Genital warts: When a small rash hints at something more serious

Unprotected sex with an infected partner or having multiple sexual partners increases the risk of genital warts transmission. [Courtesy]

It begins with a late-night Google search, followed by fear of the unknown: what are these rashes or small dots on my vagina or penis? What disease causes rashes in the private parts? For many, this ‘small rash’ or ‘black dots’ evolves into something far more persistent, perhaps mistaken at first for a minor irritation or an ingrown hair.

For many, this ‘small rash’ develops into something more enduring. Genital warts are caused by the Human Papillomavirus (HPV), although it should be noted that not all forms of HPV cause warts. Arguably, genital warts are among the most common sexually transmitted infections (STIs) globally, yet they remain shrouded in myths about who carries them and how they are treated.

Genital warts are not merely skin-deep. People who have been infected describe them as growths with a ‘cauliflower-like’ appearance or as small black or brownish dots. They may also appear as individual stalks or tiny clusters, and their location is what gives them their name.

According to the Cleveland Clinic, warts are contagious because HPV is contagious. The virus can spread through direct or indirect contact. Direct contact includes touching someone else’s wart or skin-to-skin contact during sexual activity. Indirect contact may involve using objects such as towels or razors that have come into contact with a wart or the virus. Unprotected sex with an infected partner or having multiple sexual partners increases the risk of transmission.

In men, these lesions typically appear on the shaft of the penis, the scrotum or the groin area. They may take a long time to become noticeable, depending on how the virus manifests. In women, the situation can be more complex; warts may develop on the vulva, the vaginal walls or even inside the cervix.

“It depends on where they grow,” notes Dr Boniface Otieno of Ivory Hospital. “For women, these growths can sometimes become large enough to obstruct the birth canal, making even routine examinations or delivery difficult and potentially requiring surgical intervention.”

There is a persistent notion that men are the primary ‘carriers’ of the virus while women are the victims. The reality is more equal: anyone who is sexually active can contract and spread HPV.

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While having multiple partners is a known predisposing factor, the virus is highly contagious. Because it spreads through skin-to-skin contact, even the use of protection, such as condoms, does not offer complete security, as the virus can be present on areas of skin not covered by a condom.

For many patients, the discovery of any unusual skin growth in the genital area triggers immediate alarm. However, medical experts are quick to draw a clear distinction between common skin tags and the viral nature of HPV.

Dr Boniface Otieno notes that skin tags are frequently and incorrectly linked to genital warts in the public imagination. This confusion often leads to unnecessary anxiety. According to Dr Otieno, the presence of skin tags is rarely an indicator of a sexually transmitted infection. “A very young child, even at the age of eight, can develop skin tags without ever having been sexually active or exposed to genital warts,” says Dr Otieno. “Skin tags tend to be genetic and have absolutely nothing to do with the virus.”

Unlike warts, which are caused by a highly contagious virus, skin tags are benign growths often linked to heredity or simple skin friction. While genital warts require medical intervention to prevent their spread, skin tags are primarily a cosmetic concern and do not indicate a lapse in sexual health.

One of the most sobering realities of genital warts is that while the symptom (the wart) can be treated, there is currently no cure for the virus itself. Treatment focuses on removing the physical growths through several methods:

Chemical cauterisation: Using agents such as podophyllin (often referred to colloquially as ‘Podosol’). This ‘paint’ burns off the wart but requires precision; healthy skin must be protected with a barrier such as petroleum jelly to avoid chemical burns.

Cryotherapy involves freezing the warts with liquid nitrogen, causing them to harden and eventually fall off. Laser therapy is often recommended for larger or more stubborn internal warts, using concentrated light energy to destroy the affected tissue. In some cases, excision may be necessary, where the warts are surgically cut away to remove the growth completely.

If you have had warts treated, are you in the clear? Not necessarily. Like other latent viruses, HPV can remain in the body. “It’s not necessarily like HIV, but the virus stays there,” explains Dr Otieno. “If your immunity is suppressed due to stress, illness or other underlying conditions, the warts can reappear years after the initial treatment.” Conversely, a robust immune system can sometimes suppress the virus so effectively that small warts may disappear on their own without intervention.

A common misconception is that the HPV vaccine is useless once a person becomes sexually active. While the vaccine is most effective when administered to young people (typically aged 9–14) before any exposure to the virus, medical consensus has shifted to suggest that even adults who are already sexually active can benefit from the vaccine. Although it will not treat an existing infection, it can protect against other high-risk strains of HPV that the person has not yet encountered, including those linked to cervical, anal and throat cancers.