Genital HPV infection is a sexually transmitted disease (STD) that is caused by human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own.
Some of these viruses are called "high-risk" types, and may cause abnormal Pap tests. They may also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called "low-risk" types, and they may cause mild Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area, and sometimes are cauliflower shaped.
Causes
Genital warts are caused by the human papillomavirus (HPV). HPV is a family of more than 80 extremely common viruses. Many types of HPV cause harmless skin warts, such as those on the fingers or feet. Only a few specific types of HPV are thought to cause genital warts.
HPV is easily spread during oral, genital, or anal sex with an infected partner. About two-thirds of people who have sexual contact with a partner who has genital warts will develop them also, usually within three months of contact.
Most people will be exposed to a form of HPV at some point in their lives, although not all will become infected or develop symptoms. Warts can appear within several weeks after sexual contact with an infected person, or they can take months to appear.
Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year.
Complications of HPV:
Cancer
Most strains of HPV that produce genital warts do not cause cancer. But certain strains of HPV may cause cervical cancer, or less commonly, cancers of the vulva, anus, or penis. For this reason, it is important for women to have annual Pap tests to detect any HPV-related abnormalities.
Pregnancy/Childbirth Complications
Genital warts may become larger during pregnancy, which may make it difficult to urinate. If the warts are in or near the vaginal opening, they may block the birth canal during delivery.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for contracting HPV and/or genital warts:
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Age: 15-30 years old
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Multiple sexual partners
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Having sex without condoms
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Skin-to-skin contact with an infected partner
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Previous history of genital warts
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Pregnancy
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Smoking
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Oral contraceptives
Symptoms
Genital warts often look like fleshy, raised growths with a cauliflower shape. They often appear in clusters.
In women, warts may be found in the following areas:
In men, genital warts are less common. If present, they are usually found in the following areas:
The following symptoms may also be present:
Diagnosis
Evidence of genital warts may be diagnosed by the following:
Visual Exam
A doctor can diagnose genital warts by visual examination. If external warts are found, the cervix is usually checked for warts as well. Application of acetic acid may assist in identifying lesions that do not have classic features.
Pap Smear
Abnormal Pap smear results may indicate the presence of HPV. However, the Pap test is not the most accurate test for HPV. Further tests, such as a colposcopy, should be performed if Pap results are abnormal.
Colposcopy and Biopsy
Colposcopy is a test that enables the doctor to identify warts that might not be easily visible. A biopsy involves taking a sample of tissue to be tested.
HPV Testing
A swab or some cells from the affected area can be checked for specific types of HPV.
Treatment
Treatment for genital warts depends on the size and location of the warts. Treatment only alleviates the symptoms, itt does not cure the virus. Visible genital warts can be removed by medications the patient applies, or by treatments performed by a health care provider. Some individuals choose to forego treatment to see if the warts will disappear on their own. No treatment regimen for genital warts is better than another, and no one treatment regimen is ideal for all cases. Since the virus remains, warts or other complications may recur later.
Treatments may include:
Topical Treatments
Your doctor may recommend one of the following treatments or solutions, to be applied to the affected areas:
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Imiquimod cream
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Podophyllum resin
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Podofilox solution
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5-Fluorouracil cream
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Trichloroacetic acid
Cryosurgery, Electrocautery, or Laser Treatment
Cryosurgery (freezing), electrocautery (burning), and laser are all methods that instantly destroy warts. These methods are used if the warts are small, or if the warts are large and have not responded to other treatment. Surgical removal is sometimes recommended for large warts. An antiviral drug called alpha interferon can be injected directly into warts that keep recurring.
Prevention
The only way to completely prevent the spread of an HPV infection is to avoid physical contact with an infected sexual partner.
Latex condoms may help reduce the spread of HPV infection and genital warts. However, they are not 100% effective, because they cannot cover the entire genital area.
Other preventive measures include:
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Sexual abstinence
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Monogamous sexual relationships
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Regular checkups for sexually transmitted diseases
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Regular Pap smears for women starting at age 18 or at the onset of sexual activity, whichever comes earlier
Special Considerations
Anogenital warts are rare in children. Such a diagnosis should prompt consideration of sexual abuse, and should be reported.
RESOURCES:
American Social Health Association
http://www.ashastd.org
Planned Parenthood
http://www.plannedparenthood.org
United States Centers for Disease Control and Prevention
http://www.cdc.gov/std
References:
Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics, 17th ed. Saunders: Philadelphia PA; 2004.
Chang TY, Brashear R. Warts, genital. Emedicine website. Available at: www.emedicine.com/derm/topic454.htm. 2005.
Kazzi AA, Ghadishah D. Warts, genital. Emedicine website. Available at: www.emedicine.com/emerg/topic640.htm. 2004.
National Center for HIV, STD and TB Prevention, Division of Sexually Transmitted Diseases
National Institute of Allergy and Infectious Disease website. Available at: http://www3.niaid.nih.gov/.
CDC
