Human Papillomavirus (HPV) and Genital Warts

Human Papillomavirus (HPV) is the virus responsible for genital warts. Warts can occur either visibly on the outside of the body or can also infect areas inside of the body, such as the cervix of women.

HPV is rapidly becoming one of the most common sexually transmitted infections diagnosed today. It is estimated that about 5.5 million people are diagnosed with the virus every year and about 20 million Americans are currently infected. Because HPV is a virus, those who are infected can carry the virus with them for the rest of their lives. It is important to remember that not everyone who carries HPV will get visible warts on the outside of the body. Most people who are infected with the virus do not show symptoms and are unaware of their infection. Many women discover they carry the virus as a result of an abnormal pap smear, which tests the cervix for precancerous cell changes. A woman discovered to have HPV on her cervix is at a higher risk for developing cervical cancer later on in life.

Unlike many other sexually transmitted infections, HPV is not transmitted through semen, blood or vaginal secretions. HPV lives underneath skin and is transmitted through intimate skin-to-skin contact. It can be present underneath skin that appears completely normal, therefore it is very difficult to tell if someone is infected with HPV just by looking at them.

Fewer than 1 percent of those infected with HPV will develop symptoms. The visible symptoms are the appearance of small fleshy warts that can be similar to warts that appear on other areas of the body. Warts can appear a variety of ways:
o Flesh-colored or a little bit darker than the surrounding tissue
o They can be raised or flat
o Most are painless, although occasionally they do itch
o Can appear anywhere in the anal and genital area including the inner labia and vagina in women and the urethral opening in men
It can take months from the time of infection until the development of visible warts; therefore, it is often difficult to determine where the infection originated.

There is often difficulty in testing for genital warts. A visual inspection is performed looking at the entire genital area. If the doctor suspects a genital wart, the doctor will often put an acetic acid solution on the area to turn see if the suspected wart turns white, which could confirm the diagnosis. Currently, if a person does not have any visible external warts, there is no screening test that can be done to look for HPV. A blood test is under development, but not widely available. If a woman has an abnormal pap test result, the doctor will often retest those same cells for HPV using the Digene Hybrid Capture Test. This will determine if a woman is at an increased risk for cervical cancer due to an internal HPV infection.

Although some genital warts disappear on their own, most do need treatment to remove them. Different methods of removal include cryotherapy (freezing), topical medications, laser surgery, and standard surgical removal. It is common to need several treatments to completely remove warts. If an HPV infection is discovered on a woman’s cervix, the infected area is often removed. It is important to remember that many people are infected with HPV and still have healthy, active sex lives.

Condoms do provide some protection against HPV; however, it is still possible to transmit HPV if the infection lives on areas of the genital area that condoms do not cover. Practicing abstinence, limiting sexual partners, and communicating about sexual history are all ways to help limit the spread of HPV.