Sexually transmitted infections

Genital warts

What is human papillomavirus or HPV?

Human papillomaviruses (HPVs) make up a group of more than 100 types of viruses with multiple health outcomes, including genital warts and cervical cancer. Most HPVs do no harm to a person. They are called papillomaviruses because they tend to cause warts, or papillomas. Warts are benign (noncancerous) growths. Different types of HPVs cause the skin warts and plantar warts that grow on the hands and soles of the feet. HPV infections of this type are very common, harmless, non-cancerous, and can be easily treated.

About 30 types of HPV are spread through sexual contact, affecting the anogenital tract and causing infection and genital warts (also known as condylomata acuminatum). These types of HPV, mostly caused by types 6 and 11, can also cause cancer of the cervix (opening to the uterus, or womb) and other genital cancers. HPV is one of the most common causes of sexually transmitted disease (STI). And, 75 percent of people with HPV infection have no symptoms at all.

What are genital warts? How are they spread?

HPV infection can cause genital warts, benign (non-cancerous) growths on a person's genitals. A woman can develop warts inside and around the outside of the vagina, on the vulva ("lips" or opening to the vagina) and cervix, and around the anus. Genital warts are less common in men and are usually seen on the tip of the penis. They can also be found on the shaft of the penis, on the scrotum, or around the anus. While very rare, genital warts can grow in the mouth or throat of a person who has had oral sex with an infected person.

The size of genital warts varies and some may be so small, you can't see them with your eye. They can be flat and flesh-colored or look bumpy like cauliflower. They often occur in clusters, or groups, and can spread into large masses in the genital or anal area.

Genital warts are spread very easily during oral, vaginal, or anal sex with someone who has HPV. More than two-thirds of people who have sexual contact with someone who has HPV will develop warts, most often within 3 months of contact.

Why should I worry about HPV or genital warts?

HPV is an infection that, once you get it, never goes away. When you have HPV, you need to be sure to see your health care provider on a regular basis for check ups. If you have symptoms, such as genital warts, you need to seek treatment right away. It is easy to give HPV to another person and you can infect someone even when you have no symptoms. Some types of HPV can cause cancer of the cervix. But for most women, HPV does not turn into cancer of the cervix. It is important to have regular pelvic exams and Pap tests if a woman has abnormal cervical cells. Other types of HPV may be related to cancer of the vulva, anus, and penis (a very rare cancer).

During pregnancy and childbirth, HPV can cause a number of problems. Genital warts can become larger during pregnancy, making it hard to urinate. If warts are inside the vagina, they can cause problems during birth by blocking the vagina. Although rare, infants born to women with genital warts can get warts in their throats (called laryngeal papillomatosis). This can be life threatening for the baby and often requires laser surgery to help the baby breathe.

How can you tell if you have HPV or genital warts? Do you always get genital warts when you have HPV?

Most people who have HPV infection have no symptoms. If a person has HPV with no symptoms, they can still pass HPV to another person. And, they can also still develop problems from the infection.

A health care provider can tell if you have genital warts by seeing them during a pelvic exam. Sometimes a woman can see them around her genital area herself. If you do have genital warts, you need to also have your provider check to make sure you don't have these warts on your cervix.

Genital warts can be very small and hard to see. During an exam, your provider may apply a vinegar-like solution to areas where she or he thinks you may have a problem. The vinegar causes the warts to turn white, making them easier to see. The provider may also do a procedure called a colposcopy, where an instrument is used to enlarge (magnify) the vagina and cervix to better see if there are any warts. A small sample of tissue from the cervix is taken and examined with a microscope to see very small warts or other problems. Another test your provider may do to see if you have HPV is a Pap test, which looks at tissue from the cervix for cancer or other problems.

How are genital warts treated?

Genital warts often go away without any treatment. They can also develop into a small, fleshy raised growth that looks like cauliflower. There is no way to tell if the warts will grow or go away. This is why it is so important to see your health care provider if you think you may have genital warts.

Trying to remove the visible warts does not always eliminate HPV, and genital warts can reappear. Therefore, it is important to know that while treatments can get rid of the warts, no treatment gets rid of the virus. In other words, treatments remove the lesion or wart, not the virus. This is because, unlike bacteria, viruses cannot be destroyed with antibiotics, and there is currently no medical cure to eliminate an HPV infection and although vaccination is preventative, and it will not destroy any existing virus.

This means that once you get HPV, it becomes a lifelong infection, whether you have symptoms or not. HPV is considered a lifelong infection because, when the lesion, wart, or pre-cancer disappears, it is thought that the virus is contained in the cells but can awaken if the immune response wanes. Put another way, the body's immune system will eventually develop protection against the virus, preventing HPV from leaving the cell and creating lesions, or transmitting the infection to babies or partners. Most people that get an HPV infection will have it for life, but their immune system protects them from recurrences.

At this moment, there are no treatments directed at killing the virus. Vaccination is preventative, and it will not destroy any existing virus.

Depending on the size and location of the genital warts, your health care provider may give you one of several topical treatments:

• Imiquimod cream
• Podophyllin and podofilox solutions—don't use these when pregnant because they may cause birth defects
• 5-fluorouracil cream—don't use when pregnant because this may cause birth defects; can also cause severe skin irritation
• Trichloroacetic acid (TCA)

Small warts are sometimes removed by your doctor with freezing (cryosurgery), burning (electrocautery), or laser treatment. Very large warts may sometimes need to be removed with surgery when they do not respond to other treatments.

When warts return after treatment, the antiviral drug alpha interferon can be injected directly into the warts. But, this treatment costs a lot and doesn't always prevent the warts from coming back or reduce the number of warts that can return again. It can't be used during pregnancy.

How can I prevent HPV infection?

The only way to prevent getting HPV is to avoid direct contact with the virus. HPV is passed from one person to another by skin-to-skin contact. If you or your sexual partner has warts in the genital or anal area that you can see, you should not have any sexual contact until the warts are treated. Some studies have shown that using male latex condoms may protect you from getting diseases linked to HPV, such as genital warts and cancer of the cervix.

Here are some guidelines to help you reduce your risk for HPV:

Here are some guidelines to help you reduce your risk for HPV:

• The best way to prevent HPV and any STI is to practice abstinence (don't have sex). Delaying having sex for the first time is another way to reduce your chances of getting an STI. Studies show that the younger people are when having sex for the first time, the more likely it is that they will get an STI. The risk of getting an STI also becomes greater over time, as the number of a person's sex partners increases.
• Have a sexual relationship with one partner who doesn't have any STIs, where you are faithful to each other (meaning that you only have sex with each other and no one else).
• Practice "safer sex." This means protecting yourself with a condom every time you have vaginal, anal, or oral sex.
  For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. If needed, use only water based lubricants with male and female condoms. For oral sex, use a dental dam, a device used by dentists, made out of a rubbery material, that you place over the opening to the vagina before having oral sex. If you don't have a dental dam, you can cut an unlubricated male condom open and place it over the opening to the vagina.
  Even though it may be embarrassing, if you don't know how to use a male or female condom, talk to your health care provider. The biggest reason condoms don't work is because they are not used correctly.
• Be aware that condoms don't provide complete protection against STIs. But, they do decrease your chances of getting an STI. Know also that other methods of birth control, like birth control pills, shots, implants, or diaphragms don't protect you from STIs. If you use one of these methods, be sure to also use a condom every time you have sex.
• Limit your number of sexual partners. Your risk of getting HPV increases with the number of partners you have.
• Don't douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This can increase your risk for getting HPV.
• Learn how to talk with your partner about STIs and using condoms. It's up to you to make sure you are protected. See There's No Excuse Not To Use a Condom for tips for talking with your partner. You can also talk with your health care provider about this.
• When you are sexually active, especially if you have more than one partner, get regular exams for STIs from a health care provider. Tests for STIs can be done during an exam. And, the earlier an STI is found, the easier it is to treat.
• Learn the common symptoms of HPV infection and other STIs. Seek medical help right away if you think you may have HPV or another STI.

What should I do if I have HPV?

Sometimes a person may be too scared or embarrassed to ask for information or help. But, keep in mind most STIs are easy to treat. Early treatment of STIs is important. The quicker you seek treatment, the less likely the STI will cause you severe harm. And the sooner you tell your sex partners about having an STI, the less likely they are to spread the disease to others (because they can get treated). Doctors, local health departments, and STI and family planning clinics have information about STIs. The American Social Health Association (ASHA) has free information and keeps lists of clinics and doctors who provide treatment for STIs. Call ASHA at (800) 227-8922. You can get information from the phone line without leaving your name.

If you have HPV:

• Get it treated right away. Studies suggest that having an STI increases your risk for getting infected with HIV, the virus that causes AIDS.
• Follow your health care provider's orders and finish all the medicine that you are given. Even if the symptoms go away, you still need to finish all of the medicine.
• Avoid having any sexual activity while you are being treated for HPV.
• Be sure to tell your sexual partners, so they can be tested.
• Remember that HPV is a lifelong disease. Even though you may have long periods with no symptoms, you can still pass the virus to another person. Talk with your health care provider (and see the above question) about what you can do to lower your risk for both recurrences of HPV, and for passing he virus to another person.

Also be sure to read...

Cervical cancer
How can I avoid or prevent cervical cancer?
Diagnostic tests for women with abnormal cervical cytology results
Treating cervical cancer
Pap test
Chlamydia
Human papilloma virus (HPV)
Genital warts