Caitlain's Corner

What is it?

HPV is a sexually transmitted infection that is caused by human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva, or anus, and the linings of the vagina, cervix, or rectum. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own.

Some of these viruses are called "high-risk" types (strains 16, 18, 31, 45), and may cause abnormal Pap tests. They may also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called "low-risk" types, and they may cause mild Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area, and sometimes are cauliflower shaped.

How prevalent is it?

HPV is by far the most common sexually transmitted infection. Approximately 20 million people are currently infected with HPV in the U.S. alone. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year.

How do you get it?

The types of HPV that infect the genital area are spread primarily through genital contact. Most HPV infections have no signs or symptoms; therefore, most infected persons are unaware they are infected, yet they can transmit the virus to a sex partner. Rarely, a pregnant woman can pass HPV to her baby during vaginal delivery. A baby that is exposed to HPV very rarely develops warts in the throat or voice box. Genital HPV is spread through skin-to-skin contact, not through an exchange of bodily fluid, so even casual sexual contact can spread the infection.

The strains of HPV that cause genital warts are usually different from those causing warts on other body parts, such as the hands or feet. You can’t acquire genital warts by touching the warts on someone’s hands or feet. Additionally, warts are not commonly found in the mouth, so many experts believe that transmission through oral sex is not as likely as with genital-to-genital or genital-to-anal contact.

Signs & Symptoms

Most people who have a genital HPV infection do not know they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis. In rare instances, HPV infection results in anal or genital cancers.

Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.

There are several normal conditions on the penis that resemble warts include, including Tyson's glands, Lymphoceles, Fordyce spots, and pearly penile papules, which appear in one out of three men.

Diagnosis and Treatment

Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. Also, a specific test is available to detect HPV DNA in women. The test may be used in women with mild Pap test abnormalities, or in women over 30 years of age at the time of Pap testing. The results of HPV DNA testing can help health care providers decide if further tests or treatment are necessary. There is no HPV diagnostic test for males at this time.

HPV infections that cannot be seen with the naked eye may be seen with a variety of clinical instruments

There is no "cure" for HPV infections, although in most women the infection goes away on its own. The treatments provided are directed to the changes in the skin or mucous membrane caused by HPV infection, such as warts and pre-cancerous changes in the cervix.

There are several chemicals that can be applied directly to genital warts. Podofilox and imiquimod are prescribed for use at home. A doctor applies other treatments, such as podophyllin, TCA, and BCA. Some treatments can cause discomfort. And some cannot be used during pregnancy.

Genital warts also may be removed with cryotherapy (frozen off). They may be electrocauterized (burned off). Or they may be removed with surgery or with lasers. Less commonly, they are treated with injections of interferon or 5-fluorouracil/epinephrine.

What is the connection between HPV and cancer?

All types of HPV can cause mild Pap test abnormalities which do not have serious consequences. Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to development of cervical cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with "high-risk" types of HPV is the main risk factor for cervical cancer.

A Pap test can detect pre-cancerous and cancerous cells on the cervix. Regular Pap testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer. The Pap test used in U.S. cervical cancer screening programs is responsible for greatly reducing deaths from cervical cancer. Approximately 14,000 women will develop invasive cervical cancer each year, and about 5,000 women will die from this disease. Most women who develop invasive cervical cancer have not had regular cervical cancer screening.

HPV is also believed to be responsible for some forms of cancer of the anus.

How can it be prevented?

Abstinence is the only 100 percent-effective way to avoid infection. Using condoms every time you have sex will reduce the risk of acquiring genital warts but they are not as effective against HPV as they are against more serious infections, such as HIV. You should strive to protect your immune system with a healthy lifestyle, and stop smoking. Smokers may be more likely to develop genital warts than nonsmokers. They are also more likely to have warts recur.

Finally, see your doctor about the new Gardasil vaccine . This vaccine prevents infection from a number of HPVs, including many associated with a higher risk of cervical cancer.

Resources for Additional Information

CDC
American Social Health Association
Planned Parenthood
The HPV Test

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