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Human Papillomavirus (HPV)
What is HPV?
Human papillomavirus (HPV) is a virus that affects the skin in the genital area, as well as a female's cervix. Depending on the type of HPV, symptoms can be in the form of wart-like growths or abnormal cell changes. HPV is considered the most common sexually transmitted infection (STI) in the US.
There are many different types of genital HPV; some cause genital warts and some cause abnormal cell changes in a woman's cervix
The types of HPV that cause raised external genital warts are not linked with cancer. These are called "low-risk" types. The genital warts appear as growths or bumps, and may be raised or flat, single or multiple, small or large. They tend to be flesh-colored or whitish in appearance. Warts usually do not cause itching or burning. The warts will not disappear on their own and may continue to grow if left untreated.
Sometimes genital warts are so small that they can not be seen with the naked eye. Therefore, a person may not even know she has HPV and genital warts.
Some people only have one episode of warts, while others have recurrences. When warts are present, the virus is considered active. When warts are gone, the virus remains latent in the skin cells and may or may not be contagious at this time. Warts may appear within several weeks after sexual contact with someone who has a wart-type of HPV, or it may take several months or years to appear. This makes it hard to know exactly when or from whom someone got the virus.
Other types of HPV can cause abnormal cell changes on the genital skin, usually on a female's cervix. These types of HPV are linked with cervical cancer and are usually called "high-risk" types. There are usually no symptoms for this type of HPV and women need to get regularly screened by a pap smear to detect these changes. Individuals can be exposed and have more than one type of HPV, including several high-risk types.
Most of the time, men will not have any symptoms or health risks with the high-risk types of HPV. While they do not have symptoms, men can be carriers and unknowingly transmit HPV to their sexual partners.
Transmission of HPV
HPV, regardless of the type, is usually spread by direct skin-to-skin contact during vaginal, anal or (rarely) oral sex with someone who has this infection. Genital warts are most likely to be transmitted when symptoms (warts) are actually present, but sometimes warts are too small to see with the naked eye. Warts are not commonly found in the mouth, so some experts believe that transmission through oral sex is not likely.
The types of HPV that cause genital warts do not usually cause warts on other body parts such as the hands. Warts on other parts of the body are caused by different types of HPV. People do not get genital warts by touching warts on their hands or feet.
Testing for Warts
It can be hard to tell the difference between a wart and normal bumps on the genital area. If you have any bumps or growths, visit the University Health Center and have the area examined by a clinician.
To look for warts or other abnormal tissue, the clinician may put acetic acid (vinegar) on the genitals. This causes warts to turn white and makes them easier to see, especially if they are viewed through a magnifying lens.
Testing for Cervical Changes
Abnormal cervical changes on a female are detected through a pap smear. The pap test is a screening to find abnormal cell changes on the cervix before they become cancerous. During a pelvic exam, a small brush or cotton tipped applicator will be used to take a swab of cervical cells. These cells are then put in a container with liquid and sent to the laboratory for evaluation.
If the pap smear shows abnormal cells, an HPV test may be performed to determine the type of HPV. This test checks directly for the genetic material (DNA) of HPV within cells, and can detect the types connected with cervical cancer. The test can be done with the same cell sample taken during the pap test.
The HPV test cannot be used on males. The FDA has only approved its use on the female's cervix, and research has shown that the HPV test usually shows false negative results in men. These false negatives occur because it is difficult to get a good cell sample to test from the thick skin on the penis. There is currently no testing available to determine if a male has a type of HPV that causes cervical changes. Most of the time, men will not have any health risks such as cancer with the high-risk types of HPV.
There are no blood tests available to diagnose a person for HPV.
HPV is a virus, and there is currently no cure. However, there are several treatment options available for both genital warts and cervical changes. The goal of treatment should be to remove visible genital warts or the abnormal cells. No one treatment is best for all cases. When choosing what treatment to use, the clinician will consider the type of HPV, patient preference, cost of treatment, convenience, size, location and number of warts, changes in the warts, location of abnormal cells, results of the pap smear, colposcopy, biopsy and HPV test, adverse effects, and their own experience with the treatments.
- Cryotherapy (freezing off the wart with liquid nitrogen). This can be relatively inexpensive and must be done by a trained clinician.
- TCA (trichloracetic acid) is another chemical applied to the surface of the wart.
- Cutting off warts. This has the advantage of getting rid of warts in a single office visit.
- Electrocautery (burning off warts with an electrical current)
- Laser therapy (using an intense light to destroy warts). This is used for larger or extensive warts, especially those that have not responded well to other treatments. Laser therapy can also cost a lot of money.
- There are also several at-home prescription creams. These creams are self-applied, safe, and easy to use.
Abnormal cervical cells
Sometimes treatment may not even be necessary for mild cervical changes. These cells may heal on their own, and the clinician will just want to monitor the cervix. HPV may then be in a latent state, but it is unknown if totally gone or just not detectable. The goal of any treatment will be to remove the abnormal cells which may also remove most of the cells with HPV. Treatment options include cryotherapy (freezing the cells with liquid nitrogen), LEEP (Loop Electrosurgical Exision Procedure), or conization (cone biopsy).
HPV and Other Cancers
Anal cancer is a rare occurrence that has been strongly linked to high-risk types of HPV. Abnormal cell changes in the anal area are more common among individuals who engage in receiving anal sex. Abnormal changes in the anus have also been reported in some females who have a history of severe cervical changes. Treatment is available for anal cell changes and anal cancer.
Penile cancer is extremely rare in the US, and HPV is not always the cause. There are some cases of cell changes on the penis, which are caused by high-risk types of HPV, but most males do not ever experience symptoms or health risks if they get one or more high-risk types of HPV.
HPV has been linked with some, but not all, cases of cell changes in the vagina and with vaginal cancers. Similarly, HPV has been linked with some, but not all, cases of cell changes on the vulva (outside female genital area) and with vulvar cancers. Treatment options are available for both vaginal or vulvar cell changes, depending on how mild or severe the cell changes are in this area.
Pregnancy and HPV
Most pregnant women who have had genital warts previously, but no longer do would be unlikely to have any complications or problems during pregnancy or birth. Because of hormone changes in the body during pregnancy, warts can grow in size and number, bleed, or, in extremely rare cases, make delivery harder. Very rarely, babies exposed to the wart-types of HPV during birth may develop growths in the throat; however, this risk is so minimal that a cesarean-section delivery is not necessary unless warts are blocking the birth canal.
For some pregnant women, cervical changes may increase. This may be due to hormone changes during pregnancy, but this is not proven. If a woman has an abnormal Pap smear during pregnancy, even if it's severely abnormal, many health care providers will not do treatment. They will just monitor the cervix closely with a colposcope during the pregnancy. A few weeks after delivery of the baby, the provider will look at the cervix again and do another Pap smear or another biopsy. Many times after pregnancy, the cell changes will have spontaneously resolved - and no treatment will be necessary. The types of HPV that can cause cell changes on the cervix and genital skin have not been found to cause problems for babies.
Any person who is sexually active may come in contact with this common virus. Ways to reduce your risk include not having sex with anyone or having sex only with one partner who has sex only with you. People who have many sex partners are at higher risk of getting other STIs.
If someone has visible symptoms of genital warts, he or she should not have sexual activity until the warts are removed. This may help to lower the risk of giving the virus.
Condoms used correctly from start to finish for each act of sex may provide some protection. Because HPV is transmitted skin-to-skin, and condoms do not cover the entire genital region, it is still possible to transmit the virus.