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.
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.
If you are infected but have no symptoms, you can still
spread HPV to your sexual partner and/or develop complications
from the virus.
SYMPTOMS
In women, genital 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 you can see or feel. 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
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 health
care provider can diagnose HPV infection based on results from
an abnormal Pap smear, a primary cancer-screening tool for
cervical cancer or pre-cancerous changes of the cervix. In some
cases, a health care provider will take a small piece of tissue
from the cervix and examine it under the microscope.
Another test to diagnose HPV infection detects HPV DNA, which
may indicate possible infection.
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.
TREATMENT
There are treatments for genital warts, though
the warts 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
The besst way to 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 can be seen in the genital area, you should avoid any
skin-to-skin and sexual contact until the warts are treated.
Recently, the
Food and Drug
Administration (FDA)approved a vaccine called
Gardasil. Gardasil is highly effective in preventing persistent
infection with HPV types 16 and 18, two "high-risk" HPVs that
cause most (70 percent) of cervical cancers, and types 6 and 11,
which cause virtually all (90 percent) of genital warts.
Gardasil has not been proven to provide complete protection
against persistent infection with other HPV types, some of which
also can cause cervical canter. Therefore, about 30 percent of
cervical cancers and 10 percent of genital warts will not be
prevented by the current vaccine. In addition, Gardasil does not
prevent other STIs, nor does it treat HPV infection or cervical
cancer.
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 blocking 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
In June 2006, FDA approved
Gardasil, the first vaccine developed to prevent cervical
cancer, precancerous lesions, and genital warts due to HPV types
6,11,16, and 18. FDA licensed the vaccine for use in girls and
women aged 9 to 26 years.
Researchers continue to work on another vaccine for HPV to help
protect against HPV types 16 and 18.