do not need symptoms to be tested — most STIs cause no symptoms. A full STI screen covers chlamydia, gonorrhoea, syphilis, HIV, hepatitis B, and hepatitis C. Specific sites tested (urine, swabs, blood) depend on your sexual practices. Results are usually available within 1–2 weeks. Positive results trigger automatic partner notification advice.
Not all STIs are curable, but all are treatable. Bacterial STIs — chlamydia, gonorrhoea, and syphilis — are fully curable with antibiotics when diagnosed promptly. Viral STIs — HIV, herpes, HPV, and hepatitis B — cannot be cured but can be effectively managed. HIV is controlled with ART to the point of undetectability. Herpes is managed with antivirals that suppress outbreaks. HPV often clears naturally within 1–2 years in people with healthy immune systems. Genital warts can be treated and removed, though the underlying HPV virus may persist. The key message: all STIs are manageable with prompt diagnosis and treatment.
Yes. HIV is now a manageable chronic condition, not a death sentence. With antiretroviral therapy (ART), people with HIV can live long, healthy lives with a normal life expectancy. ART suppresses the virus to undetectable levels in the blood, meaning it cannot be transmitted sexually (Undetectable = Untransmittable, or U=U). Most people on modern ART take a single tablet daily and experience minimal side effects. HIV does not prevent you from having children, working, or having a fulfilling life. In the UK, HIV care is excellent and free on the NHS. The biggest barrier to good outcomes is late diagnosis — testing early is life-saving.
PEP (post-exposure prophylaxis) is a 28-day course of antiretroviral drugs that prevents HIV infection after a potential exposure. It must be started within 72 hours — the sooner the better. PEP is available from A&E departments, sexual health clinics, and some GUM clinics 24/7. It is free on the NHS for NHS patients. PEP is not a substitute for PrEP or condoms and should be used only in genuine emergencies (unprotected sex with a known HIV-positive person not on suppressive ART, condom failure, sexual assault, or needlestick). After completing PEP, an HIV test at 45 days and 3 months confirms whether infection was prevented.
Yes, but safely. With modern antiviral suppression, the risk of transmitting herpes to a partner is substantially reduced. Daily suppressive valaciclovir reduces transmission risk by approximately 50%, combined with condom use. Disclosing herpes to a new partner is an important conversation — most people with herpes have had it from a previous partner without knowing. Your sexual health clinician can help with disclosure conversations and partner testing. Most people with herpes continue to have satisfying, loving relationships. Herpes is extremely common — HSV-2 affects around 1 in 6 adults — and carries significant social stigma disproportionate to its medical impact.
Without treatment, chlamydia can persist silently for months or years, causing progressive damage to the reproductive tract. In women, untreated chlamydia causes pelvic inflammatory disease (PID) in 10–15% of cases, leading to tubal factor infertility, chronic pelvic pain, and ectopic pregnancy risk increased 6–10-fold. In men, chlamydia causes epididymo-orchitis, which can impair sperm production and quality. Reactive arthritis (formerly Reiter's syndrome) — involving joint inflammation, eye inflammation, and urethritis — is a rare but recognised complication. These complications are entirely preventable with prompt diagnosis and a simple 7-day course of doxycycline.