| HPV: Human Papillomavirus |
OVERVIEW
Human papillomavirus (HPV) is one of the most common causes of sexually
transmitted infection (STI) in the world. Health experts estimate there are more
cases of genital HPV infection than any other STI in the United States. According to
the Centers for Disease Control and Prevention (CDC), approximately 6.2 million new
cases of sexually transmitted HPV infections are reported every year. At least 20
million people in this country are already infected.
Genital warts
Genital warts (sometimes called condylomata acuminata or venereal warts) are the
most easily recognized sign of genital HPV infection. Many people, however, have a
genital HPV infection without genital warts.
Genital warts are soft, moist, or flesh colored and appear in the genital area within
weeks or months after infection. They sometimes appear in clusters that resemble
cauliflower-like bumps, and are either raised or flat, small or large. Genital warts can
show up in women on the vulva and cervix, and inside and surrounding the vagina
and anus. In men, genital warts can appear on the scrotum or penis. There are
cases where genital warts have been found on the thigh and groin.
CAUSE
More than 100 different types of HPV exist, most of which are harmless. About 30
types are spread through sexual contact and are classified as either low risk or high
risk. Some types of HPV cause genital warts-single or multiple bumps that appear in
the genital areas of men and women including the vagina, cervix, vulva (area
outside of the vagina), penis, and rectum. These are considered low risk types. High-
risk types of HPV may cause abnormal Pap smear results and could lead to cancers
of the cervix, vulva, vagina, anus, or penis. Many people infected with HPV have no
symptoms.
Some types of HPV cause common skin warts, such as those found on the hands
and soles of the feet. These types of HPV do not cause genital warts.
TRANSMISSION
Genital warts are very contagious. You can get them during oral, vaginal, or anal sex
with an infected partner. You can also get them by skin-to-skin contact during
vaginal, anal, or (rarely) oral sex with someone who is infected. About two-thirds of
people who have sexual contact with a partner with genital warts will develop
warts, usually within 3 months of contact.
In women, the warts occur on the outside and inside of the vagina, on the opening
to the uterus (cervix), or around the anus.
In men, genital warts are less common. If present, they usually are seen on the tip
of the penis. They also may be found on the shaft of the penis, on the scrotum, or
around the anus.
Rarely, genital warts also can develop in your mouth or throat if you have oral sex
with an infected person.
Like many STIs, genital HPV infections often do not have signs and symptoms that
can be seen or felt. One study sponsored by the National Institute of Allergy and
Infectious Diseases (NIAID) reported that almost half of women infected with HPV
had no obvious symptoms. If you are infected but have no symptoms, you can still
spread HPV to your sexual partner and/or develop complications from the virus.
DIAGNOSIS
HPV infection is usually diagnosed based on results from an abnormal Pap smear, a
primary cancer-screening tool for cervical cancer or pre-cancerous changes of the
cervix. Another test to diagnose HPV infection detects the HPV DNA, which may
indicate possible infection.
Your health care provider usually diagnoses genital warts by seeing them. If you are
a woman with genital warts, you also should be examined for possible HPV infection
of the cervix.
Your provider may be able to identify some otherwise invisible warts in your genital
tissue by applying vinegar (acetic acid) to areas of your body that might be infected.
This solution causes infected areas to whiten, which makes them more visible. In
some cases, a health care provider will take a small piece of tissue from the cervix
and examine it under the microscope.
TREATMENT
There are treatments for genital warts, though they often disappear even without
treatment. There is no way to predict whether the warts will grow or disappear.
Therefore, if you suspect you have genital warts, you should be examined and
treated, if necessary.
Depending on factors such as the size and location of your genital warts, your
health care provider will offer you one of several ways to treat them.
If you are pregnant, you should not use podophyllin or podofilox because they are
absorbed by your skin and may cause birth defects in your baby. In addition, you
should not use 5-fluorouracil cream if you are pregnant.
If you have small warts, your health care provider can remove them by one of three
methods.
If you have large warts that have not responded to other treatment, you may have
to have surgery to remove them.
Some health care providers inject the antiviral drug alpha interferon directly into
warts that have returned after removal by traditional means. The drug is expensive,
however, and does not reduce the rate that the genital warts return.
Although treatments can get rid of the warts, none get rid of the virus. Because the
virus is still present in your body, warts often come back after treatment.
PREVENTION
GARDASIL is the only vaccine that may help guard against diseases caused by
human papillomavirus (HPV) Types 6, 11, 16, and 18:
HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11
cause 90% of genital warts cases.
The only way you can prevent getting an HPV infection is to avoid direct contact with
the virus, which is transmitted by skin-to-skin contact. If you or your sexual partner
has warts that are visible in the genital area, you should avoid any skin-to skin and
sexual contact until the warts are treated.
Historically, research studies have not confirmed that male latex condoms prevent
transmission of HPV. Recent studies, however, demonstrate that consistent condom
use by male partners suggests strong protection against low and high risk types of
HPV infection in women. Unfortunately, many people who don't have symptoms don't
know that they can spread the virus to an uninfected partner.
COMPLICATIONS
Cancer
Some types of HPV can cause cervical cancer. Other types are associated with vulvar
cancer, anal cancer, and cancer of the penis (a rare cancer).
Most HPV infections do not progress to cervical cancer. If you are a woman with
abnormal cervical cells, a Pap smear will detect them. If you have abnormal cervical
cells, it is particularly important for you to have regular pelvic exams and Pap smears
so you can be treated early, if necessary.
Pregnancy and Childbirth
Genital warts may cause a number of problems during pregnancy. Because genital
warts can multiply and become brittle, your health care provider will discuss options
for their removal, if necessary. Genital warts also may be removed to ensure a safe
and healthy delivery of the newborn. Sometimes they get larger during pregnancy,
making it difficult to urinate if the warts are in the urinary tract. If the warts are in
the vagina, they can make the vagina less elastic and cause obstruction during
delivery.
Rarely, infants born to women with genital warts develop warts in their throats
(respiratory papillomatosis). Although uncommon, it is a potentially life-threatening
condition for the child, requiring frequent laser surgery to prevent obstruction of the
breathing passages. Research on the use of interferon therapy with laser surgery
indicates that this drug may show promise in slowing the course of the disease.
Human papillomavirus (HPV) is one of the most common causes of sexually
transmitted infection (STI) in the world. Health experts estimate there are more
cases of genital HPV infection than any other STI in the United States. According to
the Centers for Disease Control and Prevention (CDC), approximately 6.2 million new
cases of sexually transmitted HPV infections are reported every year. At least 20
million people in this country are already infected.
Genital warts
Genital warts (sometimes called condylomata acuminata or venereal warts) are the
most easily recognized sign of genital HPV infection. Many people, however, have a
genital HPV infection without genital warts.
Genital warts are soft, moist, or flesh colored and appear in the genital area within
weeks or months after infection. They sometimes appear in clusters that resemble
cauliflower-like bumps, and are either raised or flat, small or large. Genital warts can
show up in women on the vulva and cervix, and inside and surrounding the vagina
and anus. In men, genital warts can appear on the scrotum or penis. There are
cases where genital warts have been found on the thigh and groin.
CAUSE
More than 100 different types of HPV exist, most of which are harmless. About 30
types are spread through sexual contact and are classified as either low risk or high
risk. Some types of HPV cause genital warts-single or multiple bumps that appear in
the genital areas of men and women including the vagina, cervix, vulva (area
outside of the vagina), penis, and rectum. These are considered low risk types. High-
risk types of HPV may cause abnormal Pap smear results and could lead to cancers
of the cervix, vulva, vagina, anus, or penis. Many people infected with HPV have no
symptoms.
Some types of HPV cause common skin warts, such as those found on the hands
and soles of the feet. These types of HPV do not cause genital warts.
TRANSMISSION
Genital warts are very contagious. You can get them during oral, vaginal, or anal sex
with an infected partner. You can also get them by skin-to-skin contact during
vaginal, anal, or (rarely) oral sex with someone who is infected. About two-thirds of
people who have sexual contact with a partner with genital warts will develop
warts, usually within 3 months of contact.
In women, the warts occur on the outside and inside of the vagina, on the opening
to the uterus (cervix), or around the anus.
In men, genital warts are less common. If present, they usually are seen on the tip
of the penis. They also may be found on the shaft of the penis, on the scrotum, or
around the anus.
Rarely, genital warts also can develop in your mouth or throat if you have oral sex
with an infected person.
Like many STIs, genital HPV infections often do not have signs and symptoms that
can be seen or felt. One study sponsored by the National Institute of Allergy and
Infectious Diseases (NIAID) reported that almost half of women infected with HPV
had no obvious symptoms. If you are infected but have no symptoms, you can still
spread HPV to your sexual partner and/or develop complications from the virus.
DIAGNOSIS
HPV infection is usually diagnosed based on results from an abnormal Pap smear, a
primary cancer-screening tool for cervical cancer or pre-cancerous changes of the
cervix. Another test to diagnose HPV infection detects the HPV DNA, which may
indicate possible infection.
Your health care provider usually diagnoses genital warts by seeing them. If you are
a woman with genital warts, you also should be examined for possible HPV infection
of the cervix.
Your provider may be able to identify some otherwise invisible warts in your genital
tissue by applying vinegar (acetic acid) to areas of your body that might be infected.
This solution causes infected areas to whiten, which makes them more visible. In
some cases, a health care provider will take a small piece of tissue from the cervix
and examine it under the microscope.
TREATMENT
There are treatments for genital warts, though they often disappear even without
treatment. There is no way to predict whether the warts will grow or disappear.
Therefore, if you suspect you have genital warts, you should be examined and
treated, if necessary.
Depending on factors such as the size and location of your genital warts, your
health care provider will offer you one of several ways to treat them.
- Imiquimod cream
- 20 percent podophyllin antimitotic solution
- 0.5 percent podofilox solution
- 5 percent 5-fluorouracil cream
- Trichloroacetic acid (TCA)
If you are pregnant, you should not use podophyllin or podofilox because they are
absorbed by your skin and may cause birth defects in your baby. In addition, you
should not use 5-fluorouracil cream if you are pregnant.
If you have small warts, your health care provider can remove them by one of three
methods.
- Freezing (cryosurgery)
- Burning (electrocautery)
- Laser treatment
If you have large warts that have not responded to other treatment, you may have
to have surgery to remove them.
Some health care providers inject the antiviral drug alpha interferon directly into
warts that have returned after removal by traditional means. The drug is expensive,
however, and does not reduce the rate that the genital warts return.
Although treatments can get rid of the warts, none get rid of the virus. Because the
virus is still present in your body, warts often come back after treatment.
PREVENTION
GARDASIL is the only vaccine that may help guard against diseases caused by
human papillomavirus (HPV) Types 6, 11, 16, and 18:
- Cervical cancer
- Cervical abnormalities that can sometimes lead to cervical cancer
- Genital warts
HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11
cause 90% of genital warts cases.
The only way you can prevent getting an HPV infection is to avoid direct contact with
the virus, which is transmitted by skin-to-skin contact. If you or your sexual partner
has warts that are visible in the genital area, you should avoid any skin-to skin and
sexual contact until the warts are treated.
Historically, research studies have not confirmed that male latex condoms prevent
transmission of HPV. Recent studies, however, demonstrate that consistent condom
use by male partners suggests strong protection against low and high risk types of
HPV infection in women. Unfortunately, many people who don't have symptoms don't
know that they can spread the virus to an uninfected partner.
COMPLICATIONS
Cancer
Some types of HPV can cause cervical cancer. Other types are associated with vulvar
cancer, anal cancer, and cancer of the penis (a rare cancer).
Most HPV infections do not progress to cervical cancer. If you are a woman with
abnormal cervical cells, a Pap smear will detect them. If you have abnormal cervical
cells, it is particularly important for you to have regular pelvic exams and Pap smears
so you can be treated early, if necessary.
Pregnancy and Childbirth
Genital warts may cause a number of problems during pregnancy. Because genital
warts can multiply and become brittle, your health care provider will discuss options
for their removal, if necessary. Genital warts also may be removed to ensure a safe
and healthy delivery of the newborn. Sometimes they get larger during pregnancy,
making it difficult to urinate if the warts are in the urinary tract. If the warts are in
the vagina, they can make the vagina less elastic and cause obstruction during
delivery.
Rarely, infants born to women with genital warts develop warts in their throats
(respiratory papillomatosis). Although uncommon, it is a potentially life-threatening
condition for the child, requiring frequent laser surgery to prevent obstruction of the
breathing passages. Research on the use of interferon therapy with laser surgery
indicates that this drug may show promise in slowing the course of the disease.
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