Genital Warts: Causes, How to Tell Them Apart from Skin Tags, Molluscum and Pearly Penile Papules, Why the "Wart Root" Does Not Exist, and Treatment by Type

Genital warts (condyloma acuminata) are rough-surfaced bumps or growths that appear on the genitals, in the groin or around the anus. They are caused by human papillomavirus (HPV) infection, and about 90% are due to types 6 and 11, which carry a low risk of cancer. This is a common sexually transmitted infection. The visible warts can be cleared with topical medicines or procedures, but virus that stays in the surrounding skin means warts return in about 20–30% of people within the first 3 months.

This article explains the symptoms by location in women and men, how to tell warts from bumps that look similar, the medicines and procedures doctors actually use, and what to discuss with your partner. Having genital warts says nothing about who you are or whether anyone has been unfaithful. It is simply an infection that many people have been exposed to without knowing it.

What causes genital warts, and how are they spread?

Genital warts are caused by HPV entering the upper layer of skin cells through tiny breaks in the skin. There are more than 100 types of HPV. Types 6 and 11 cause warts, while types 16 and 18 are linked to cancer. A person can be infected with several types at once.

The virus spreads through skin or mucosal contact in the genital area with an infected person, including every form of sexual contact, and it can spread even when there are no symptoms. Most people who carry the virus never develop warts and are unaware of it. The body usually controls the virus on its own within 1–2 years. Catching it from a drinking glass, towel or toilet seat is very unlikely and is not the main route.

Factors that make warts more likely or longer-lasting include smoking, poorly controlled diabetes, pregnancy, HIV infection and the use of immunosuppressive medicines.

What do early genital warts look like?

Appearance: They start as small bumps 1–2 mm across, flesh-coloured, pink or light brown, either rough or flat. There may be a single spot at first, which gradually multiplies and merges into clusters resembling cauliflower or a cockscomb. The bumps are usually uneven in size and scattered. Most are painless; some people have itching, burning or bleeding with friction.

Cause: Skin cells infected with HPV multiply more than normal, thickening the skin into a bump. It takes about 3 months on average after exposure.

Severity/urgency: Not an emergency, but do not wait long, because the bumps can multiply, can be passed to a partner, and are easier to treat while there are only a few.

When to see a doctor: When you notice new bumps on the genitals, in the groin or around the anus, especially bumps that increase in number over 2–4 weeks. If you are unsure what kind of bump you have, see the overview at What causes bumps on the genitals?

Genital warts in women: vulva, vagina and cervix

Appearance: They occur on the labia, vaginal opening, vaginal wall, cervix, perineum and around the anus. Bumps on the outside can often be felt or seen in a mirror, while those inside the vagina or on the cervix usually cannot be seen and cause no symptoms. Some women have more discharge, itching or bleeding after sex.

Cause: Mainly HPV types 6 and 11. The skin here is thin and moist, so warts are often soft and can spread quickly.

Severity/urgency: Warts on the outside are not life-threatening. Warts on the cervix need further testing to rule out precancerous changes before treatment begins. The doctor will do a pelvic examination together with cervical cancer screening (Pap smear or HPV DNA test) on schedule, and colposcopy if a lesion is seen. Having external warts alone does not change the screening interval, but screening should be done on time.

When to see a doctor: Rough bumps on the labia or vaginal opening, abnormal bleeding, never having had cervical cancer screening or being overdue, or being pregnant.

Genital warts in men: penis, scrotum and urethral opening

Appearance: They occur under the foreskin, on the rim of the glans, on the shaft, on the scrotum, in the groin and at the urethral opening. Bumps on the dry skin of the shaft tend to be flat and thicker, while those under the foreskin tend to be soft and clustered. They vary in size and do not line up in rows.

Cause: Mainly HPV types 6 and 11. Minor friction in this area helps the virus enter the skin.

Severity/urgency: Mostly harmless. HPV testing is not routinely done in men, so diagnosis relies on examining the lesions directly. Warts inside the urethra can cause a split urine stream, blood in the urine or a feeling of obstruction, which need examination by a specialist.

When to see a doctor: Bumps that are scattered or increasing in number, blood in the urine or abnormal discharge, or your partner has been diagnosed and you see bumps you are unsure about.

Genital warts around the anus

Appearance: Rough bumps or soft lumps around the anal opening. They may itch, bleed when wiping or feel like a lump when sitting, and are often mistaken for haemorrhoids.

Cause: HPV can spread from nearby areas, so these warts also occur in people who have never had anal sex.

Severity/urgency: Moderate. Doctors often examine inside the anal canal (anoscopy) because warts can occur inside as well. Topical medicines used at home are not for warts inside. People with HIV should be followed more closely because they have a higher risk of precancerous changes in the anus.

When to see a doctor: Bumps that are clearly not haemorrhoids, repeated bleeding, pain when passing stool, or a lump that is hard and growing quickly.

Genital warts in the mouth and throat

Appearance: Soft, rough or finger-like white-pink bumps on the inner lip, tongue, palate or throat. They are usually painless.

Cause: Exposure to HPV types 6 and 11 through the lining of the mouth, including oral sex.

Severity/urgency: Low, but bumps in the mouth have many possible causes, and a lump that persists must be distinguished from other lesions. The doctor may take a biopsy and use excision or cryotherapy. Medicines made for the genitals are not used in the mouth.

When to see a doctor: Bumps in the mouth lasting more than 2 weeks, a sore that does not heal, or a lump in the throat that makes swallowing difficult. See an ENT doctor or a specialist dentist.

Genital warts during pregnancy

Appearance: Warts may grow quickly and become more numerous during pregnancy, bleed more easily than usual, and in many women shrink on their own after delivery.

Cause: Changes in local immunity and increased blood supply to the genital area. This does not mean the infection is new, since the virus may have been there long before pregnancy.

Severity/urgency: Every pregnant woman should consult her obstetric doctor. Podophyllotoxin and sinecatechins must not be used, and imiquimod is not recommended. Options that can be used are cryotherapy, trichloroacetic acid (TCA) or excision. Passing the infection to the baby is very rare, for example warts in the larynx, and caesarean section is not done specifically to prevent it. The doctor considers a caesarean when warts block the birth canal or there is a risk of heavy bleeding. HPV vaccination is not recommended during pregnancy.

When to see a doctor: As soon as you see new bumps during pregnancy, and tell your antenatal care doctor about any genital warts you have had before.

Warts with weakened immunity, and large lumps that need a biopsy

Appearance: Many warts, large size, fast growth, resistance to treatment, or a hard fixed lump with abnormal dark colour and ulceration. Giant condyloma (Buschke-Löwenstein tumour) is rare but can invade deep into tissue.

Cause: HIV infection, immunosuppressive medicines after an organ transplant, or illnesses that lower immunity, so the body cannot control the virus well.

Severity/urgency: Higher than ordinary warts. The doctor will take a biopsy when a lesion is unclear, abnormally coloured, hard, ulcerated, bleeds easily, does not respond to treatment, or the patient has weakened immunity, because it must be distinguished from precancerous lesions and genital skin cancer.

When to see a doctor: Book an examination within 1–2 weeks if a lump has these features. Do not wait and watch.

How long is the incubation period for genital warts?

The incubation period is commonly reported as about 3 weeks to 8 months, averaging about 3 months, and the virus can remain dormant without bumps for much longer. Some people picked up the virus years ago and only see warts when their immunity changes.

This matters for relationships, because the time warts appear cannot tell you when or from whom the infection was caught. Seeing warts now does not prove that either partner was unfaithful, and no current test can establish when infection happened.

Bumps that resemble genital warts: how far can the eye tell them apart?

Many bumps in the genital area are normal features of the skin or are other conditions that are treated differently. As a rough guide, if the bumps are rough, uneven in size and increasing in number, suspect genital warts. If they are neatly arranged, uniform in size and unchanged for months, they are usually normal. If they are clear, painful blisters that break into shallow sores, think of genital herpes, which is a different virus and is treated with oral antiviral medicines.

This guide is only for initial thinking. The final decision rests on examination by a doctor, because each type of bump is treated very differently, and putting wart-removing acids on normal bumps causes unnecessary sores.

Telling them from PPE and vestibular papillomatosis

Appearance: PPE (pearly penile papules) are bumps 1–3 mm across arranged in a row around the rim of the glans, found in about 14–48% of men. Vestibular papillomatosis in women consists of soft, rounded pink bumps arranged symmetrically at the vaginal opening.

Cause: Normal anatomy, unrelated to HPV or hygiene.

Severity/urgency: Not serious, not contagious and not cancerous, so no treatment is needed. Do not apply wart-removing medicines.

When to see a doctor: When you are unsure, or if bumps appear out of line and have a rough surface. The doctor may use a dermatoscope (dermoscopy) to help tell them apart.

Telling them from Fordyce spots

Appearance: Pale yellow spots 1–3 mm across, flat or slightly raised, numerous on the penile shaft, scrotum, labia or lips.

Cause: Normal oil glands showing through thin skin, usually more noticeable after adolescence.

Severity/urgency: Not a disease, not contagious, no treatment needed.

When to see a doctor: When the bumps change shape, hurt, ulcerate, or do not look like the smooth yellow spots described.

Telling them from skin tags

Appearance: Soft, flesh-coloured tags on a stalk, with smooth, not rough, skin. They occur in the groin, neck and armpits and usually do not multiply quickly.

Cause: Skin friction, body weight and age, not an infection. Read more at What causes skin tags?

Severity/urgency: Harmless and not contagious. They can be removed if they interfere with daily life.

When to see a doctor: A tag directly on the genitals, with rough skin, or several bumps increasing quickly, because genital warts with a stalk can look similar.

Telling them from molluscum contagiosum

Appearance: Round, smooth, shiny bumps 2–5 mm across with a dimple in the centre, flesh-coloured or pearly white. They usually appear in groups on the lower abdomen, pubic area and thighs.

Cause: A poxvirus, which is a different virus from HPV, spread by skin contact. Read more at How is molluscum contagiosum treated?

Severity/urgency: Harmless and usually clears on its own in 6–12 months in people with normal immunity, but it can spread to nearby skin, so doctors may treat it when it is in the genital area.

When to see a doctor: Widespread bumps, inflammation, or if you have weakened immunity.

Telling them from condyloma lata of secondary syphilis

Appearance: Flat, raised patches with a moist, smooth surface, grey or pink, around the anus or genitals. Some people also have a rash on the palms and soles, fever or swollen lymph nodes.

Cause: The syphilis bacterium (Treponema pallidum), not HPV.

Severity/urgency: Fairly urgent, because untreated syphilis affects many body systems, but it can be treated with penicillin. The doctor confirms with a blood test. This lesion should not be cauterised before the result is known.

When to see a doctor: Moist patches around the anus or genitals together with a body-wide rash. Be examined within a few days.

How do doctors diagnose genital warts, and is a blood test needed?

In most cases the doctor diagnoses from the appearance of the lesions, with dermoscopy when it is not clear, without a blood test or HPV test, because an HPV result does not change wart treatment. There is no blood test that shows genital warts, and a biopsy is used only when a lesion is unclear or looks suspicious. Women may have a pelvic examination, and people with lesions around the anus may have an examination inside the anal canal.

Doctors usually recommend testing for other sexually transmitted infections at the same time, such as HIV and syphilis, because the routes of infection are similar. This is standard for everyone with symptoms in this group and is not a judgement about behaviour. Test information is medically confidential, and you can choose to share only what is necessary for your care.

Can genital warts be self-treated, and can wart medicines from the pharmacy be used?

The straight answer is no, not before you have been examined. Over-the-counter wart medicines and wart-burning devices are not designed for genital warts.

• Wart-removing salicylic acid or lactic acid preparations (salicylic acid, lactic acid): These are made for warts on the hands and feet, where the skin is thick. On genital skin or mucosa they cause chemical burns, pain and scarring.

• Freezing sprays and wart-burning pens: The cold or heat cannot be controlled on thin skin, and they are not indicated for warts in this area.

• Strong acids, balms, herbal remedies, anti-itch medicines and steroid creams: They do not remove the virus, deep wounds become infected easily, and steroid creams can change the look of the lesion so that it is harder to diagnose.

• Tying off, cutting or picking at warts yourself: There is a risk of bleeding, infection and spread of the virus to nearby skin.

Another reason is diagnosis. A bump you think is a wart may be PPE, syphilis or a precancerous lesion. The only things patients can genuinely apply themselves are the prescription medicines in the next section, after a doctor has examined them and explained how to use them. Warts on the hands and feet are a different matter, covered at What causes warts?

Is there really a "wart root", and must it be pulled out completely?

Warts do not have roots like a plant. A wart is epidermis that has thickened because of infection. The virus lives in the upper skin cells, and there is no deep root thread that needs to be dug or pulled out. The tiny blood spots seen in some warts are just capillaries.

Warts come back because of virus lingering in normal-looking skin around them, not because the root was not pulled out completely. Picking or gouging deeper therefore does not reduce recurrence but only adds wounds and scars. The goal of treatment is to remove the visible lesions and let the immune system control the remaining virus. Products advertised as pulling out the wart root are based on a misunderstanding of the disease.

Prescription medicines for genital warts: names, doses and duration

All three of these medicines suit external warts that you can reach yourself. They are not used in the vagina, on the cervix, in the urethra or inside the anus. The clearance rates below come from studies that differ widely by location and patient group, so they are only a general picture.

Imiquimod 5% cream: Stimulates local immunity. Apply a thin layer at bedtime 3 times a week and wash off with mild soap after 6–10 hours, for up to 16 weeks. The 3.75% form is applied every night for up to 8 weeks. About half of users clear their warts, and results are usually seen after several weeks of use. Mild redness and irritation are common. If sores form or it is very painful, stop and consult a doctor. This medicine can weaken condoms. Success depends on consistent application and the location of the warts. Moist, thin skin responds better than thick skin.

Podophyllotoxin 0.5% solution or gel: Stops wart cells dividing. Apply only to the bumps twice a day for 3 days, then stop for 4 days, for no more than 4 cycles. Use on a total wart area of no more than 10 cm² and no more than 0.5 mL per day. About 45–75% clear. It may sting or cause temporary shallow sores. Must not be used during pregnancy. Success depends on applying it only to the bumps and on there not being too many warts.

Sinecatechins 15% ointment: A green tea extract with a medical indication. Apply a thin layer 3 times a day for up to 16 weeks. It does not need to be washed off, and you should not have sex while it is on the skin. About 50–60% clear. Not recommended in people with HIV, weakened immunity, genital herpes, or during pregnancy. This medicine is still not widely available in some areas.

Podophyllin resin is an old medicine and international guidelines no longer recommend it because of its toxicity. Oral antibiotics and oral antivirals have no effect on genital warts.

Procedures for genital warts performed by a doctor

Liquid nitrogen cryotherapy: Destroys infected cells with extreme cold. Repeated every 1–2 weeks, and many people need 3–6 sessions. About 45–75% clear. It can be used in pregnancy and suits a small number of warts on thick or dry skin. Blistering and stinging may last 1–2 weeks after treatment. Success depends on freezing to the right degree and attending all appointments.

Trichloroacetic acid (TCA) 80–90%: The doctor touches it onto the bumps only, once a week, for as many sessions as the response requires. About 55–80% clear. It suits small bumps on moist skin, can be used in pregnancy, and can be used for warts in the vagina or anus. Too much causes deep sores, so it must be done by a doctor only.

Electrocautery and surgical excision: Warts are removed in a single session under local anaesthetic. Suitable for large lumps, many warts or those resistant to medicines. The wound takes about 2–4 weeks to heal and may scar. Excision also gives tissue for testing, so it is better when a lesion is suspicious.

Carbon dioxide laser (CO2 laser): Uses light energy to vaporise wart tissue layer by layer under anaesthetic. It suits many warts or locations where other methods are difficult. Results vary between people and some need more than one session. Risks are pain, wound infection, scarring, skin colour change and recurrence. It is not suitable when it is not yet clear that the lesion is a wart and a biopsy is needed first, or when there is an active skin infection, in which case surgery is the better choice. Tell the doctor if you take blood thinners or have had keloid scars. Afterwards, clean the wound gently, apply medicine as instructed and avoid sex until healed. Smoke from lasers and electrocautery may carry viral particles, so it must be done in a room with smoke extraction and protective equipment. Assessment and the procedure must be in a doctor's hands.

How does the doctor choose a treatment for genital warts?

No single method suits everyone. The doctor considers location, number, size, skin type, pregnancy, immunity and how easily you can attend follow-up. A commonly used overview is:

• A few external warts on moist skin: Topical medicine used at home, cryotherapy or TCA.

• Warts on dry or thick skin, such as the penile shaft: Cryotherapy or excision.

• Warts in the vagina or anus: Cryotherapy, TCA or excision by a specialist doctor, with no topical medicine at home.

• Warts at the urethral opening: Cryotherapy or excision.

• Warts on the cervix: Colposcopy first to rule out precancerous lesions, then treatment together with a gynaecologist.

• Large or numerous warts: Electrocautery, excision or carbon dioxide laser.

Most respond within 3 months. If there is no clear improvement after 3 procedures or after the full 16 weeks of a topical medicine, the doctor usually changes the method and reviews the diagnosis at the same time. The choice of method, dose and prescription is a decision for the doctor who examines the patient only, and the medicine table in this article should not be used by yourself.

How often do genital warts come back?

Recurrence is common and does not mean the treatment failed. Most reports put it at about 20–30% in the first 3 months. Some reports that count over a longer period find about 30–70% within 6 months, depending on the treatment, how outcomes are counted and the patient's immunity.

Warts that return quickly usually come from the same virus that was lying dormant, not a new infection, and they are not a sign that your partner caught it elsewhere. What actually lowers the risk is to stop smoking, control diabetes or other chronic conditions, return for a check about 3 months after the warts clear, and examine yourself once a month so that you can treat while bumps are still small. The chance of recurrence falls as time passes, and the body usually controls the virus on its own within 1–2 years.

With no treatment at all, about 30% of warts may disappear on their own within 3–4 months, while the rest may stay the same or increase. Treatment therefore helps with symptoms and peace of mind, and reduces the amount of lesion in contact with a partner.

Does my partner need testing, and how should I tell them?

You should tell your current partner and encourage them to be tested, even if they have no symptoms, to see whether there are any lesions and to use the opportunity to test for other sexually transmitted infections. However, there is no HPV blood test that shows whether a partner carries the virus. A partner with no bumps does not need treatment, and there is no need to chase every past partner.

Partners who have been together a long time often already share the virus, so there is no need to work out who gave it to whom. A sentence you can use is: "The doctor says it is a wart from the HPV virus, which can lie dormant for months or years, so I would like you to be checked too." The doctor can help explain it to your partner if you wish.

Avoid sex while there are wounds from treatment, until the skin has healed. Condoms reduce transmission, by about 70% in one study when used every time, but they do not protect fully because the virus is also present outside the area a condom covers, and some medicines weaken condoms, so ask the doctor before using them together.

Are genital warts dangerous, and do they turn into cancer?

Warts from types 6 and 11 almost never turn into cancer, but a person with warts may also carry high-risk types. Women should therefore have cervical cancer screening on schedule, which is not because the warts will become cancer.

The more common effects are worry, embarrassment and the impact on relationships. If this disturbs your sleep or daily life, tell the doctor, because it is part of your care. The signs that call for prompt examination are a hard fixed lump, dark colour, a sore that will not heal, easy bleeding or rapid growth.

The HPV vaccine and preventing genital warts

The 9-valent HPV vaccine covers types 6, 11, 16, 18, 31, 33, 45, 52 and 58 and prevents about 90% of genital warts. It can be given to both women and men, starting from age 9. People who start before age 15 have 2 doses 6–12 months apart, and those who start at 15 or older have 3 doses at months 0, 1–2 and 6. The vaccine works best when given before exposure. It is recommended mainly up to age 26, and at ages 27–45 you should discuss it with a doctor individually.

The vaccine is not a treatment for existing warts, but it still protects against other types you have not yet acquired, so people who have had warts can still consider it. Besides the vaccine, consistent condom use, not smoking and testing for sexually transmitted infections when starting a new relationship also reduce risk. Genital warts in children should be assessed fully by a paediatrician.

In brief

• Genital warts are caused by HPV, and about 90% are types 6 and 11, which carry a low risk of cancer.

• Rough bumps of uneven size that are increasing suggest genital warts. Bumps in a row of equal size are usually PPE or normal features.

• The incubation period is about 3 weeks to 8 months, so the time warts appear does not show who they were caught from.

• Do not use over-the-counter wart removers on genital skin. The medicines actually used are imiquimod, podophyllotoxin or sinecatechins by doctor's prescription, and procedures by a doctor.

• Warts can return in about 20–30% within the first 3 months. Tell your partner to be tested, and women should have cervical cancer screening on schedule.

• What to do: have a doctor examine you before applying any medicine, and be seen promptly if a lump is hard, dark, ulcerated or you are pregnant.

Frequently asked questions about genital warts

Can genital warts be treated at home?

Not before you have been examined. Wart-removing salicylic acid, freezing sprays and wart-burning pens that you can buy yourself are made for warts on the hands and feet. Used on genital skin they cause burns and scars. A bump you think is a wart may be a normal bump or another condition. What patients can apply themselves are prescription medicines such as imiquimod 5% or podophyllotoxin 0.5%, after a doctor has confirmed the diagnosis and explained how to use them. If the warts are in the vagina, urethra or anus, only a doctor should treat them.

Are genital warts dangerous?

Generally not life-threatening, because about 90% come from HPV types 6 and 11, which almost never become cancer. But high-risk types may also be present, so women should have cervical cancer screening on schedule. Warts can still be passed to a partner and can grow large in pregnant women or people with weakened immunity. If a lump is hard and fixed, dark, a chronic sore, bleeds easily or grows quickly, have a doctor examine it promptly, and a biopsy may be needed, because it must be distinguished from precancerous lesions.

Can genital warts be cured?

Visible bumps can be removed with topical medicines or procedures, and most respond within 3 months, but no method can yet remove HPV directly from the body, so warts can return in about 20–30% within the first 3 months. Recurrence does not mean the treatment was wrong. The good news is that most people's immunity controls the virus on its own within 1–2 years. Keep your follow-up appointments, stop smoking, and treat early when you see new bumps.

How long is the incubation period for genital warts?

The incubation period is about 3 weeks to 8 months, averaging about 3 months, and the virus can stay dormant with no symptoms for years longer. Many people therefore cannot say when or from whom they were infected. Having only just noticed warts does not prove that either partner was unfaithful. If you have had a risk exposure and have no bumps, no test specific to warts is needed, but watch yourself for about 8 months and test for other sexually transmitted infections as appropriate.

What medicines are used for genital warts?

Doctors use three main groups: imiquimod 5% cream applied 3 times a week for up to 16 weeks; podophyllotoxin 0.5% applied twice a day for 3 days, then 4 days off, for no more than 4 cycles; and sinecatechins 15% ointment 3 times a day for up to 16 weeks. No oral medicine or antibiotic treats this type of wart. The doctor chooses the medicine according to the location and number of warts, and some people are better suited to cryotherapy or TCA.

Do genital warts itch?

Mostly they do not itch or hurt, so they are often found in the shower or during an examination. But some people have itching, burning, more discharge or bleeding with friction, especially with warts around the anus and large lumps. Not itching therefore does not rule the condition out. Conversely, severe itching without rough bumps may be a fungal infection, scabies or another rash, and painful burning blisters suggest herpes. Do not apply steroid cream yourself before a doctor has looked, because it changes the look of the lesion.

Related reading: for an overview of bumps in this area see Genital bumps: 10 types and how to tell them apart, for conditions that are hard to tell apart see genital herpes and molluscum contagiosum, for warts elsewhere see What causes warts?, and for soft tags see What causes skin tags?. Other skin condition articles are at All skin condition articles.

The information in this article is general knowledge, based on the CDC STI Treatment Guidelines and IUSTI-Europe, and is not a diagnosis or an individual treatment order. The choice of medicine, dose and procedure must be under the examination and care of a doctor.

Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed November 4, 2026

Warning: Carbon dioxide laser treatment carries a risk of not achieving the expected result and may cause harm or side effects. Results vary from person to person. It should always be assessed and performed by a doctor.