GENITAL WARTS & HPV

Warts on other parts of the body, such as the hands, are caused by different types of HPV. Contact with these warts does not seem to cause genital warts. 

Warts may appear within several weeks after sexual contact with an infected person, they may take months to appear, or they may never appear. This makes it hard to know exactly when or from whom you got HPV.

Genital warts are one symptom of HPV. Genital warts are growths or bumps that appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin or thigh. They may be raised or flat, single or multiple, small or large. Some cluster together, forming a cauliflower-like shape.

Sometimes people do not notice warts because they are inside the vagina, or on the cervix, or in the anus. In addition, they are often flesh coloured and painless. In rare cases they cause symptoms such as itching, pain or bleeding.

HPV can also cause changes in the cells that can’t be seen, and would need to be diagnosed by a specialist.

In most people, HPV is harmless and causes no symptoms.

However, in some people, genital HPV that you can't see can cause changes to skin cells that, if not found and treated, can lead to cancer including cervical, vaginal, vulvar, anal, throat and penile cancers.

The HPV vaccine is highly effective at preventing the cancer-causing strains of HPV. The vaccine works best if you have it before becoming sexually active. 

Cervical screening in Aotearoa changed in September 2023. There's now an option to do a vaginal swab, which detects HPV. You can do the swab yourself or a healthcare professional can help.

If HPV is found in your sample, it doesn’t mean you have cervical cancer, but you'll be checked to see if there are any changes to the cells of your cervix through a 'smear test'. Cancer can almost always be prevented through finding and treating these cell changes.

Sometimes, your healthcare provider might recommend you just do a smear test, instead of the new HPV swab test first.

Find out more at: www.timetoscreen.nz/cervical-screening/ 

For genital warts, treatment is optional. Most genital warts will clear up on their own sooner or later. However you may want to have them treated if they're causing your discomfort or distress. There are several available treatments, and no particular treatment is perfect for all people or all warts. Here are the options for treating genital warts:

• Podophyllotoxin (Condyline™) solution

A patient-applied treatment for external genital warts, recommended for people with a penis only as it is too difficult to self-apply for internal warts. For external warts, it is easy to use and safe if instructions are followed.

• Imiquimod (Aldara™) cream

A patient-applied treatment for external genital and perianal warts. It is easy to use and safe if instructions are followed. Not recommended in pregnancy.

• Cryotherapy

This involves freezing off the wart with liquid nitrogen and can be performed by a trained health practitioner.

• Trichloroacetic acid (TCA)

A chemical applied to the surface of the wart by a trained health practitioner. TCA is unavailable in some areas.

• Laser therapy

Using an intense light to destroy the warts, or surgery (cutting off the warts) has the advantage of getting rid of the warts in a single visit. Laser treatment can be expensive and the healthcare provider must be well trained in these methods. It is only available in a few centres. Recurrences may occur.

Things to keep in mind about treatment of genital warts

• Factors that might influence selection of treatment include size, location and number of warts, changes in the warts, your preference, cost of treatment, convenience, adverse effects, and the healthcare provider’s expertise.
• It is advisable to seek medical advice before starting treatment for genital warts. Ask your doctor for an explanation of the treatment, including the costs and likely benefits. Be sure to understand the follow-up instructions, such as what to do about discomfort and when to seek help.
• Be patient—treatment often takes several visits and a variety of approaches. None of the available treatments is a cure for HPV. The virus can remain in the skin after treatment. Because the virus can lie dormant in the cells, in some cases warts can return months or even years after treatment. In other cases warts never recur.
• If you are pregnant or think you might be, tell your doctor so that they can choose a treatment that won’t be harmful to you or your baby.
• Don’t use over-the-counter treatments which are not specifically for genital warts. These are not meant for sensitive genital skin.
• It is recommended to avoid sexual contact with the infected area during treatment, to protect the treated area of skin from friction and to help it heal.

HPV infection can cause certain abnormal cell changes on the cervix. These are found by attending cervical screening as advised by your healthcare provider.

Abnormal cervical smears are called ‘Cervical Intraepithelial Neoplasia’ (CIN). CIN is categorised as low grade (known as CIN1), or high grade (CIN2 to 3). The majority of low grade changes i.e. CIN1, are harmless and return to normal by themselves. People with high grade changes, i.e. CIN2 or 3, are treated to avoid the risk of progressing to cancer. High grade changes are not cancers and they take many many years to turn into cancer.

Depending on the degree of smear abnormality and sometimes the result of the HPV DNA/Type test (a simple swab test that is used in certain clinical situations usually in conjunction with a smear test), the doctor or nurse may recommenda repeat test in  12 months or if further investigation is required a colposcopy examination. The test can be helpful in deciding what follow-up is required.

A colposcope is like a pair of medical binoculars on a stand and it magnifies the cells on the cervix. Colposcopy shows where the abnormal cells are. A tiny piece of tissue may be removed (a biopsy) which may cause brief discomfort. The biopsy is sent to a laboratory to confirm if an abnormality is present. These procedures are simple and require only a short visit to a hospital clinic or private specialist.  

Depending on the results of this test, you may be advised to have a repeat cervical smear, a further colposcopy, or it may be recommended that the abnormal cells are removed by a simple outpatient treatment. 

More information on HPV testing is available on www.timetoscreen.nz/cervical-screening/.

The HPV vaccine is highly effective at preventing genital warts and HPV-related cancers.

Vaccination is highly recommended for people of all genders and, ideally, should be completed prior to becoming sexually active. For people who are already sexually active, the vaccine may still be of benefit as it will prevent getting new HPV infections for the strains the vaccine covers.

The HPV vaccine (Gardasil 9) is free for people in Aotearoa NZ up until their 27th birthday. Ask your health provider for further information about how you can receive the vaccine. Read more about the HPV vaccine here.

If you have a cervix, even if you've had the HPV vaccine, you should still attend cervical screening as advised by your doctor or nurse.

If you are diagnosed with warts and you have a partner it is a good idea to discuss this, however the majority of partners have probably acquired the infection subclinically (no symptoms) and it's almost impossible to know when or where the infection came from. Your partner can see a nurse or doctor or go to a sexual health clinic to have a check up too. You can also read our page on how to tell a partner about an STI.