When should I consider referring a patient with genital warts to a specialist?

Consider referring a patient with genital warts to a sexual health specialist if:

• The diagnosis is uncertain.
• There are recurrent perianal warts.
• There are accompanying urinary symptoms such as haematuria or abnormal urine stream.
• There is suspected malignancy or intraepithelial neoplasia.
• The patient is immunosuppressed, including those with HIV.
• There are present or suspected cervical, intrameatal, or intra-anal warts.
• The patient is pregnant.
• The patient is a child or elderly.
• There is concern about possible sexual abuse in children, especially those under 13 years old.

If referral to a sexual health specialist is not possible or declined, management in primary care is acceptable only if the diagnosis of external genital warts is confident and the necessary expertise and resources for comprehensive assessment, treatment, and STI screening are available.

Screening for co-existing sexually transmitted infections is essential, particularly in people younger than 25 years and those with other genital symptoms.

Follow-up after treatment completion is recommended to monitor success and consider further therapy or referral if treatment response is inadequate.

Referral for counselling should be considered if the patient experiences psychological distress.

These recommendations are based on the British Association for Sexual Health and HIV (BASHH) UK national guidelines and related UK clinical guidance.