Diagnosis

Because it's often difficult to detect genital warts, your doctor may apply a mild acetic acid solution to your genitals to whiten any warts. Then, he or she may view them through a special magnifying instrument, a colposcope.

Pap tests

For women, it's important to have regular pelvic exams and Pap tests, which can help detect vaginal and cervical changes caused by genital warts or the early signs of cervical cancer — a possible complication of genital HPV infection.

During a Pap test, your doctor will use a device called a speculum to hold open your vagina. He or she will then use a long-handled tool to collect a small sample of cells from your cervix — the passage between your vagina and your uterus. The cells are examined with a microscope for abnormalities.

HPV test

Only a few types of genital HPV have been linked to cervical cancer. A sample of cervical cells, taken during a Pap test, can be tested for these cancer-causing HPV strains.

This test is generally reserved for women ages 30 and older. It isn't as useful for younger women because their immune systems usually can kill even cancer-causing varieties of genital HPV without treatment.

Treatment

If your warts aren't causing discomfort, you may not need treatment. But if your symptoms include itching, burning and pain, or if visible warts are causing emotional distress, your doctor can help you clear an outbreak with medications or surgery. However, the lesions are likely to come back after treatment. There is no treatment for the virus itself.

Medications

Genital wart treatments that can be applied directly to your skin include:

  • Imiquimod (Aldara, Zyclara). This cream appears to boost your immune system's ability to fight genital warts. Avoid sexual contact while the cream is on your skin. It may weaken condoms and diaphragms and may irritate your partner's skin.

    One possible side effect is redness of the skin. Other side effects may include blisters, body aches or pain, cough, rashes, and fatigue.

  • Podophyllin and podofilox (Condylox). Podophyllin is a plant-based resin that destroys genital wart tissue. Your doctor must apply this solution. Podofilox contains the same active compound, but can be safely applied by you at home.

    Your doctor may want to administer the first application of podofilox, and will recommend precautionary steps to prevent the medication from irritating surrounding skin. Never apply podofilox internally. Additionally, this medication isn't recommended for use during pregnancy. Side effects can include mild skin irritation, sores or pain.

  • Trichloroacetic acid (TCA). This chemical treatment burns off genital warts, and can be used for internal warts. Side effects can include mild skin irritation, sores or pain.
  • Sinecatechins (Veregen). This cream is used for treatment of external genital warts and warts in or around the anal canal. Side effects are often mild and may include reddening of the skin, itching or burning, and pain.

Don't try to treat genital warts with over-the-counter wart removers. These medications aren't intended for use in the moist tissues of the genital area. Using over-the-counter medications for this purpose can cause even more pain and irritation.

Surgery

You may need surgery to remove larger warts, warts that don't respond to medications or — if you're pregnant — warts that your baby may be exposed to during delivery. Surgical options include:

  • Freezing with liquid nitrogen (cryotherapy). Freezing works by causing a blister to form around your wart. As your skin heals, the lesions slough off, allowing new skin to appear. You may need repeated cryotherapy treatments. The main side effects include pain and swelling.
  • Electrocautery. This procedure uses an electrical current to burn off warts. You may have some pain and swelling after the procedure.
  • Surgical excision. Your doctor may use special tools to cut off warts. You'll need local or general anesthesia for this treatment, and you may have some pain afterward.
  • Laser treatments. This approach, which uses an intense beam of light, can be expensive and is usually reserved for very extensive and tough-to-treat warts. Side effects can include scarring and pain.

Preparing for your appointment

You'll probably first bring your signs and symptoms to the attention of your family doctor. If you are a woman, you may wish to schedule your initial appointment with your gynecologist.

What you can do

Before your appointment you may want to write a list that describes your:

  • Symptoms. Describe your symptoms and note whether your sexual partner has ever had similar symptoms.
  • Sexual history. List all recent exposures to possible sources of infection. These may include having unprotected sex or sex with a new partner.
  • Key medical information. Write down any other conditions you're being treated for and the names of any medications, vitamins or supplements that you're taking.

Creating your list of questions in advance can help you make the most of your time with your doctor. For genital warts, some basic questions to ask your doctor include:

  • Do I have genital warts?
  • Are there any other possible causes for my symptoms?
  • What tests do you recommend?
  • Should I also be tested for other sexually transmitted infections?
  • What treatment approach do you recommend, if any?
  • How soon after I begin treatment can I expect to get better?
  • Am I contagious? How can I reduce the risk of passing this infection to others?
  • Should my partner be tested for this condition?
  • When can I safely have sex again?
  • Will my genital warts come back?
  • Am I at risk of complications related to genital warts?
  • How often should I be screened for other health conditions related to genital warts?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time if you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

  • What are your symptoms, if any?
  • When did you begin experiencing symptoms?
  • How severe are your symptoms?
  • Do you practice safe sex? Have you done so since you became sexually active?
  • Have you recently had sex with a new partner?
  • Has your partner been tested for sexually transmitted infections?
  • Have you had the HPV vaccine? When?
  • Are you pregnant or planning to become pregnant?
Nov. 19, 2016
References
  1. Habif TP. Sexually transmitted viral infections. In: Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. Edinburgh, U.K.; New York, N.Y.: Mosby Elsevier; 2016. https://www.clinicalkey.com. Accessed Sept. 9, 2016.
  2. Genital HPV infection: Fact sheet. Centers for Disease Control and Prevention. http://www.cdc.gov/std/HPV/STDFact-HPV.htm. Accessed Sept. 9, 2016.
  3. Breen E, et al. Condylomata acuminata (anogenital warts). http://www.uptodate.com/home. Accessed Sept. 9, 2016.
  4. Bennett JE, et al. Papillomaviruses. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. https://www.clinicalkey.com. Accessed Sept. 9, 2016.
  5. Goldman L, et al., eds. Papillomavirus. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Sept. 9, 2016.
  6. Gynecologic cancers: What should I know about screening? Centers for Disease Control and Prevention. http://www.cdc.gov/cancer/cervical/basic_info/screening.htm. Accessed Sept. 9, 2016.
  7. Human Papillomavirus (HPV). Centers for Disease Control and Prevention. http://www.cdc.gov/hpv/parents/questions-answers.html. Accessed Sept. 9, 2016.