What is Human Papilloma Virus (HPV)?
HPV is a large family of viruses that infect the skin, often causing irregular cell growth or
warts. There are more than 60 types of HPV. Some types of the virus are transmitted by nonsexual personal contact and cause common
skin warts. Several types of HPV are spread by sex and primarily infect the genitals or anal area. Of the sexually transmitted types,
some cause cancer and pre-cancerous changes of the cervix, anus, or the skin of the penis or female genitals. Other types cause warts
of the genitals or anal area. Genital warts are the most common symptoms of HPV infection. However, most HPV infections do not lead
to either warts or cancer; most infections go away by themselves, without causing any symptoms.
How common is HPV?
HPV infections are
believed to be the most common of all sexually transmitted diseases (STDs); most sexually active persons get at least one HPV infection,
usually without ever knowing it. At any time, somewhere around 20 million to 40 million Americans are infected with sexually transmitted
types of HPV, and the frequency of infection and disease appears to be increasing.
What are the symptoms of HPV?
Most HPV infections
cause no symptoms at all. However, some infections cause warts of the genital or anal areas and others cause cancer or pre-cancerous
changes.
Genital warts range from cauliflower-like growths that are easily seen to smooth bumps or flat, almost invisible
growths. Some warts are hard and rough and others soft and fleshy. They are painless, but may bleed easily or itch. Warts usually
remain small (less than a quarter inch in size), but very large warts (sometimes an inch or more across) sometimes occur if warts
are not treated when small. Warts are most common at sites of friction or rubbing during sex. Therefore, the most common sites in
women are on the labia minor or around the vaginal opening. In men, the head or shaft of the penis is most commonly involved. However,
warts commonly are seen in other areas, such as the anus, scrotum, or labia major. Anal warts are most common in gay men, but also
occur frequently in both women and heterosexual men. Warts usually appear a few weeks up to 3 months after catching HPV, but sometimes
warts may first appear many months or even a few years after catching the virus. Therefore, the appearance of warts doesn't always
mean recent sex with an infected partner.
Cancer and Related Problems
The types of HPV that cause cancer and pre-cancerous changes are
called "high risk" types. Most infections with high-risk HPV types do not lead to cancer; the immune system is able to remove the
virus before it causes problems. When it does occur, cancer takes time to develop. First HPV causes abnormal cells to grow. It usually
takes 5 years to 10 years, or even more, for cancer to develop. This is why Pap smears are so important for women; a Pap smear can
detect these abnormal cell changes so that they can be treated before they lead to cancer. At this stage, the disease is easily cured
by minor surgery to remove the abnormal cells. Therefore, a woman who gets regular Pap smears every one to three years is almost 100%
protected from getting cervical cancer. Research is going on to learn whether Pap smears of the anus might help protect men who have
sex with men from developing anal cancer. Other cancers due to HPV (cancer of the penis in men or vulva in women) are extremely rare
and usually show up first as a wart-like growths
How is HPV transmitted?
Genital HPV is only transmitted through skin-to-skin contact
during sex; infected skin of one-person rubs against the skin of the other person and transfers the virus. Almost all infections are
acquired through vaginal or anal intercourse, but rarely HPV may be transmitted by oral-genital sex. The male condom is not as effective
at preventing HPV transmission as it is for the prevention of other STDs; the male condom does not prevent all skin-to-skin contact
during sex. The female condom provides wider coverage and therefore might offer greater protection. Most infections do not have symptoms--no
warts or Pap smear abnormalities-- but transmission of the virus is possible even though there are no visible signs of infection.
Infants born to infected mothers may become infected, usually in the mouth or throat.
How do I avoid infection with HPV?
Because most
genital HPV infections do not have symptoms and millions of people already are infected, HPV infection is very difficult to prevent.
On the other hand, most HPV infections remain entirely silent and never cause serious health problems, so it may be less important
to avoid HPV than it is to prevent most other STDs.
· Abstinence from all sexual activity (not having vaginal, anal, or oral sex)
is the surest way to avoid becoming infected with HPV.
· The next surest way is to limit sexual contact to one uninfected partner
who only has sex with you (mutual monogamy). If either of you has ever had another sexual partner, it is likely that you could already
be infected with genital HPV and pass it to your partner.
· For those choosing to be sexually active, condoms should be used correctly,
and consistently to minimize transmission. Please Note: The male condom is not as effective at preventing HPV transmission as it is
for prevention of other STDs; the male condom does not prevent all skin-to-skin contact during sex. The female condom provides wider
coverage and therefore might offer greater protection.
· Avoid sexual contact with a new partner if you or your partner has untreated,
visible warts (or bumps that might be warts) on or near the genital area, or if either partner has newly diagnosed (untreated) Pap
smear abnormalities. However, it probably is not necessary to avoid sex with an ongoing partner. If you suspect that you might have
genital warts or other HPV infection (or any sexually transmitted disease), seek immediate medical care.
· Before having sex,
talk to your partner(s) about HPV and other sexually transmitted diseases. Negotiate a risk reduction strategy with them that feels
comfortable to both of you.
· You should notify your current sex partner if you have HPV. If you have newly diagnosed genital
warts, you should also inform any partners you had sex with in the 3 months before your warts appeared.
How do I find out if I have
HPV?
Genital warts usually are diagnosed just by examining them carefully; an experienced health care provider usually can tell whether
a bump is a wart by looking at it, sometimes using a magnifying glass.
A Pap smear can determine whether a woman has pre-cancerous
changes caused by HPV. A newly developed test for HPV itself sometimes is used to help determine how to treat women with Pap smear
abnormalities. However, testing for HPV is not recommended for healthy persons; there is no treatment for silent HPV infection and
most infections never cause health problems.
When a woman with Pap smear abnormalities has a further examination, a biopsy often is
done examine the tissues more carefully than is possible by the Pap smear itself. (A biopsy is the removal of a piece of tissue for
examination under a microscope.) Once in a while, a biopsy also is done for genital bumps or warts, especially if the diagnosis is
uncertain or the provider suspects cancer or a pre-cancerous lesion.
What is the treatment for HPV?
No treatment is recommended for
most HPV infections. Treatment is only recommended if there are visible warts or Pap smear abnormalities. No antibiotics or other
drugs kill HPV; treatment depends on destroying or removing abnormal tissues, such as warts, pre-cancerous cellular abnormalities,
or cancer itself. Even when these tissues are removed or destroyed, HPV often persists in surrounding areas. Therefore, although the
symptoms of HPV can be treated, HPV infections themselves usually cannot be cured. Most warts and pap abnormalities will eventually
go away on their own, even if not treated.
Several treatments are available for genital or anal warts. The best choice
depends on such things as the size and location or the warts, convenience, and cost. Patients should consult their doctors to determine
the best treatment for them.
There are two classes of treatment, those that are applied by the health care provider and those that
the patient can use at home. There are no approved "over-the-counter" treatments that do not require a prescription or treatment by
a health care provider. Never attempt to treat warts without a doctor's guidance.
Patient-applied Treatments:
The two main treatments
that can be used by the patient at home are Podofilox (Condylox™) and Imiquimod (Aldara™). Both are creams that are applied to the
warts. Podofilox chemically damages the wart and Imiquimod works by stimulating the body's immune system, which in turn destroys the
wart. Both require several weeks of repeated treatment and both can cause irritation and soreness of the treatment area. Pregnant
women must avoid both of these treatments.
Provider-applied Treatments:
The most common provider-applied treatments are:
· Freezing
the warts, usually using liquid nitrogen
· Trichloroacetic acid, which chemically "burns" the wart and
· Podophyllin resin,
which is similar to Podofilox but must be applied in the doctor's office.
All of these require several treatments over at least 2 or
3 weeks. Freezing usually works fastest, but can be somewhat painful. All three can cause soreness and irritation around the treated
area. Some warts are best treated by directly removing them with surgery or by destroying them with electrocautery (burning) or laser
treatment.
None of these treatments works in all cases; if the first treatment doesn't completely clear the warts, another method usually
is successful. With all methods, warts sometimes return and repeat treatment sometimes is needed. But also remember that most warts
will eventually go away on their own, even if not treated.
High-Risk HPV Infection
Infection with high-risk HPV types, usually diagnosed
because a woman has an abnormal Pap smear, is only treated by removing or destroying the infected tissues. The most common method
is a kind of office surgery called loop electrosurgical excision procedure (LEEP). If early cancer is present, more extensive surgery
may be necessary. The best treatment is determined by a specialist individually for each patient.
How does HPV effect pregnancy?
A mother
with genital warts (or with silent infection with the wart-cause types of HPV) can pass the infection to her infant during birth.
Genital warts sometimes enlarge during pregnancy. Some treatments may harm the baby in the womb and must be avoided during pregnancy.
Research
& Information for HPV.
HIV/STD Hotline: 209-572-2437
HIV/AIDS Program: HIVSTDInfo@scap4.org
CDC national STD/HIV hotline numbers:
800-227-8922
or 800-342-2437
Spanish 800-344-7432
TTY 800-243-7889
Websites:
National Institutes of Health Fact Sheet
Planned Parenthood: Human Papilloma Virus: The Facts
