context: Warts are caused by viruses and can appear anywhere on the body. Those that show up in the genital area are caused by the human papillomavirus, commonly called HPV, and are easily transmitted by sexual contact. HPV infection is the most common sexually transmitted disease ( STD) in North America. Certain forms of the virus can cause cervical, rectal, vulvar, vaginal, and penile cancer. According to the CDC, at least 50% of sexually active men and women will get a genital HPV infection at some point in their lives. After a person has been infected by HPV, it may take one to three months (or longer in some cases) for warts to appear. Some people who have been infected never get warts. Genital warts look like small flesh-colored, pink or red growths in or around the sex organs. The warts may look similar to the small parts of a cauliflower or they may be very tiny and difficult to see. They often appear in clusters of three or four, and may grow and spread rapidly. They usually are not painful, although they may cause mild pain, bleeding, and itching. Like many STDs, HPV does not always have visible symptoms. But when symptoms do occur, warts may be seen around the genital area. In women, warts can develop on the outside and inside of the vagina, on the cervix (the opening to the uterus), or around the anus. In men, they may be seen on the tip of the penis, the shaft of the penis, on the scrotum, or around the anus. Genital warts also can develop in the mouth or throat of a person who has had oral sex with an infected person. Because there is no way to predict whether the warts will grow or disappear, people who have been infected should be examined and treated, if necessary. Your doctor may perform the following tests to check for genital warts and/or related STDs: An examination of visible growths to see if they look like genital warts Application of a mild acetic acid (vinegar) solution to highlight less visible growths A complete pelvic exam and Pap smear (for women) A specialized test for high-risk HPV (low risk should not be screened for), collected in a way similar to a Pap smear Biopsy of cervical tissue ( if abnormal pap smear or visible abnormality) to make sure there are no abnormal cells that could develop into HPV-related cervical cancer; a cervical biopsy involves taking a small sample of tissue from the cervix and examining it under a microscope. Examination of the rectum Female patients may be referred to a gynecologist (a doctor who specializes in female reproductive health) for further testing and biopsy. Unfortunately, no treatment can kill the HPV virus that causes the genital warts. Your doctor can remove the warts with laser therapy or by freezing or applying chemicals. Some prescription treatments are available for at home-use. Surgery may be necessary for genital warts that are large or difficult to treat. Still, recurrence remains a problem. You may need to return to your doctor for more treatment. If you have genital warts: Keep the area as dry as possible. Wear all-cotton underwear. Man-made fabrics can irritate the area and trap moisture. Unfortunately, despite treatment, having high-risk HPV can increase your risk of cervical, rectal, and penile cancer. But not all forms of the virus are associated with these cancers. If you have genital warts, it is important to get annual check-ups to screen for cancer. Your best bet at preventing HPV infection and genital warts is to abstain from sex or limit sexual contact to one uninfected person. If that is not an option, condoms may provide some protection, but condoms are not 100% effective, because they do not cover the entire penis or surrounding areas. There are three vaccines approved to protect against HPV. Gardasil protects against infection from four strains of the HPV virus and offers modest protection against genital warts. Two of these strains, HPV-16 and HPV-18, account for about 70% of cervical cancers. The other two strains covered by the vaccine, HPV- 6 and HPV-11, account for about 90% of genital warts. The vaccine is approved for 9- to 26-year-old females and males. Gardasil-9 has been proven as effective as Gardasil for the prevention of diseases caused by the four shared HPV types (6, 11, 16, and 18). It also protects against five other strains of HPV virus (31, 33, 45, 52, and 58). It is 90% effective in protecting against cervical, vaginal and vulvar cancers in females, and anal cancer in females and males as well as protecting against genital warts. Cervarix is given only to females and also protects against HPV-16 and HPV-18. These vaccines do not treat pre-existing conditions.