Fewer than 1 percent of people who are infected with HPV develop symptoms. For those who do, the visible symptom is the external genital wart or warts, which look like the warts one might have on the hand: they are usually flesh colored or a little bit darker, and they are harder than the surrounding tissue. They can be raised or flat. The raised warts tend to have a cauliflowerlike appearance when looked at closely or with a hand-held lens. Warts may occur singly or in groups, often of varying size, and they may grow together to form larger warts. They do not hurt unless scratched or picked at, in which case they can become irritated. In about 20 percent of people they itch, and in 20 percent of people, they disappear on their own. They may remain the same size for some time, or they may continue to enlarge.
It can be difficult to know whether or not these “bumps” are warts, because the genital skin is somewhat irregular in appearance in most men and women anyway. Bumps can be a normal part of the genital anatomy—pearly penile papules in men, sebaceous cysts in men and women, or hymen remnants for women. An experienced health care provider can help determine whether the bumps are simply normal anatomy, are caused by HPV infection, or are due to another infection, such as molluscum contagiosum.
Warts can occur anywhere in the anal and genital area, as high up as the lower abdomen and as low down as the upper thighs. A man may have warts in the urethral opening, where they may or may not be noticed. Symptoms include urethral bleeding or discharge, or a change in the stream of urine, although generally warts in the urethra do not cause symptoms.
Women may have warts on the soft surfaces of the inner labia and vagina and on the cervix. Warts on the inner labia and vagina may be raised or flat. Warts on the cervix are usually flat. Internal warts may not be noticed by the woman and may only be revealed upon examination by a health care provider.
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