Genital Warts Or Monkeypox? Here's How To Tell The Difference

Both share a common symptom: lumps on your bits.
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Genital warts and monkeypox share a common symptom: lumps on your bits. So, how can you tell the difference between the two?

With monkeypox still circulating – as of last week the total number of cases confirmed in the UK was 3,340 – and genital warts being one of the most common sexually transmitted infections (STIs), it’s worth knowing the signs.

It can be difficult to tell the difference between the two, says Dr John McSorley, a consultant in genitourinary and HIV medicine and past president of the British Association for Sexual Health and HIV (BASHH).

“In general, a clinician familiar with both can recognise differences straight way but there can be uncertainty, even among professionals,” he tells HuffPost UK.

Genital warts are small fleshy growths, bumps or skin changes that appear on or around the genital or anal area. They are one of the most commonly Googled STIs, according to Chemist4U, with 110,000 average monthly searches.

Meanwhile monkeypox, which causes genital lesions that eventually scab over, is a lot less common. The current outbreak is predominately appearing in gay, bisexual and other men who have sex with men, though it’s not limited to these groups. It isn’t a STI, but rather an illness that spreads through close contact.

One of the key ways to tell them apart is that monkeypox tends to present alongside a general viral illness, whereas genital warts do not. “The person may already be feeling unwell with fever, muscle aching and aches and pains in the area where the lumps are appearing,” explains Dr McSorley of monkeypox.

Another way to tell the difference is in the lumps themselves and the way they look. “Monkeypox lesions appear quickly and tend to start as tiny pustules which then change daily, getting bigger and then forming a scab that heals,” explains Dr McSorley.

These lesions can be sore as they develop, and then itchy as they heal. The process is usually all over and healed within three weeks.

In contrast, genital warts, which are caused by a type of human papillomavirus (HPV), tend to develop extremely slowly, often over weeks or even months. Sometimes people don’t even notice them until they’ve been there a while. “They can be hard to distinguish when very small, but over time tend to become more clearly differentiated,” says Dr McSorley.

Warts may form into “small clusters of tiny cauliflower-like growths” or flatter lesions that have a “cobblestone appearance”, he adds. What’s more, they tend to be painless.

“They are not associated with any general systemic health symptoms, though some people may report some localised itching which can be annoying and/or bring the lumps to their attention in the first place,” he says.

Regardless of whether your downstairs lumps and bumps are genital warts or monkeypox, you should definitely speak to a sexual health professional who can advise on what to do next. In the meantime, sex should be off the cards until the bumps have gone.

With warts, the treatment route is typically a self-applied topical therapy in the form of cream or lotion, says Dr McSorley. These work to irritate the wart, ultimately leading to them disappearing.

“Additional therapies include cryotherapy (freezing), diathermy (heat), laser or, for large lesions, surgical removal,” he adds. “There are a range of options to suit most individuals that will be effective, though some people may not respond fully to the first choice.”

With monkeypox, the route to getting better is more about waiting it out – and not having sex or close contact with others while you do.

“Monkeypox lesions are generally self-resolving and self-healing as part of the viral illness runs its course,” adds the consultant.

“Rarely, a specific anti-viral, tecovirimat, may be used if the lesions are at a critical site – e.g. the eyes – or very extensive, or the person had additional health considerations.”

In some people, the monkeypox lesions may be a source of secondary bacterial infection and antibiotics may also need to be used. “But of course antibiotics are not effective against viruses such as monkeypox,” he adds.