Anogenital Warts
Symptoms, diagnosis and treatment options for anal and anogenital warts (genital warts), including self-applied creams and clinic-based treatments.
Summary: Anogenital warts are usually benign. Treatment destroys the warts but does not necessarily clear the HPV virus, so warts can sometimes return.
Anal & anogenital warts: symptoms, diagnosis and treatments
What are anogenital warts and what causes them?
Anogenital warts (genital warts) are small lumps that develop on the genitals and/or around the anus (back passage). They’re caused by the human papillomavirus (HPV). There are many types of HPV, and most anogenital warts are caused by types 6 or 11.
How do you get anogenital warts?
HPV is passed on by sexual contact and close skin-to-skin contact, so penetrative sex is not always required for transmission. Sharing sex toys can also pass on infection. Warts may take weeks or months to appear after infection, and many people carry HPV without visible warts. It’s also possible to pass on the virus after warts have been treated or have gone.
Important: Because warts can appear long after infection, new warts don’t necessarily mean a partner has been recently unfaithful.
How common are anogenital warts?
They are common and are among the most frequently diagnosed sexually transmitted infections in the UK. Many more people are infected with HPV but do not develop visible warts. An individual has over a 5 in 10 chance of HPV infection in their lifetime, though most people have no symptoms. Only around 1–2 in 100 people with HPV infection develop anogenital warts.
Where do anogenital warts develop?
- In men: often on the outer skin of the penis.
- In women: often on the vulva, just outside the vagina.
- In men and women: around the anus is common.
- They can also develop inside the vagina, on the cervix, scrotum, inside the urethra, or inside the anus.
- Rarely, they occur in the mouth or nose.
What do anogenital warts look like?
They often look like small skin-coloured lumps. Warts on warm, moist, non-hairy areas (e.g., vulva) tend to be softer, while warts on dry, hairy skin (e.g., penile shaft) tend to be firmer. Some people have only a few; others may have many.
What are the symptoms?
- Often no physical discomfort.
- Sometimes irritation or soreness, especially around the anus.
- May bleed or cause pain during intercourse.
- If inside the urethra or anus, can cause bleeding with urination or bleeding from the anus.
Good to know: Warts are usually benign (not serious physically), but they can be distressing.
Do I need any tests?
Warts are often diagnosed by typical appearance during examination. Your clinician may examine external genitalia and may recommend an internal examination of the vagina or back passage if needed. Tests are not usually required to confirm warts.
However, up to 1 in 4 people with anogenital warts also have another sexually transmitted infection, so swabs/tests are commonly advised, even if you have no symptoms.
What are the treatment options?
There are several treatment approaches. It can take weeks to clear warts and sometimes up to six months. Treatments may irritate the surrounding skin, and smokers may respond less well—stopping smoking may help. Over-the-counter wart treatments from pharmacies should not be used for anogenital warts.
1) No treatment
Some people choose no treatment. Warts are not serious and may resolve without treatment—about one third of visible warts disappear by themselves over six months.
2) Chemical treatments
- Podophyllotoxin (cream or lotion): typically applied twice daily for 3 days, then 4 days rest; repeated over several weeks. Not used in pregnancy; avoid broken skin; avoid getting it on normal surrounding skin; avoid sex soon after application due to irritation risk; follow instructions carefully.
- Imiquimod (cream): applied at bedtime, washed off after 6–10 hours; repeated 3 times per week for up to 16 weeks. Not used in pregnancy; may irritate partner if sex soon after application; avoid broken skin; can affect skin pigmentation in some people; may weaken condoms/diaphragms.
3) Physical treatments
- Cryotherapy (freezing with liquid nitrogen): often requires several treatments a week or so apart; commonly used for small to moderate numbers of warts.
- Surgical removal under local anaesthetic for a small number of accessible warts.
- Electrocautery (burning) or laser (burning) in selected cases.
Which is best? It depends on number/location of warts, pregnancy status, and whether you prefer home vs clinic treatment. Some chemical treatments should not be used internally (cervix/vagina/inside anus).
Partners, prevention and outlook
What about my sexual partner?
Current partner(s) may wish to be checked for warts and other sexually transmitted infections.
Is there a link with cervical cancer?
The HPV types that most commonly cause warts (6 and 11) do not increase cervical cancer risk. However, other HPV types can increase risk, and it’s possible to have more than one HPV type. Cervical screening should be done at the usual recommended times.
How can you prevent anogenital warts?
- Condoms can reduce transmission to new partners but do not fully protect because uncovered skin can still transmit HPV.
- Condoms also help protect against other STIs such as chlamydia and HIV, and are advised during treatment and for at least 3 months after warts have gone.
- Do not share sex toys; use condoms for oral sex.
- HPV vaccine (e.g., Gardasil covering HPV 6/11/16/18) helps protect against common wart-causing types.
What is the outlook?
Warts can usually be cleared with treatment, but in about 1 in 4 cases, new warts appear at some time after successful treatment. Recurrence is often due to re-activation of the same infection rather than a newly acquired infection.
Further help and information
If you suspect warts or another STI, see your GP or contact a local sexual health (GUM) clinic. You can usually attend without a GP referral. Additional resources may include the Family Planning Association and BASHH.