Symptoms and Signs of Genital Warts
(HPV Infection)

Genital Warts
(HPV Infection) Symptoms

Although genital warts are painless, they may be bothersome because of their location, size, or due to itching.

• The size may range from less than one millimeter (1 mm = 0.039 inches) across to several square centimeters (1 cm = 0.39 inches) when many warts join together.
• Men and women with genital warts will often complain of painless bumps, itching, and discharge.
• Rarely, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral opening (the opening where urine exits the body.)
• Warts in more than one area are common.
• There may be a history of previous or concurrent sexually transmitted diseases (STDs).

Specific descriptions

• In men, genital warts can infect the urethra, penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many fingerlike projections (anal warts). Others may appear pearly, cauliflower-like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Sometimes lesions may be hidden by hair or in the inner aspect of the uncircumcised foreskin in males.
• In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals warrant a thorough examination of the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. Rarely, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.

Genital Warts
(HPV Infection) Causes

Genital warts are caused by the human papillomavirus (HPV). Over 100 types of HPVs have been identified; about 40 of these types have the potential to infect the genital area.

• Most genital warts are caused by two specific types of the virus (HPV-6 and -11), and these HPV types are considered "low risk," meaning they have a low cancer-causing potential. Other HPV types are known causes of premalignant changes and cervical cancers in women. HPV-16, one of the "high-risk" types, is responsible for about 50% of cervical cancers. HPV types 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 are other known "high risk" virus types. High-risk HPV types are also referred to as oncogenic HPV types. HPV is believed to cause 100% of cases of cervical cancer.
• Common warts are not the same as genital warts and are caused by different HPV types that infect the skin.

The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years may occur, during which there is no evidence of infection.

• Generally, about two-thirds of people who have sexual contact with a partner who has genital warts develop them within three months.
• Genital warts are indirectly associated with use of birth control pills due to increased sexual contact without the use of barrier protection, multiple sex partners, and having sex at an early age.