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HPV
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Human
Papillomavirus and Genital Warts
WHAT IS HUMAN PAPILLOMAVIRUS?
Human papillomavirus (HPV)
is one of the most common causes of sexually transmitted infection
(STI) in the world. More than 100 different types of HPV exist,
most of which are harmless. About 30 types are spread through sexual
contact. 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. Many people infected with HPV have no symptoms.
There are high-risk and
low-risk types of HPV. High-risk HPV may cause abnormal Pap smear
results, and could lead to cancers of the cervix, vulva, vagina,
anus, or penis. Low-risk HPV also may cause abnormal Pap results
or genital warts.
Health experts estimate
there are more cases of genital HPV infection than any other STI
in the United States. According to the American Social Health Association,
approximately 5.5 million new cases of sexually transmitted HPV
infections are reported every year. At least 20 million people in
this country are already infected.
WHAT
ARE 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.
CAN
HPV CAUSE OTHER KINDS OF WARTS?
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.
HOW
ARE GENITAL WARTS SPREAD?
Genital warts are very
contagious and are spread during oral, vaginal, or anal sex with
an infected partner. They are transmitted 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.
HOW
ARE HPV AND GENITAL WARTS DIAGNOSED?
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.
If you have an abnormal
Pap smear result, it may indicate the possible presence of cervical
HPV infection. A laboratory worker will examine cells scraped from
your cervix under a microscope to see if they are cancerous.
HOW
ARE HPV AND GENITAL WARTS TREATED?
HPV has no known cure.
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 expecting.
If you have small warts,
your health care provider can remove them by one of three methods.
• surgical excision
(often with biopsy)
• 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
use the antiviral drug alpha interferon, which they inject directly
into the warts, to treat 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 cure the virus. Because the virus is
still present in your body, warts often come back after treatment.
HOW
CAN HPV INFECTION BE PREVENTED?
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 sexual contact until the warts are treated.
Research studies have
not confirmed that male latex condoms prevent transmission of HPV,
but studies do suggest that using condoms may reduce your risk of
developing diseases linked to HPV, such as genital warts and cervical
cancer. Unfortunately, many people who don’t have symptoms don’t
know that they can spread the virus to an uninfected partner.
POSSIBLE
COMPLICATIONS OF HPV AND GENITAL WARTS
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 test will detect them. If you have abnormal
cervical cells, it is particularly important for you to have regular
pelvic exams and Pap tests so you can be treated early, if necessary.
Pregnancy and Childbirth
Genital warts may cause a
number of problems during pregnancy. Sometimes they get larger during
pregnancy, making it difficult to urinate. 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 (laryngeal
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.
RESEARCH
Scientists are doing research
on two types of HPV vaccines. One type would be used to prevent
infection or disease (warts or pre-cancerous tissue changes). The
other type would be used to treat cervical cancers. Researchers
are testing both types of vaccines in people.
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