Genital warts are a sexually transmitted infection caused by a virus called the human papillomavirus (HPV). Genital warts are a common sexually transmitted infection in the UK with around 75,000 new cases in 2010. Though younger people tend to be more frequently affected, anyone who is sexually active may be exposed to the genital wart virus.

Some forms of HPV can lead to cervical or anal cancer. This risk is higher in people with HIV because there is more chance that the virus will become re-activated due to loss of immunity.

It is worth emphasising that both cervical and anal cancer are rare in people with HIV.

The genital wart virus can be contracted during unprotected anal, vaginal or oral sex. It can also be transmitted by close physical contact with the genital warts themselves, as these may shed the virus.

Using a condom for anal, vaginal and oral sex offers a degree of protection from infection with genital warts, or from passing on the virus to somebody else. People who are sexually active are advised to have regular sexual health check-ups, where genital warts can be diagnosed if present, and tests for other sexually transmitted infections performed. Most HIV treatment centres have an associated sexual health clinic where free and confidential treatment can be obtained without referral from your GP or your HIV doctor.

Two vaccines have been approved that offer protection against certain strains of HPV that have the highest risk of cervical cancer. Vaccination is currently only available to teenage girls. 

Research is underway to see how effective the vaccine is in other groups. One study showed that one of the vaccines was highly effective at preventing pre-cancerous anal cell changes in gay men.

There are no recommendations about the use of these vaccines in people with HIV.

There have been reports of some people with HIV paying to obtain private vaccinations. If you are considering this then make sure that you have a blood test to see if you are already infected with the strains of HPV the vaccine is meant to protect against. If you are already infected with these strains, then vaccination will not be effective. If you are considering paying for a private vaccine, talk to your HIV doctor first.

Genital warts look just like warts which may appear on other parts of the body – usually small nodules with a slightly rough texture.

Some people who contract the wart virus do not have symptoms, however, or else do not notice the presence of warts. In women, warts may appear on the inside or outside of the vagina, on the neck of the cervix, or around the anus. In men, warts may appear on the tip or shaft of the penis, or around the anus.

Some forms of the genital warts virus are associated with an increased risk of cervical or anal cancer. However, these are not the most common form of the virus. Strains 16, 18, 31, 33 and 35 are associated with the development of genital cancers.

Genital warts are diagnosed by visual and manual examination of the genital and anal area.

A screening test is used to detect pre-cancerous cellular changes called dysplasia early, before cancer develops. This is called cervical cytology, but is often referred to as a cervical smear or a Pap smear. The test involves taking a small scraping of cells from the cervix. When these cells are examined under a microscope, it is possible to see if there are any changes in the cells which suggest there is a risk that cervical cancer could develop in the future.

HIV-positive women are recommended to have cervical screening when they are first diagnosed with HIV, six months later, and then at least once a year.

Screening of the anal canal for pre-cancerous cells is under investigation, and some people recommend that gay men with anal warts should receive regular assessment, although there is a need for further research to see how effective this would be.

Blood tests can also be used to see if you have been infected with HPV.

In most cases, the immune system naturally clears infection with HPV.

None of the available treatments can cure genital warts. Treatment involves either the warts being painted with a chemical which burns them, freezing, laser surgery or an immune stimulating cream called imiquimod. These procedures may feel a little uncomfortable.

The HPV vaccines do not treat pre-existing HPV infection.

When genital warts are diagnosed you may be referred to see a health adviser. Health advisers can give you information about safer sex and how to protect your own and other people’s sexual health. They may also be able to help you, where possible or practicable, to contact your sexual partners so they can be tested or treated if necessary. In turn this is intended to prevent you from becoming infected with a sexually transmitted infection through continuing to have sex with someone who is themselves infected.