Anal or Genital Warts (Human Papillomavirus)

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Genital warts are small, hard lumps in the anal or genital area that are caused by the Human Papillomavirus (HPV). There are over 200 different strains of HPV that can affect different parts of the human body, cause visible warts, and cause cancer. 

Genital HPV is very common among all people who are sexually active. There are about 40 strains of genital HPV and over 90% of adults carry at least one strain of genital HPV in their body. Most people who have genital HPV will not show any symptoms and will keep the virus under control naturally. However, some types of HPV can cause warts to appear around the genitals, anus, inside the vagina, rectum, and urethra. The types of HPV that cause warts do not cause HPV-related cancer. 

Some types of HPV infections can cause changes to cells in the area that it has infected and can lead to cancer. Cancers can occur in the cervix, vulva, vagina, penis, anus, rectum, and the throat and usually happens over a number of years. Cervical cancer is the most common form of HPV-related disease. While anal cancer is a relatively rare form of cancer in the general population, the incidence of anal cancer has been steadily rising over a number of decades and gay and bisexual men, especially those who have HIV, are at particularly higher risk of developing HPV-related anal cancer. 

For sex workers who provide services that involve skin to skin genital contact, it may be very difficult to prevent being exposed to HPV in a sex work setting. However, staying up to date with cervical screening tests and getting vaccinated against HPV can greatly reduce your risk of getting genital warts and HPV-related cancers. 

HPV (Penile Warts)

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Transmission

  • Genital skin to skin contact with a person who has HPV (e.g. penis/balls to vulva, vulva to vulva, penis to penis, anus to balls). 
  • The virus is highly contagious if a wart is visible or if the skin on the wart has been broken. However, transmission can happen even when warts are not visible. 
  • Transmitting HPV from the genital area to the mouth is also possible though is very uncommon. However, there is growing evidence that HPV infection in the mouth and throat, transmitted through oral sex, is a major cause of throat cancer. 
  • Only the skin area covered by the condom, glove or dam is protected from the virus. 

As there is a long incubation period between being exposed to HPV and developing genital and anal warts, the appearance of warts does not indicate that you were exposed to HPV recently. It is possible that you could have been exposed to HPV months or years before seeing the presence of warts. 

Signs and Symptoms

HPV infection is diagnosed with the presence of warts. There is no blood or swab test available to test for the presence of HPV. However, HPV infection on the cervix may show up on a cervical screening test.

If you think you have warts, have been exposed to warts, or are worried about HPV, speak to your healthcare professional for an examination. 

Visible warts:

  • Found on the vulva, penis and around the anus.
  • Raised hard skin lumps, maybe cauliflower shaped, or flat and smooth. They are usually painless.
  • Warts can be single growths or in groups, which vary in size.

Invisible warts:

  • Not seen by the naked eye and are extremely common.
  • Present on the vulva, vagina, cervix, penis, foreskin, balls, around the anus and in the rectum.
  • Sometimes HPV can cause abnormal bleeding which may occur during vaginal or anal sexual activity or when passing urine or stool. Contact your local sexual health clinic or healthcare professional if this is occurring
  • People may not be aware they have anal or genital warts, as they are usually painless.

Treatment

  • Sometimes warts disappear spontaneously without treatment as a result of the body’s own immune response. 
  • There are many treatments to remove warts depending on the size, number and location of warts. The most common treatment is the self-application of a paint called podophyllin (particularly if warts are easy to reach). This is best suited for external warts. 
  • Other treatments include freezing (cryotherapy), immune boosting creams or laser or surgical removal. 
  • Removing the warts does not ‘cure’ HPV, though reduces its contagiousness. Recurrence rates are common.

Prevention

Vaccination

Getting vaccinated against HPV is the best way to protect against genital warts and other HPV-related illnesses. There are two types of vaccines available in Australia: Cervarix and Gardasil®9. Both of these vaccines provide immunity against 99%of all HPV types that cause genital warts and types 16 and 18, the HPV strains that cause 70% of cervical cancers. 

The vaccines provide protection from HPV for people of all gender identities. The new Gardasil®9 vaccine provides protection against 9 types of HPV strains that cause most types of warts and an additional 15% of all cervical cancers. In addition, it provides protection against other types of genital cancers, including anal, cervical, vaginal, vulval, penile and throat cancers. 

The vaccine cannot ‘cure’ an existing infection of HPV. As a result, it provides the most amount of protection from HPV and HPV-related illnesses if it is taken before a person is sexually active and has been exposed to HPV. However, as the Gardasil®9 vaccine provides protection against a number of different strains of HPV, it may still provide you with protection against strains of HPV that you have not been exposed to even if you take it after you have become sexually active. 

For children aged 12 -15 years of age, the Gardasil®9 vaccine is delivered in a course of two injections a minimum of 6 months apart. For people over the age of 15 years, the Gardasil®9 vaccine is delivered in three injections over a six month period.

Gardasil®9 is provided for children aged between 12-15 years of age for free as part of the National Immunisation Program. People under the age of 19 can also obtain two doses of the vaccine for free. For everyone else aged 20 and over, the vaccination is available at a cost from your healthcare professional. Some states may provide the vaccine for free for some ‘at risk’ groups. 

If you decide to get vaccinated, make sure you let your healthcare professional know in advance that you want to get vaccinated to ensure that they have the vaccine in stock. 

Cervical Screening Test

Some types of HPV may lead to precancerous skin cell changes on the cervix. Scheduled cervical tests will detect the virus on the cervix and early treatment will substantially reduce the risk of cervical cancer. 

It is highly recommended that anyone who has a cervix, has had any form of sexual contact, and is over 25 have cervical screenings every five years, even if you have received the HPV vaccine. This is because the vaccine does not provide protection against all types of HPV that cause cervical cancer. 

See Cervical Screenings for more information. 

Use of condoms and dams

Condoms and dams provide some protection from HPV transmission during sex; however, it cannot provide complete protection.  While they protect against transmission from areas of the skin physically covered by the condom or dam (e.g., the shaft of the penis, mouth, vagina, or anus), direct skin contact with other exposed skin areas (e.g., the testicles, vulva and buttocks) can transmit the virus at any time during sex. There is always a risk of HPV transmission for any sexually active person. This cannot be avoided no matter how careful you may be.