Human Papillomavirus (HPV) - Overview

BASIC INFO
What is HPV?
How is it spread?
What are the symptoms?
Can HPV be cured?

GENITAL WARTS What are they? Are warts dangerous? How are warts treated?

ABNORMAL CELL CHANGES What are abnormal cell changes? What is the cervix? How are abnormal cell changes found? What is a Pap smear? When should I get a Pap smear? Should I worry about getting cervical cancer?

HPV AND PENILE AND ANAL CANCER

What is HPV?

HPV, or human papillomavirus, is the name of a group of viruses that has more than 70 different types. HPV is sometimes called the wart virus because certain types of HPV cause warts on the hands, feet or genitals.

The types of HPV that cause visible warts on the genitals (vulva, vagina, penis, scrotum) or anus (butt hole) are different types than those that cause warts on the hands and feet. People may have HPV and not have any warts that they can see with naked eye. Still other types may cause cells on the cervix or in the anus to change and, in some cases, develop into cancer over many, many years if left untreated.

How is it spread?

HPV and genital warts are usually spread by direct, skin-to-skin contact during vaginal, anal or oral sex with a partner who already has the virus. HPV can infect any person who is sexually active.

A person may not know right away—or even ever—if they have been infected by HPV. Genital warts do not always appear right away. And many people who get HPV never develop warts or any cervical or anal cell changes. It’s different for each person. Some people may see warts:

• Within several weeks after having sex with a person who has HPV
• Within several months after having sex with a person who has HPV (this is MOST common)
• Within several years after having sex with a person who has HPV
• NEVER (and they may never know they have HPV)

And since genital warts may not appear until weeks, months or years after the infection it may be hard to know exactly when you got the virus and who passed it on to you.

REMEMBER:

HPV and genital warts are very common. HPV is the most common STD in the United States.

• Many people don’t know they have it.
• Many people infect their partners without meaning to.
• You may not know right away that you have an HPV infection or genital warts.

What are the symptoms?

• Sometimes HPV lives in the skin without causing ANY warts or other skin changes that can be seen at all. This is called latent (or hidden) HPV infection.
• Some people will develop visible growths or bumps in the genital area. These are visible genital warts.
• Some people have tiny changes on the skin that can’t be seen with the naked eye. This is called sub clinical HPV. Doctors and nurses can find these by looking at the skin with special instruments that magnify (make what they look at appear larger).
• Some women to have abnormal cell changes on their cervix, which is found by a Pap smear.

Some people will know they have HPV when:

• They see warts or bumps in their genitals or their sex partner’s genitals
• Their doctor or nurse sees warts that are inside the vagina or in the anus may be found during a physical exam or a pelvic exam
• They have an abnormal Pap smear. An abnormal Pap smear may be the first warning sign to women that HPV is present—but this is NOT a direct test for HPV.

Can HPV be cured?

No. HPV is a virus and there is no direct treatment for the virus. But warts or other cell changes caused by the virus can be treated.

Experts disagree about whether the virus ever goes away completely, or is just suppressed (kept in check) by the immune system so much that it cannot be detected, even by very sensitive tests.

Most people never have a problem with HPV because their body’s immune system keeps the virus from ever becoming a problem. HPV can be treated and managed if symptoms do develop.

You should go to the doctor or clinic if:

• You notice any unusual growths, bumps or skin changes on or near the penis, vagina, vulva, anus, scrotum or groin.
• Your sex partner(s) tells you that he or she has genital HPV or genital warts.
• You are female and sexually active (having intercourse). Sexually active women should have a yearly pelvic exam, Pap smear and STD screening.
• You are male and sexually active (having intercourse) for a yearly physical exam and STD screening.

What are they?

Genital warts that are visible are growths or bumps in the genital area. They may be:

• Flat (smooth on the skin)
• Raised (like a bump or skin growth)
• Single (only one wart)
• Multiple (more than one in the same area or many areas)
• Small or large

Genital warts and other abnormal tissue are diagnosed by:

• A doctor or nurse may use a vinegar solution on the genitals (this may sting a little). The vinegar solution makes the warts or abnormal tissue turn white and be easier to see.
• The doctor or nurse may use a special magnifying lens to look closely at the warts or cervical infection—this is NOT a test for HPV, but helps check for it.

Are warts dangerous?

No. The types of HPV that cause raised or "cauliflower"-shaped warts are not the same types that cause cervical, penile or anal cancer, although flat warts are often of the same type. But, if you have genital warts, you may have also come into contact with the types of HPV that are linked to cervical cancer. Like any other sexually active woman, a woman with genital warts should get yearly Pap smears.

How are warts treated?

Some people are never bothered by genital warts and are never treated for them. Sometimes the immune system will manage the HPV infection and the genital warts may go away by themselves.

When choosing what treatment to use your doctor or nurse will consider the size, location and number of warts, changes in the warts, patient preference, cost of treatment, convenience, adverse effects and their own experience with the treatments.

If genital warts are itching, burning or bleeding, or you just want to do whatever you can to get rid of them, there are several ways to treat them.

• Podofilox liquid or gel is a self-applied treatment that can be put on by the patient at home for external genital warts. It doesn’t cost much and is safe and easy to use. It’s available by prescription only.

• Imiquimod cream is a self-applied treatment that can be put on by the patient at home for external genital warts and warts near the anus. It is safe, effective and easy to use. The cream is not harsh on the skin and does not cause scarring like some other treatments. It’s available by prescription only.

• Cryotherapy (freezing off the wart with liquid nitrogen) is relatively inexpensive, but it must be done by a trained doctor or nurse.

• Trichloracetic acid (TCA) is another chemical applied to the surface of the wart by a doctor or a nurse.

• Laser therapy (using an intense light to destroy warts) or surgery (cutting off warts) has the advantage of getting rid of warts in a single office visit. However, treatment can cost a lot and the doctor must be well trained in these methods.

• The drug interferon is sometimes used, but less expensive treatments work just as well with fewer side effects.

**CAUTION: NEVER TREAT GENITAL WARTS WITH TREATMENTS DESIGNED FOR WARTS ON THE HANDS OR FEET**

Some things to think about before any treatment for genital warts:

• Ask your doctor or nurse to tell you about the treatment, including how much it costs and the likely benefits of the treatment.

• Avoid treatments that cause bad side effects or scarring.

• Be sure you know what to do after you have the treatment done, like what to do about any itching, burning or pain, and when to come back to the office or clinic.

• Be patient—most people have to be treated more than once or your doctor or nurse may have to try more than one treatment.

• If you are pregnant or think you might be, tell your doctor or nurse so a treatment can be chosen that won’t be harmful to you or your baby.

• Some doctors or nurses may tell you not to have sex while having treatment. This is to protect the treated areas of skin and help it heal.

• It’s OK to ask the doctor or nurse questions. They are there to help you and explain what is happening if you have any questions.

None of the treatments listed above is a cure for HPV (although the treatment of warts may help stimulate your immune system to fight warts), and warts can return even months later after treatment. In some cases, warts may come back years later, but that doesn’t happen very often. It’s hard to tell if the warts that appear much later are a return of the old warts or a new case. In most cases, warts never come back.

If a woman is sexually active, having a Pap smear every year is the best way to keep from getting cervical cancer. Cancer almost always can be prevented before it occurs when abnormal cells are found and treated early.

What is a cervix?

A cervix is the neck of the uterus (womb) that forms the passageway between the uterus and the vagina inside a female’s body. The cervix in young women is often not fully mature. This can make it easier for a young woman to develop cell changes from HPV and to become infected with other STDs.

How are abnormal cells changes found?

Doctors and nurses test for abnormal cell changes through a simple procedure called a Pap smear. A Pap smear is usually part of an annual pelvic examination. A pelvic exam includes the doctor or nurse checking the external genital area. They also use their hands to feel the shape of the internal reproductive organs to make sure they feel normal.

What is a Pap smear?

A Pap smear is a test made to find abnormal cells on the cervix before they turn into cancer (precancerous changes). Precancerous changes are caused by HPV.

The Pap smear is simple and quick, and most women have little discomfort. A small wooden spatula and a small brush are used to collect cells from the cervix. The cells are fixed onto a slide and the slide is examined by a pathology lab to make sure the cells look normal.

If the cells don’t look normal your doctor or nurse may repeat the Pap smear in a few months.

Often, the repeated Pap smear will be normal. Or, they may ask you to come in to look at your cervix with a specially lighted magnifying lens called a colposcope (this looks like a pair of binoculars with a bright light).

If you are asked to repeat your Pap smear in a few months and it is again abnormal, you will also have a colposcopy. As an alternative, some doctors will do a test for HPV and if it is positive for the virus (HPV is found to be present on the cervix) you will have a colposcopy.

When should I get a Pap Smear?

Women should begin having yearly Pap smears when they become sexually active, that is, begin to have sexual intercourse. A yearly Pap smear helps check for any sign of abnormal cell growth on the cervix.

Should I worry about getting cervical cancer?

Cervical cancer, in most cases, is preventable through annual Pap smears. Many women die annually from cervical cancer, and in most cases, these would have been preventable deaths if Pap smears had been done regularly.

The main purpose of Pap smears is NOT to screen for cancer. It screens for abnormal cell changes that happen long before any cancer develops. That’s why this simple procedure is so important for taking care of your sexual health.