Vaginal warts are soft bumps on the labia, at the vaginal opening, on the perineum or around the anus. They come from HPV, almost always type 6 or 11 (Steben, 2014). Those types do not cause cancer.
And now the confusion we meet most often. The smear from the national screening programme looks for high-risk HPV. Those are different types. So you can get a result saying "no HPV found" and still have warts.
That is not an error in the test. The test simply looks for something else. Below we set out what is what.
What are vaginal warts?
Vaginal warts, also called genital warts or condylomas, are benign skin growths. They arise from low-risk HPV, usually type 6 or 11. They sit on the labia, at the vaginal opening, on the perineum or near the anus. Sometimes they sit inside the vagina, where you cannot see them yourself.
They are harmless, which does not make them pleasant.
Each year 160 to 289 new cases of genital warts appear per 100,000 people, and in women the peak falls before age 24 (Patel, 2013). So you are in good company, even if it does not feel that way.
What do vaginal warts look like?
They are small, soft and skin-coloured to pinkish red or greyish white. Usually they sit in clusters. They generally do not hurt, though they can itch or feel burning from friction. A single wart is a few millimetres across, but several can merge into a rough patch.
They feel firm, not moist. Painful blisters point more towards herpes.
The full comparison with other bumps sits in what genital warts look like, and the broader differential in bumps or blisters on your genitals.
Does the cervical smear find vaginal warts?
No. The Dutch cervical cancer screening programme run by RIVM looks for high-risk HPV in cells from the cervix, mainly types 16 and 18. Vaginal warts come from low-risk HPV, types 6 and 11. Those are different types, and the test does not look for the ones that cause warts.
This is where most women get stuck, and understandably so.
Picture this: you are 32 and last month your smear came back with "no high-risk HPV found". This week you see two bumps on your labia. That is not a contradiction and it is not a lab error. The test looked for types 16 and 18. Your bumps most likely come from type 6 or 11. Two different questions, two different answers.
| Your question | Smear or self-sampling kit | Blood or urine test with us |
|---|---|---|
| Do I have high-risk HPV (types 16, 18)? | Yes, that is exactly what it is for | No |
| Do I have low-risk HPV (types 6, 11), so warts? | No, it does not look for that | No |
| Are these warts or something else? | No, a doctor assesses this by looking | No |
| Do I have chlamydia, gonorrhoea or trichomonas? | No | Yes, PCR on urine |
| Do I have HIV, syphilis or hepatitis B? | No | Yes, Viral Infections Package |
In short: a negative HPV result from the screening programme means no high-risk HPV was found. It says nothing about warts. The reverse holds too: high-risk HPV found does not mean you will get warts.
Can you get vaginal warts with a steady partner?
Yes. HPV can sit quietly in the skin for years before anything becomes visible. A wart appearing now can stem from an infection long ago. So it is no proof that anyone cheated, however tempting that conclusion is.
We say this emphatically, because we see what it does when people do not know it.
Research into the natural course in young women shows HPV infections come and go, and that the immune system usually clears them (Ho, 1998). A condom clearly lowers the risk: with consistent condom use researchers saw 37.8 infections per 100 patient-years, against 89.3 with rare use (Winer, 2006). That is a substantial drop, but not zero, because a condom does not cover all the skin.
Vaginal warts and pregnancy
Warts can grow faster or become more numerous during pregnancy. That is down to changes in your immune system and blood flow. It is usually not dangerous for the baby, but it is worth discussing with your midwife or GP, because some treatments are not used during pregnancy.
So do not treat on your own with a product left over from an earlier episode.
Which STI checks are common in pregnancy is covered in STI testing during pregnancy.
What can you have checked?
The STIs you cannot see. Chlamydia and gonorrhoea frequently run without symptoms in women and can damage the fallopian tubes over time. Those test well. Syphilis and HIV sit in the blood. A wart does not rule those infections out, which is exactly why you treat them as separate questions.
The wart goes to the GP. The rest goes to the lab.
Thuisarts.nl describes the treatment options for warts, from a cream to freezing. If you want to rule out the silent infections at the same time, you can do that with the chlamydia, gonorrhoea and trichomonas test or the Viral Infections Package. More context sits in STI testing for women and in our hub on genital warts and HPV.
References
- Steben M, Garland SM. Genital warts. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1063-1073. PMID 25155525.
- Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998;338(7):423-428. PMID 9459645.
- Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354(25):2645-2654. PMID 16790697.
- Patel H, Wagner M, Singhal P, Kothari S. Systematic review of the incidence and prevalence of genital warts. BMC Infect Dis. 2013;13:39. PMID 23347441.
- RIVM. Cervical cancer screening programme. Available via rivm.nl.
- Thuisarts.nl (NHG). I have genital warts. Available via thuisarts.nl.
This information is general and does not replace personal medical advice. Every STI test result at Discreet Test is reviewed by a BIG-registered doctor. Always discuss symptoms or treatment decisions with your GP, the GGD or a Centre for Sexual Health.
Author
