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Sexual Health

STIs: Human Papillomavirus (HPV)/Genital Warts
What is Human Papillomavirus?

Human Papillomavirus is the name given to a group of more than 100 strains of a virus. More than 30 strains of HPV are sexually transmitted and infect the genital areas of both men and women. There are 13 known strains that are "high-risk" for causing cervical cancer. Many people infected with HPV will not experience any symptoms and the infection will clear up on its own. Some people develop warts in the genital region-genital warts are caused by the low risk strains.

HPV strains are considered either low-risk or high-risk. "High-risk" HPV may cause abnormal cell growth and, if untreated, may lead to cancer of the cervix, vulva, vagina, anus, or penis. In women, this abnormal cell growth is often discovered during a routine Pap exam. "Low-risk" HPV may cause Pap abnormalities or genital warts, which are single or multiple growths (known for the cauliflower shape they sometimes take) that appear in the genital area.

How is genital HPV transmitted?

Genital HPV is spread through vaginal, anal, and oral sex. It is spread through skin-to-skin contact. It can be spread to a newborn during childbirth if the mother is infected.

Is genital HPV common?

Genital HPV is the most common STI in the United States. At least half of all sexually active U.S. men and women will contract HPV at some point. Approximately 20 million people are currently living with HPV, and 6.2 million Americans get a new genital HPV infection each year.

What are the symptoms of genital HPV?

Most people who have genital HPV have no symptoms. This means that they could unknowingly pass the infection along to their partners.

Visible symptoms are genital warts. Genital warts can have a variety of characteristics: soft, moist, pink or flesh-colored, raised or flat, single or multiple, small or large, and sometimes cauliflower-shaped. Genital warts can grow on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh, and, rarely, the throat. Genital warts might itch, burn, and bleed.

If symptoms appear, they usually develop within weeks, months, or up to a year after infection.

How is genital HPV diagnosed?

HPV is diagnosed by the appearance of genital warts or from an abnormal Pap test. Currently, there is no other method of testing to detect HPV infection in men without visible warts.

Genital warts in women may not be noticed without gynecological exam. For both men and women, if warts are present, your healthcare provider may use a vinegar wash on the infected area to make the warts easier to see (the acetic acid turns them white) and diagnose visually. A sample of the abnormal tissue can also be taken and analyzed in a lab to determine if the virus is present.

How is genital HPV treated?

There is no cure for the virus, and genital warts sometimes disappear on their own. Visible genital warts can be treated by freezing the wart with liquid nitrogen (cryotherapy), application of certain chemical compounds (Podophyllin, trichloracetic acid, and Aldara gel), cutting off warts, burning off warts with an electric current (electrocautery), laser therapy, and Interferon (a substance injected into the wart that has only a 42-62% success rate within 12 to 20 weeks). Home treatment is also available in the form of cream or gel prescribed by your healthcare provider. After initial treatment, new warts sometimes grow and require treatment.

Infection that causes abnormal Pap smears may be treated with a procedure called a colposcopy. Many of these infections will clear without treatment. Prevention with the Gardasil vaccine and limiting your number os sexual partners is best.

Does my partner need to be treated?

Your partner may be infected with genital HPV and be asymptomatic. If no symptoms (i.e. genital warts) are present, treatment is not essential. However, because HPV can cause abnormal cell growth in the cervix, vagina, vulva, penis, and anus, it is important that your partner be aware of the exposure so that he or she can speak with a healthcare provider.

Regardless of your partner's symptoms, he or she needs to know about your condition. Since the virus can be transmitted even if symptoms are not present, you or your partner might also have HPV without being aware of it and pass it on to others. Be aware that while latex condoms can help prevent the spread of HPV, the virus can infect areas that are not protected by a condom and the virus can still be spread.

Are there serious consequences of genital HPV?

HPV is the main cause of penile and cervical cancer, which takes 10-20 years to develop.

Penile cancer is much rarer than cervical cancer. Approximately 13 of the 30 strains of genital HPV have been linked to cervical cancer. A persistent infection with the "high-risk" types of HPV is the main risk factor for cervical cancer. A Pap test can detect the presence of precancerous and cancerous cells on the cervix. If an abnormal Pap occurs, it should be repeated in 3-6 months. Many (80%) of HPV infections clear within 3 years even without treatment. If necessary, a cervical biopsy can be taken which removes abnormal cells.

Women who are pregnant may experience rapid growth of genital warts. Occasionally, delivery can be more difficult as a result and require Caesarean section. Rarely, babies exposed to genital warts during birth develop growths in the throat.

HPV Vaccine for PREVENTION of abnormal pap smears

(Gardasil is now on the market and available for males and females ages 9-26. The vaccine protects against four types of HPV, including two that cause 70% of cervical cancers and two that cause 90% of genital warts. The vaccine is administered in a series of three intra-muscular injections over a six-month period. There are no serious side effects to the vaccination, though pain at the injection site and low-grade fever are common. The vaccine is believed to be effective in preventing some strains of HPV for 5-10 years, but women must continue to have Pap smears during this time for early detection of other strains. Other vaccines are being developed.

Vaccinated individuals still need to protect themselves from STIs by using latex condoms and/or dental dams. The vaccination will not protect against other types of STIs or pregnancy. IUPUI Health Services now offers the HPV vaccine at a discounted cost. Usual cost is $156 per injection.

Your healthcare provider or Planned Parenthood clinics might also offer this vaccine. For more information, visit the CDC's web site. Merck manufactures the vaccine and has a patient assistance program that waives the manufacturer's cost. IUPUI Health Services does not participate in the program as our discount is substantial. See the manufacturer's website for more information.