Anal & Genital Warts
HPV is transmitted via genital skin-to-skin contact with a person who has HPV. Over 90% of adults carry at least one strain of genital HPV in their bodies, but not all strains cause visible symptoms, such as warts. Transmission can happen even when warts are not visible.
Because genital HPV is very common among all sexually active people, it may be challenging for sex workers who provide skin-to-skin genital contact to prevent exposure to HPV in a sex work setting. Staying up to date with Cervical Screening Tests (CST) and getting vaccinated against HPV can significantly reduce your risk of getting genital warts and HPV-related cancers, such as cervical cancer.
Understanding HPV
There are over 200 strains of HPV, and many cause no health issues at all. Some kinds of HPV can cause genital warts, and others can cause cancer of the cervix, vagina, vulva, or anus. Most people who have genital HPV will not show any symptoms and will naturally control or clear the virus.
There is no cure for HPV itself, but there are treatments for the health problems that HPV can cause, such as genital warts, cervical changes, and cervical cancer. Vaccination can protect you against the HPV types that cause genital warts and most cervical and other HPV-related cancers.
Signs and symptoms of HPV
HPV can often be asymptomatic, however anal and genital warts can develop 1 to 20 months after exposure. The appearance of warts does not indicate that you were exposed to HPV recently. You may have been exposed to HPV months or years before seeing the presence of warts. It can take up to 10 years for a high-risk HPV infection to develop into cancer.
Key characteristics of warts include:
- a rough, bumpy surface,
- usually flesh-coloured, white, or pink,
- can appear singular or in clusters; and
- some have tiny black dots (clotted blood vessels).
Skin tags can be mistaken for genital warts, however skin tags have a small stalk that attaches them to the skin. This makes them look different to warts, which tend to be flatter in appearance.
Vagina/vulva
Although HPV can present no symptoms at all, if signs or symptoms are present, there may be:
- a cluster that looks like a cauliflower
- a scatter of bumps that are darker than unaffected skin
- growths that may be raised, flat, smooth, or rough
- abnormal bleeding during vaginal sexual activity or when passing urine or stool.
Warts are usually indicative of low-risk (non-cancer-causing) HPV. There is a type of vulvar cancer that may present as cauliflower-like growths, so you should speak to a doctor if you see any unusual growths around the vulva.
Penis
HPV can present no symptoms at all. If signs or symptoms are present, there may be:
- a cluster that looks like a cauliflower
- a scatter of bumps that are darker than unaffected skin
- growths that may be raised, flat, smooth, or rough
- warts that appear on your scrotum or in your pubic hair
- abnormal bleeding when passing urine or stool.
Anus/rectum
HPV can present no symptoms at all. If signs or symptoms are present, there may be:
- a cluster that looks like a cauliflower
- a scatter of bumps that are darker than unaffected skin
- growths that may be raised, flat, smooth, or rough
- abnormal bleeding during anal sexual activity or when passing urine or stool.
What do anal and genital warts look like?
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How is HPV transmitted?
HPV is mainly transmitted through sexual contact, and most people are infected with HPV shortly after the onset of sexual activity. More than 90% of them clear the infection naturally.
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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).
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HPV is highly contagious if a wart is visible or if the skin on the wart has been broken, however HPV can still be transmitted when no warts are visible.
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It is also possible to transmit HPV from the genital area to the mouth, but this is uncommon.
There is growing evidence that HPV infection in the mouth and throat, transmitted through oral sex, is a major cause of throat cancer. For further information on HPV-related cancers see www.hpv.org.nz.
Getting tested for HPV
Below is some information about testing for HPV. You can view a list of sex worker-friendly sexual health clinics on our Where to Test resource.
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There is currently no approved CST for people who don’t have a cervix. If you are concerned that you might have HPV, speak to your doctor.
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If you’ve had vaginoplasty, you can still test for the presence of HPV and look for any changes to the vaginal cells.
What happens during the test?
Cervical Screening Tests are the best way to detect HPV if you have a cervix. Everyone who does a CST now has the choice of two options when testing:
- have a doctor or nurse collect the sample for you, by using a speculum and inserting a small brush into your vagina, or
- self collect the sample by inserting the swab provided to you by your doctor or nurse inside your vagina (there is usually a guide on the swab to indicate how far to insert it).
A speculum is a device that healthcare providers use to gently widen and hold open the vagina. This shouldn’t be painful, but may cause slight discomfort for the duration of the CST. To look at how a speculum is used, head to our bacterial vaginosis resource under the heading ‘What does BV look like’?.
Many people opt for a self-collected CST and have no issues. However, on the occasion that your result is inconclusive, you may be asked to return for a follow-up test collected by your practitioner.
For information about online sexual health testing, click here.
When should I get tested for HPV?
- If you or a partner develops bumps or warts in the genital area.
- If a sexual partner is diagnosed with genital warts or has any symptoms.
- All people with cervixes aged between 25 and 74 should get a CST every five years (instead of a Pap test every two years, which has been replaced by the CST).
- We provide additional information in our Cervical Screening Tests resource.
Anyone over the age of 25 with a cervix requires cervical screening, regardless of their hormonal history or gender identity. Here is some more information about navigating cervical screening.
What happens if I test positive for HPV?
One you test positive for HPV, it stays in your body until your immune system clears it. About 80% of infections resolve within 12-24 months via immune clearance, and, if they don’t, effective treatments are available (see below). If you have a high-risk strain, your doctor will talk you through what that means and what happens next.
What treatment options are available for HPV?
There are many treatments to remove warts depending on the size, number and location of warts. Be mindful that some treatments can weaken latex condoms and/or irritate the skin. Skin irritation or breakage can increase your risk of other STI.
The most common treatment for genital warts is one you can do yourself. Your health practitioner can prescribe you a medicated ‘paint’ called podophyllin. This is best suited for external warts that are easy to reach. Other treatments include freezing (cryotherapy), immune-boosting creams, or laser or surgical removal.
Other things to consider:
- Removing warts does not ‘cure’ HPV.
- It is common for HPV symptoms to come back after treatment. If this happens, you will need to treat it again.
- Treatment is also available after an abnormal CST result, depending on the type of cervical changes you have.
How much does treatment of HPV cost?
- Government-funded sexual health clinics are usually 100% free and confidential for everyone, including tourists and international students, regardless of Medicare status.
- If you see a GP, you may pay a fee or be bulk billed.
- Medicare card holders can access some newer online testing services for free such as Clinic66online, Clinic 365, or Shine (SA).
- If you are not covered under Medicare, you can access online testing services for a fee, which could be useful if you live in a rural area.
Will testing positive for HPV impact my ability to work?
Avoid having sex when you have genital warts you can see or feel, as this is when they are most contagious. If you have warts removed, it is recommended that you wait until the skin heals to have sex. Open sores increase your risk of other STI/BBV. While it is still possible to spread HPV when the warts are gone, their lower viral levels make transmission less likely. If possible, it is recommended that you avoid sex during treatment.
Legal considerations
Some states and territories have laws that criminalise sex work or sexual contact while you have an STI or BBV, so it’s worth having a look at our BBV, STI and the Law resource, or speaking to your local sex worker peer organisation.
How can I prevent transmission?
HPV spreads through skin-to-skin contact, which is often very much part of our work. However, there are ways to reduce the risk of transmission. Staying up to date with vaccination and cervical screening (below) is your best protection against HPV-related cancers.
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. Both 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.
Free HPV vaccination was introduced in Australia in 2007, so you may have been already vaccinated under the National Immunisation Program. People under the age of 19 can obtain two doses of the vaccine for free. If you are not eligible for a free vaccine, you may need to pay for it. Your doctor can give you the best information.
Some sexual health clinics may be able to vaccinate you for free. You can view a list of sex worker-friendly sexual health clinics on our Where to Test resource.
- The vaccines provide protection from HPV for people of all gender identities.
- The vaccines cannot ‘cure’ an existing infection of HPV.
- HPV vaccines offer the most protection if they are administered before a person is sexually active.
- Vaccination may still provide you with protection against strains of HPV that you have not been exposed to since you started having sex.
Safer sex strategies
Using protective barriers such as condoms, gloves and dams during bookings lowers the risk of transmission. When using personal protective equipment (PPE), only the area covered by a condom, glove, dam or other barrier is protected from the virus. If a client has visible warts, you are entitled to refuse the service or offer an alternative that avoids the affected area. Head to our ‘When Things go Wrong’ resource for guidance on managing this at work.
Cervical screening test (CST)
Some types of HPV can cause cancer. Regular cervical screening will detect the virus on the cervix, and early treatment will substantially reduce the risk of cervical cancer. Sexually active people who have a cervix aged 25 to 74 years of age should have a cervical screening test every five years until the age of 74. This is because the vaccine does not protect against all types of HPV that cause cervical cancer.
The CST is free for eligible people, but your doctor may charge their standard consultation fee for the appointment. Some doctors, clinics and health centres offer bulk billing, which means there are no out-of-pocket expenses.
See our Cervical Screening resource for more information.
For detailed information about the self-collected CST, click here.