Genital Warts

Clinical description

• Small growths or bumps on genital/anal skin: smooth, flat, raised, or cauliflower-like. ± itching, discomfort, pain, bleeding.
• Caused by HPV type 6 or 11 (different from cancer-causing types). HPV infection is not curable; genital warts commonly re-occur after removal.
• HPV vaccination and condoms are the only effective prevention.

Treatment

Treat external warts only by chemical or physical removal. Warts on urethra, vagina, cervix or anus require specialist treatment. Repeated treatment is usually needed.

Chemical removal options

• Podophyllin 0.5% paint: apply to warts, spare normal skin, let dry, wash off after 4 hours. Max 5 ml per application. Do not use in PBFW. Repeat weekly.
• Silver nitrate stick: alternative to podophyllin, safe in PBFW. Do not wash for 6–8 hours.
• Trichloroacetic acid (TCA) 80–90%: wash off after 4 hours.
• Imiquimod 5% cream: apply at bedtime every other day, leave overnight, continue up to 16 weeks.

Physical removal

• Cryotherapy (liquid nitrogen, CO₂), electro-cautery, or surgical removal. Do not cut warts with scalpel/scissors/razor — excessive bleeding risk.

Routine partner treatment is not usually needed (partners are likely already infected). HPV vaccination may be offered. Switch method if no improvement after 4–6 weeks.