What do genital warts look like? How to recognise them

Genital warts are soft, skin-coloured to greyish white bumps a few millimetres across. They often grow in clusters and usually do not hurt. Sometimes they are flat, sometimes they stick out and look like a tiny cauliflower. That last image is the most famous, but it is not the most common.

Most people see something far less dramatic. One or two bumps, skin-coloured, easy to miss in the shower.

Here is what strikes us about the questions we get: people search for photos, take fright at the worst examples, and then conclude they do not have it. Or that they do. Images alone are a poor guide. What you need is the pattern.

What do genital warts look like?

A genital wart is usually small, soft and skin-coloured. The colour runs from skin tone through pinkish red to greyish white. They are rarely larger than a few millimetres each, though clusters can merge into a bigger patch. They feel rough or grainy, not moist or filled with fluid.

That last point is the key clue. Warts are firm. Blisters are not.

Picture two people of 25 who each see 3 bumps of 2 millimetres. For one they are dry and grainy and do nothing. For the other they are moist, they stung for two days before appearing, and they hurt. Same number, same size, different story. The first fits warts, the second fits herpes.

Genital warts are almost always caused by HPV type 6 or 11, two low-risk types that do not cause cancer (Steben, 2014). They are not rare either: 160 to 289 new cases per 100,000 people appear each year (Patel, 2013).

Where do they usually sit?

Genital warts sit where skin meets skin during sex. In men that is often the shaft or head of the penis, the foreskin, or the skin around the anus. In women it is the labia, the vaginal opening, the perineum and the anal rim. They can also sit inside the vagina or anal canal, where you cannot see them yourself.

So they are not always somewhere you can check in a mirror.

The picture differs per location. We describe that separately for genital warts on the penis, for vaginal warts and for warts around the anus.

Wart, or something else?

Four things get mistaken for genital warts most often: a herpes blister, a syphilis ulcer, molluscum contagiosum and pearly penile papules. The difference sits in the shape, the pain and the course. And there is a practical difference: some of these can be tested, others cannot.

Of those four, the syphilis ulcer is the most dangerous to miss. It does not hurt and it disappears on its own, but the infection stays. More on that in syphilis: stages and early signs.

Do genital warts hurt?

Usually not. Genital warts are typically painless. What does happen is itching, a burning feeling or irritation from friction, for example during sex or with tight clothing. Sometimes a wart bleeds a little when it gets damaged. Persistent pain fits herpes better than warts.

Itching without visible bumps often has a completely different cause. We explain that in itching and irritation down there.

Can a test confirm they are warts?

No. No blood test and no urine test finds HPV or genital warts. Our panels do not either. HPV lives in skin cells, not in your bloodstream. A GP, GGD doctor or dermatologist makes the diagnosis by looking, usually in a single consultation. Thuisarts.nl describes how that conversation goes.

That is the honest version, and you do not often hear it from a test provider.

What a test can do is rule out something else. Herpes and syphilis show up in blood. And chlamydia and gonorrhoea often run without symptoms, so you can have them without seeing anything. If a bump has already got you thinking, that is a logical moment for a chlamydia, gonorrhoea and trichomonas test.

What do you do now?

Have the bump looked at by your GP. That is the only way to know for sure whether it is a wart, and it costs one appointment. Comparing photos online mostly produces anxiety. We see that every week in the questions that come in.

If you also want to know whether something else is going on, have chlamydia and gonorrhoea checked. The full picture of HPV sits in our hub on genital warts and HPV. The virus itself does not sit in a test tube. The rest of your questions sometimes do.

References

1. Steben M, Garland SM. Genital warts. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1063-1073. PMID 25155525.
2. 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.
3. Giuliano AR, Lee JH, Fulp W, et al. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Lancet. 2011;377(9769):932-940. PMID 21367446.
4. RIVM. Genital warts. Available via rivm.nl.
5. 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.