Genital Warts vs Skin Tags: Understanding the Difference

Genital warts and skin tags are benign growths affecting sensitive body areas that may raise concerns due to symptoms like pain and cosmetic deformity. These lesions may look the same to the untrained eye, but their causes and remedies differ. Importantly, one is more likely to transform into skin cancer than the other.

Patients may want to know more about these conditions or hesitate before consulting for treatment. However, delaying therapy may lead to complications. This article discusses the differences between genital warts and skin tags in terms of their appearance, causes, risk factors, clinical course, diagnosis, treatment, and prevention.

What Is a Genital Wart?

A genital wart, also known as condyloma acuminatum (plural: condylomata acuminata), is a benign lesion that can grow on the skin and mucosal surfaces of the private area. Genital warts are raised and either rounded (papule) or flat-topped (plaque). They have distinct edges and vary in color from skin tone to reddish brown.

Genital warts may appear as single or multiple lesions, with some fusing together to form bigger masses. Many have irregular surfaces, resembling a cauliflower. Sizes range from a few millimeters to more than 10 centimeters.

Condylomata acuminata that grow on dry skin areas usually have thick and tough surfaces. By comparison, lesions on moist mucosal regions are often soft and pale, with some appearing white. Mucosal lesions can grow as high up the cervix in women, penile urethra (lower urinary tract) in men, and anal canal in both sexes.

What Is the Main Cause of Genital Warts?

Genital wart formation arises from infection by the human papillomavirus (HPV). Over 150 HPV types have been identified. Types 6 and 11 cause most anogenital warts. These strains belong to the so-called “low-risk” groups because they are infrequently associated with cancer in people with good immunity. However, poor immune resistance and co-infection with other HPV strains can increase the risk of cancer in people infected with low-risk HPV.

“High-risk” HPV types include 15 variants, the most common being HPV-16 and HPV-18. These viruses are associated with premalignant warts and squamous cell carcinoma of the cervical, external genital, anal, and mouth regions.

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How Are Genital Warts Transmitted?

The most significant transmission route of anogenital HPV infection is by sexual contact. Mothers infected with the virus may also pass it on to their infants at birth or when caring for them with unwashed hands. Autoinoculation may occur when a person touches the genital wart and spreads the virus to other body areas. Sharing of underwear and swimwear with people with genital warts can also spread the infection from person to person.

Who Is At Risk for Developing Condyloma Acuminatum?

Risk factors for genital wart formation include having unprotected sexual contact, multiple sexual partners, and previous occurrences of other sexually transmitted infections, including HIV. Poor immunity, oral contraceptive use, and smoking also increase an individual’s risk of developing warts in the genital area.

Unprotected sex with a person with genital warts is associated with a 75% risk of genital HPV transmission and a 50% chance of developing condyloma acuminatum.

How Do Genital Warts Develop?

Genital HPV enters the body through small genital skin and mucosal abrasions. The virus infects the cells, which can remain normal for some time until the organism multiplies and causes abnormal cellular reactions. Low-risk HPV types normally replicate without affecting human DNA. However, high-risk viruses can insert their genetic material into human DNA, making cells cancer-prone.

People infected with genital HPV may be asymptomatic for the first 2-8 months. However, the risk of transmitting the virus during such latency periods is as high as 70%. Anogenital warts typically grow slowly. The lesions may not be noticeable until they become visible or palpable to a partner or cause symptoms like itchiness, pain with movement or sexual intercourse, or bleeding.  

What Can Happen if Genital Warts Are Left Untreated?

Anogenital HPV infection can involve both the skin and mucosal areas. Untreated condyloma can grow big enough to produce cosmetic deformity and obstruction in affected areas.

For example, growth in the urinary tract can produce bleeding or a burning sensation when urinating. Anal warts can cause pain or bleeding with defecation and constant anal discomfort. Mouth and throat lesions can result in difficulty chewing, swallowing, breathing, and speaking. 

An anogenital wart can impair sexual activity and produce a foul odor. Giant condylomata acuminata, often associated with poor immunity, may cause kidney disease due to severe urinary obstruction. Importantly, untreated genital HPV infection can give rise to external genital and cervical cancer, though malignant transformation of anogenital warts can take many years. Vaginal bleeding after sexual intercourse is a symptom of cervical cancer.

How Do Dermatologists Diagnose Genital Warts?

Highly trained board-certified dermatologists can easily identify genital warts by simply inspecting the private area during their physical examination. A biopsy is often unnecessary unless cancer is suspected, for example, when the lesion has unusual features or an immense size.

During history taking, the doctor may ask how the lesion evolved and if related symptoms have developed. They may inquire about potential risk factors to determine how patients can prevent further wart growth or transmission. Doctors routinely remind patients during clinic visits about safe sexual practices and smoking abstinence to control HPV disease.

The dermatologist may also take wart scrapings or tissue samples to identify the HPV type present and the risk of cancer development. HPV type determination can help the doctor decide if long-term cancer monitoring is necessary. Female patients may be given a gynecology referral to have a pap smear done to rule out cervical cancer. Evaluation for other sexually transmitted infections, including HIV, may also be performed. 

How Do You Get Rid of Genital Warts?

Treatment of this skin growth focuses on lesion removal but not HPV eradication. FDA-approved topical medications that may be prescribed for home use include the following:

• Podophyllotoxin, which disrupts the proliferation of infected skin cells
• Imiquimod, which boosts the skin’s immune reaction toward the virus
• Sinecatechins, which are green tea essences with immune-enhancing, antiviral, antioxidant, and anticancer properties

In-office genital wart treatment options include the following:

• Trichloroacetic acid application, which cauterizes the visible wart
• Cryotherapy, which freezes the wart tissue with liquid nitrogen
• Surgical excision, which entails manual wart removal under local anesthesia
• Laser treatment, which uses powerful light rays to burn the wart or its blood supply

Among these treatment options, disease control is often best achieved by in-office procedures, which dermatologists perform under strict protocols. Treatment-resistant and recurrent lesions usually require a combination of different procedures.

By comparison, home treatments have high failure and recurrence rates. Some lesions may be invisible or inaccessible under ordinary conditions, and some patients may not fully comply with the prescribed regimen.

About 30% of anogenital warts heal on their own within 4 months, usually in people with good immunity. However, treated and spontaneously resolving condyloma cases may recur within 3 months after resolution. Around one-third of patients develop chronically relapsing disease. Poor immune status and high-risk HPV infection increase the risk of genital wart recurrence and cancer development.

Can Genital Warts Be Prevented?

As with any other infection, HPV warts are preventable. Most condyloma cases arise as a sexually transmitted infection. Sexual abstinence is thus the most effective way of preventing disease spread.

Condom use is an option but is not 100% effective because these barriers do not cover all parts of the anogenital region. Additionally, condom protection benefits men more than women. Limiting the number of partners is also not 100% reliable, as condyloma has been documented in some patients with only one sexual partner within their lifetime.

HPV vaccination is another highly effective genital wart prevention method. The three HPV vaccine formulations currently available target at least HPV-16 and HPV-18. Two of these formulas immunize against HPV types other than 16 and 18. Studies show that HPV vaccines deter as much as 90% of HPV infections, 90% of genital wart formation, and up to 85% of cervical cancer development.

Other ways to prevent the spread of condyloma include practicing good hygiene, washing hands frequently (especially if caring for infants, children, and people with poor immunity), and avoiding sharing personal items with others. A C-section may prevent mother-to-infant genital wart spread but is only required if the lesion is blocking the birth canal.

What Is a Genital Skin Tag?

A skin tag is a skin lesion predominantly made of loose fibrous tissue. These benign growths, also called “acrochordons” or “fibroepithelial polyps,” commonly appear on skin folds in sites like the neck and armpits and occasionally in the genital area. Most skin tags are small, soft, skin-colored to slightly hyperpigmented, rounded masses attached to the skin surface with a stalk. Unlike genital warts, genital skin tags rarely affect mucosal surfaces.

Skin tags may appear singly or multiply. Lesion sizes vary from a few millimeters to 5 centimeters in diameter. Genital skin tags as long as 42 centimeters have been reported. Many giant skin tags arise in hormonally sensitive areas such as the genitalia. 

What Causes Skin Tags in a Private Area?

The cause of skin tag formation remains poorly understood. However, this skin problem is associated with type 2 diabetes mellitus, abnormal lipid levels, obesity, cardiovascular disease, some genetic disorders (e.g., tuberous sclerosis and Birt-Hogg-Dube syndrome), normal aging, and previous HPV infection. Excess sex hormone levels are linked to skin tag growth in adolescents and pregnant women. 

How Do Genital Skin Tags Form?

Skin tags grow in body sites with scanty elastic tissue and are frequently exposed to friction. Their appearance is believed to be influenced by cellular and tissue growth promoters like tissue growth factor (TGF) and epidermal growth factor (EGF). Growth factors are highly active in the presence of metabolic imbalance, as happens in obesity and diabetes.

Genital skin tags arise in skin regions responsive, not only to TGF and EGF, but also to sex hormones like estrogen, progesterone, and testosterone, which also promote cell growth. These sensitivities may explain why genital skin tags can grow excessively during pregnancy and adolescence, especially in people with obesity.

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Who Is At Risk for Developing Genital Acrochordons?

Skin tags mostly affect people with insulin issues, obesity, and related cardiovascular conditions. Adolescents and women of reproductive age are also prone to developing genital skin tags. Metabolic and hormonal imbalances promote cellular TGF and EGF production.

Skin tags affect both sexes equally. The lesions may appear as early as childhood but increase in occurrence with age.

Can Genital Skin Tags Cause Complications?

Small genital skin tags typically do not cause problems. However, big lesions, especially those with long stalks and bulky bodies, are prone to getting strangulated between clothes and the lower limbs when moving. These events cause unintentional trauma that may lead to inflammation, bleeding, or infection.

The risk of malignant transformation of genital skin tags is very low, even for large lesions. Skin tag removal is often performed for cosmetic reasons or when the mass is frequently traumatized, causing recurrent irritation and pain.

How Do Dermatologists Diagnose Genital Skin Tags?

Similar to genital warts, board-certified dermatologists can identify skin tags at a glance. They may look for possible contributing factors during the rest of the clinical evaluation, so they may ask about a patient’s medical history, pregnancy history, and others. The skin doctor may also document the patient’s body mass index.

A biopsy is rarely necessary unless the mass has atypical features, such as rapid growth, ulceration, rigidity, and irregular borders, which often signify cancer.

How Do You Get Rid of Skin Tags in Your Private Area?

Presently, no medical and at-home treatments are recommended for removing genital skin tags. However, dermatologists may perform the following procedures to get rid of the lesions:

• Electrodesiccation, which cauterizes the skin tag with an electric heating device
• Cryotherapy
• Laser treatment
• Surgical excision

Genital skin tags may disappear spontaneously if the inciting factor resolves, for example, after pregnancy termination. However, these lesions tend to recur posttreatment if the growth trigger remains unaddressed. Patients should leave skin tag removal in the hands of a proficient skin tag removal dermatologist and not attempt to remove the lesions at home, which can be dangerous.

How Do You Prevent Genital Skin Tags?

Skin tag occurrence is difficult to predict or prevent since the condition’s cause remains unknown. However, patients with skin tags may prevent further lesion formation by practicing good skincare habits and wearing loose clothing to reduce friction in skin fold areas. Controlling potential triggers, for example, by weight management, also helps.

How Do You Tell if It’s a Skin Tag or Genital Wart?

The table below summarizes the critical differences between genital warts and skin tags and may help you tell these conditions apart:

Prevention of any skin issue is ideal. However, the best way to address an unusual skin lesion is to have it checked by a board-certified dermatologist as soon as possible. Skin specialists are experts in identifying skin problems. Quick recognition helps patients treat skin conditions faster and avert complications.

What Can Be Mistaken for Genital Warts or Skin Tags?

Genital warts may be confused with the following skin conditions:

• Other wartlike infectious diseases occurring in the genitalia, such as molluscum contagiosum (smooth and with central markings) and syphilis-associated condyloma latum (a wet plaque)
• Genital herpes, a sexually transmitted infection marked by blister-like lesions
• Seborrheic keratosis, a condition of unknown cause signified by brown patches with greasy scales. Some lesions look like warts to the naked eye and must be distinguished microscopically.
• Genital mole, a hyperpigmented growth that may be flat or raised, benign or malignant
• Squamous cell carcinoma, a type of skin and mucosal cancer that often presents with ulceration and bleeding with slight trauma

On the other hand, genital skin tags may look like the following skin disorders:

• Filiform warts, which also have a stalk
• Genital moles
• Rare genital tumors like botryoid embryonal rhabdomyosarcoma (from malignant skeletal muscle tissue) and leiomyoma (benign tumor made of smooth muscle tissue)

Correctly identifying these lesions helps you and your healthcare provider determine the most appropriate treatment option.

When Should You See A Doctor About Genital Warts or Skin Tags?

Symptoms and signs that should prompt patients to have a skin lesion checked and treated include the following:

• Sudden color change
• Unusual colors like gray and blue
• Rapid growth
• Bleeding
• Ulceration
• Inflammation, pain, and itching
• Infection
• Functional impairment, for example, difficulty urinating, defecating, walking, chewing, and speaking
• Sexual impairment

While not all these manifestations indicate cancer, they can still affect one’s quality of life. Again, the best way to deal with a skin lesion is to have it checked and treated immediately by a board-certified dermatologist. 

Genital Warts vs Skin Tags: The Takeaways

Genital warts and skin tags are lesions that may look the same to the untrained eye but may be distinguished based on characteristic physical features, causes, risk factors, and potential complications. Both lesions are slow-growing, with big masses possibly causing obstructive symptoms, functional impairment, and poor quality of life.

However, genital warts are more frequently associated with cancer than skin tags. Quick identification and treatment are critical to prevent complications from both conditions.

Lastly, genital skin lesions should not be ignored because of the wide range of health disorders, from trivial to life-threatening, that their appearance may signify. If you or a loved one has a suspicious growth in a sensitive area, it’s best to have it checked by a board-certified dermatologist. Only a bona fide skin disease specialist can reliably and promptly diagnose and treat skin conditions.

FAQs

Does Having Genital Warts Mean You Have HIV?

No, it does not. However, sexually transmitted infections frequently occur together in the same individual who may pass them on to others simultaneously. Physicians normally screen for HIV and other sexually transmitted infections upon diagnosing genital HPV. Detection of a sexually transmitted infection can help healthcare providers promptly initiate treatment and measures that prevent complications and disease transmission.

Should You Worry About Genital Warts?

Most genital warts arise from low-risk HPV strains, which rarely produce big or cancerous lesions in people with robust immunity. However, condyloma’s frequent association with HIV and immunosuppression increases one’s risk of developing skin or mucosal cancer, even with low-risk HPV infection.

Additionally, the longer a genital wart persists, the greater the risk of transmission—to one’s partner or infant—and treatment failure. As in all other infections, the best way for patients to control anogenital warts is to have them examined and treated immediately.

Can HPV Infection Give You Skin Tags?

HPV infection is not the primary cause of skin tag growth. However, Gupta et al’s 2008 study detected a link between prior HPV infection and skin tag formation. Later investigations made by the groups of Haggag (2019), El-Askary (2019), and Kangabam (2023) substantiated the claim that HPV may have a role in the development of some skin tags.

Further research is needed to settle this debate. However, HPV’s ability to trigger abnormal skin and mucosal cell growth in warts is linked to the activity of the growth promoters EGF and TGF, similar to skin tag formation.

The Award-Winning Dermatologists of LA Are Ready to Help

If you or a loved one has a suspicious lesion in a private area, it’s best to have it checked and treated fast to avoid potential complications. In LA, the top skin disease specialists are here at BHSkin Dermatology.

Our clinic has some of California’s most trusted board-certified dermatologists. BHSkin Dermatology’s skin experts have helped many patients get rid of some of the most stubborn skin conditions. Visit us at our Glendale or Encino clinic or use our telederm platform for your consultation.

Book your appointment today!

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Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online