Which HPV type causes what?
- Low-risk types (6 and 11): the general cause of genital warts (condyloma acuminatum).
- High-risk types (most often 16 and 18): the most common cause of cancers of the cervix, vagina, vulva, anus and penis.
This distinction matters: having genital warts does not mean you are infected with a cancer-causing type. Even so, the screening recommendations should be followed in both situations — see Smear and HPV Testing.
How do they look?
HPV infection is mostly transient and causes no symptoms. When a wart does form, its appearance is as follows:
- It may be skin-coloured, light and pearly, or dark grey, brown or purple.
- It takes the form of rounded bumps or plaques (raised patches); they are described as "cauliflower-like" growths.
- They do not cause pain, but they may itch or become irritated.
In women they are seen around the vulva, inside the vagina or on the cervix. They can also appear around the anus, in the mouth and in the throat.
How are they recognised?
The diagnosis is mostly made by examination. Aids to diagnosis:
- Application of 3–5% acetic acid: it makes mucosal cells (the thin tissue lining the inner surface) infected with HPV turn white and so visible.
- Detection of HPV DNA by PCR in samples taken from the cervix and the anus; this can be done together with examination of the cells.
There are other conditions that can look like genital warts: skin tags, moles, seborrhoeic keratosis, lichen planus, cervical polyps, keloid, molluscum contagiosum and the condylomata lata of syphilis. Some skin cancers unrelated to HPV also need to be ruled out. For this reason saying "it looks like a wart" is not enough; it needs to be assessed.
How is it transmitted?
HPV enters the surface cells through very small breaks in the skin or the mucosa. This generally happens in the transformation zone of the cervix and the anus — where two different cell types meet.
Two points that should be known:
- HPV can be transmitted without sexual intercourse: transmission through intermediate objects such as clothing, medical equipment and surfaces, and through oral and non-sexual skin contact, has been documented.
- Condoms do not give complete protection. Used correctly and consistently they are quite effective; but HPV can also be transmitted by skin-to-skin contact and from areas outside the barrier.
Factors that increase the risk: a new sexual partner, an increasing number of lifetime partners, a partner who is not monogamous, and tobacco use.
HPV is mostly cleared by the immune system. But in people whose immune system is suppressed — those with systemic lupus (affecting the whole body), HIV infection or a history of organ transplant — the risk of the infection persisting is higher.
Treatment options
The centre of gravity of management is prevention. When a wart has formed there are two main families of treatment: tissue-destroying procedures and topical treatments.
Tissue-destroying procedures
- Cryotherapy (freezing): liquid nitrogen is applied; the change in temperature breaks up the cells and produces local tissue death.
- Cautery (electrocautery): heat generated by an electric current coagulates the tissue. It is generally done under local anaesthesia.
- Surgical removal: used for larger or treatment-resistant warts. It has an additional advantage: it provides a tissue sample for pathological examination.
- Laser vaporisation (CO2 laser): vaporises the wart tissue. It is particularly useful for lesions (tissue changes) that are widespread, resistant or anatomically difficult to reach.
A safety note: heat-based treatments such as laser and electrosurgery can release virus particles into the air; this carries a possible risk of warts forming in the throat. For this reason an appropriate respirator mask and a surgical smoke extractor need to be used during the procedure. This shows why where and how the procedure is carried out matters.
Topical treatments
- Applied by the person themselves: podofilox (of plant origin; it stops cell division and so produces local death of the wart tissue) and imiquimod (it modulates the immune response, supporting clearance by increasing local cytokine production).
- Applied by the doctor: sinecatechin ointment — an extract of green tea leaf with antiviral and immune-modulating properties; it needs to be applied more than once a day.
Combined and advanced options
Using tissue-destroying and topical methods together can increase the clearance rate and reduce recurrence, particularly in widespread disease. In resistant lesions, injection of interferon into the lesion is another option.
Managing expectations: whichever method is chosen, recurrence is common and people mostly need more than one treatment session. This does not mean the treatment has failed — it is the nature of the condition.
Prevention: the vaccine
The HPV vaccine is recommended routinely for adolescents and young adults aged 9–26. Bivalent, quadrivalent and nine-valent vaccines exist; the one most widely used today is the nine-valent. Clinical studies have shown that the protection the vaccine gives lasts at least 10 years.
For the detailed vaccination schedule and age recommendations you can see the Smear and HPV Testing page.
With any surgical procedure, results vary from person to person. You are advised to discuss the procedure with your doctor in detail beforehand.
Frequently Asked Questions
Do genital warts cause cancer?
The types that cause genital warts are the low-risk HPV 6 and 11. The types that cause cancers are different — most often 16 and 18. So having warts does not mean you are infected with a cancer-causing type. Even so, the screening recommendations should be followed.
How do they look, do they hurt?
They take the form of rounded bumps or plaques (raised patches) that may be skin-coloured, light and shiny, or dark grey, brown or purple; they are described as "cauliflower-like". They do not cause pain, but they may itch or become irritated.
What happens at the examination?
The diagnosis is mostly made by examination. 3–5% acetic acid may be applied as an aid — it makes mucosal cells (the thin tissue lining the inner surface) infected with HPV turn white and so visible. HPV DNA can also be looked for by PCR in the samples taken. Because there are other conditions that look like warts (skin tags, moles, seborrhoeic keratosis, molluscum, condylomata lata and some skin cancers), assessment is necessary.
Do condoms protect against it?
Partly. Used correctly and consistently they are quite effective, but they do not give complete protection: HPV can also be transmitted by skin-to-skin contact and from areas outside the barrier. It has also been documented that HPV can be transmitted without sexual intercourse — through intermediate objects such as clothing, medical equipment and surfaces, and through non-sexual skin contact.
Which treatment is right for me?
There are two families. Tissue-destroying procedures: freezing (cryotherapy), cautery, surgical removal and laser vaporisation. Topical treatments: podofilox and imiquimod (which you apply yourself) and sinecatechin ointment (applied by the doctor). The choice is made according to the site, size and extent of the warts. Surgical removal, for example, provides tissue for pathological examination, while laser is useful for widespread lesions (tissue changes) that are difficult to reach.
Do they come back after treatment?
Yes, recurrence is common and most people need more than one treatment session. This does not mean the treatment has not worked — it is the nature of the condition. Using tissue-destroying and topical methods together can increase clearance and reduce recurrence, particularly in widespread disease.
Is treatment with laser or cautery safe?
These heat-based methods can release virus particles into the air, and this carries a possible risk of warts forming in the throat. For this reason an appropriate respirator mask and a surgical smoke extractor need to be used during the procedure. That is why it matters that the procedure be carried out in a properly equipped setting.
Will my immune system clear the warts on its own?
HPV infection is mostly cleared by the immune system. But in people whose immune system is suppressed — those with systemic lupus (affecting the whole body), HIV infection or a history of organ transplant — the risk of the infection persisting is higher. Tobacco use is also among the factors that increase the risk.
Sources
- Nusynowitz J, Hanson M, Gessner N et al. — Infectious Diseases of the Genitals, section 3.5.1 (Human Papilloma Virus). In: Tyler K (Ed.), A Comprehensive Guide to Genital Skin Disease. Springer Nature, 2025. Epidemiology, clinical appearance, diagnosis, differential diagnosis, pathophysiology and treatment options.
The information on this page is based on the national and international guidelines listed above. The page is reviewed whenever those guidelines are updated.
Practice and Contact Details
The information on this page is general. Please speak to your doctor about your own situation.
- DoctorOp. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology
- AddressOp. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya
- Telephone0505 351 77 88
- HoursMonday – Saturday 09:00 – 18:00 · Closed on Sunday