HPV

HPV: HUMAN PAPILLOMAVIRUS

What is HPV?
HPV is one of the most common sexually transmitted diseases in the United States. As many as 40 million Americans are
already infected with HPV, and there are roughly one million new infections diagnosed each year. The latest estimates of HPV
prevalence among sexually active women range from at least 20% to nearly 50%, and the rates may be similar among men. The
vast majority of people with HPV infection have no symptoms at all.
HPV stands for human papillomavirus, a family of at least 60 viruses, about one-third of which cause genital problems that
affect both males and females. These problems include genital warts and cervical and penile cellular changes that can be
precancerous in a relatively small percentage of cases.
Genital warts:
Genital warts, or condyloma, are one kind of lesion caused by HPV. The lesion or growth can appear on the shaft or head of
the penis or on the vagina, vulva, or cervix. Genital warts can also appear around the anus and urethra in both men and women
and are sometimes even found in the mouth and throat. In many cases warts are not visible to the naked eye. In other cases
they may look like small, hard spots or cluster together forming a fleshy cauliflower-like growth. Although genital warts are
usually painless, they may become sore, itch, or burn if hit, rubbed, irritated, or ignored for a long period of time.
Cell change--subclinical HPV infection:
Cervical cell changes called dysplasia or cervical intraepithelial neoplasia (CIN) are lesions initiated by HPV. Intraepithelial
neoplasia also may occur in the vagina or vulva, the penis, or in the anus of males or females. These lesions have no physical
signs.
How is HPV transmitted?
HPV is usually spread by direct, skin-to-skin contact during vaginal, anal, or oral sex with someone who is infected.
Approximately two-thirds of persons who have sexual contact with a partner with genital warts will develop this disease. HPV
infection can also be transmitted by persons who have no visible lessons, but some researchers believe this condition is less
contagious than overt genital warts.
What is the incubation period of HPV?
The average incubation period, which begins immediately after the initial sexual contact with an infected person, is three to six
months. However, when HPV is transmitted from one person to another, the virus infects the top layers of the skin and can
remain inactive or latent for months or possibly years before any warts or other signs of HPV infection appear. Even in couples
that have been mutually monogamous for many years, the woman may develop an abnormal Pap smear or dysplasia (abnormal
cells) as a result of previous contact.
When should I go to a clinic or health care provider?
you notice any unusual growths, sores, or skin changes on or near your penis, vagina, or anus
your sex partner(s) tells you he or she has been diagnosed with HPV
you are experiencing any itching, burning or pain on or around the genital areas
How is HPV diagnosed?
Genital warts:
Diagnosis is made primarily by examination. Warts are often harder to see in women than they are in men. Often the health care
provider will soak suspicious areas with a dilute acetic acid solution to look for the whitening typical of wart tissue. To find very
small warts the health provider may perform an examination of the genital area with a magnifying instrument. In some cases it is
necessary to take a small sample of tissue and examine it under the microscope.
HPV infection without warts:
HPV in the absence of apparent genital warts is usually first detected in women on the Pap smear. If there is evidence of HPV
infection, a colposcopy will be done to examine and confirm HPV infection by taking biopsies from abnormal-looking areas. A
gentle scraping from inside the cervix (endocervical canal curettage) may be done to obtain a sample of cells from higher up.
These procedures help make a definite diagnosis, which is essential in deciding if further treatment is necessary.
In heterosexual relationships infection in men is most often suspected when it is detected in a female partner, since there is no
"Pap smear" equivalent for men. Dysplasia and cancer of the penis associated with HPV infections is well documented but is
much less common than dysplasia and cancer in women.
How is HPV treated?
Genital warts:
There are several methods of treatment most of which can be done during an office visit. Treatment depends on the size and
location of the wart and may include any of the following at DFMC:
Podophyllin--a chemical applied to the surface of warts by a health care provider.
Trichloroacetic acid (TCA)--an acid that is applied to the wart and surrounding tissue to destroy wart tissue. This
procedure burns slightly and the skin will turn white as it is applied resulting in a sore that quickly heals.
Cryosurgery--a procedure in which liquid nitrogen is placed on the wart and a small area of surrounding skin. The
liquid nitrogen freezes the skin causing ice crystals which results in sloughing of the wart.
Other treatments available to treat HPV include:
Interferon--an antiviral drug which is injected into the warts.
Laser Therapy--uses an intense light energy to destroy warts in complicated cases. It is the most costly method of
treatment.
While each approach has certain advantages, none is 100% effective in curing HPV. The goal of treatment is to remove the
major sites of infection by destroying skin cells where the HPV is found. Treatment cannot destroy all infected cells because the
HPV inhabits a wider area of skin than the actual location of the warts. In fact new warts may appear weeks or months after
successful treatment. Treatment should be sought as soon as possible if there is a recurrence. Your sexual partner(s) should be
simultaneously treated to diminish the potential of transmitting the disease to each other. If you do have sex, use condoms which
offer some protection against reinfection.
HPV infection without warts:
Many researchers disagree on whether or not treatment of HPV without warts is beneficial. However it is important that regular
pap smears are conducted to watch for precancerous changes on the cervix.
If the HPV infection is treated, the two most common forms are cryotherapy and TCA. Laser therapy is used for problems that
cannot be treated by those methods. Occasionally a cone biopsy is used when the abnormal cells (dysplasia) extend up into the
cervical canal where they cannot be reached by cryotherapy or laser.
What are the risks if HPV is not treated?
There may be an increased risk of cancer of the cervix, vulva, penis, or anus among people who are infected with particular
strains of HPV virus in those areas. The best defense against cancer is early detection and treatment. Women should have pap
smears once a year, especially if they have genital warts, or if they are at high risk for them (multiple partners, history of STDs).
If detected early, these cervical changes are relatively easy to treat. However, if dysplasia occurs and remains untreated, it may
later develop into malignancy (cancer). If a treatment plan is followed, the risk of cancer is greatly reduced.
How can I avoid HPV?
See "Protection From STDs" for some ways to decrease your chancesof HPV infection.
Remember that use of condoms may prevent the virus from coming in contact with susceptible skin areas. However, since HPV
can infect the scrotum and vulva, transmission can occur outside condom-covered areas.