HPV/Genital Warts Overview
HPV stands for human papillomavirus. It’s very common. Many people don’t have any symptoms, and the infection might go away on its own. But some types of HPV can lead to cervical cancer or cancer of the anus or penis.
HPV isn’t just one virus. There are more than 100 kinds, and some are riskier than others.
Types of HPV
Each HPV virus has its own number or type. The term “papilloma” refers to a kind of wart that results from some HPV types.
HPV lives in thin, flat cells called epithelial cells. These are found on the skin’s surface. They’re also found on the surface of the vagina, anus, vulva, cervix and head of the penis. They’re also found inside the mouth and throat.
About 60 of the 100 HPV types cause warts on areas like the hands or feet. The other 40 or so enter the body during sexual contact. They’re drawn to the body’s mucus membranes, such as the moist layers around the anus and genitals.
High-Risk, Low-Risk
Not all of the 40 sexually transmitted HPV viruses cause serious health problems.
High-risk HPV strains include HPV 16 and 18, which cause about 70% of cervical cancers. Other high-risk HPV viruses include 31, 33, 45, 52, 58, and a few others.
Low-risk HPV strains, such as HPV 6 and 11, cause about 90% of genital warts, which rarely develop into cancer. These growths can look like bumps. Sometimes, they’re shaped like cauliflower. The warts can show up weeks or months after you’ve had sex with an infected partner.
What Are the Symptoms?
Often, there are no symptoms of an HPV infection, and the body clears the infection on its own in a few years. Many people never know they were infected.
But sometimes an infection with high-risk types of HPV will last longer. This can cause changes in the cells of the cervix that could lead to cancer. The same thing could cause abnormal changes in cells of the penis and anus, but this is rare.
Can You Prevent HPV?
You can get HPV through sex (vaginal, anal, or oral). It spreads through skin-to-skin contact.
HPV can infect skin not normally covered by a condom, so using one won’t fully protect you.
You can’t get HPV from a toilet seat, swimming pools, or from an infected person’s blood.
The only way to avoid all risk of any type of HPV infection is to never be sexually active — no vaginal, anal, or oral sex.
To lower your risk, you can also limit the number of sex partners you have. You can also choose partners who’ve had few or no sex partners before you.
Three vaccines — Cervarix, Gardasil, and Gardasil-9 — protect against HPV. They’re available to boys and girls as young as 9 and adults up to age 26.
The vaccines focus on some of the higher-risk types of HPV. All three guard against HPV 16 and 18. Gardasil and Gardasil-9 are also effective against HPV 6 and 11, which cause most genital warts. Gardasil-9 also covers against the high-risk strains 31, 33, 45, 52, 58.
If you have HPV, you might never know it. It’s so common that the CDC estimates that almost 80 million people in the United States have it.
Depending on the type of HPV you get, you may or may not have symptoms. Many people don’t.
Some HPV types can cause genital warts. Others are linked to cancerof the cervix and other organs. And some HPV types cause common warts that you can find on other areas of the body like your hands or feet.
If you have genital warts, that’s a sign of HPV. These growths don’t all look the same. They can be raised, flat, pink, or flesh-colored. They might even be shaped like cauliflower. You could have a single wart or several. They can be small or large. They may grow on the anus, cervix, scrotum, groin, thigh, or penis.
Genital warts can show up weeks, months, or even years after you have sex (vaginal, anal, or oral) with a person who’s infected with an HPV virus. He (or she) might not know he’s infected.
Some types of genital HPV infection are linked to cancer, including cervical cancer and cancer of the vulva, anus, oropharynx (the middle part of the throat, behind the mouth), or penis. If you get infected with one of these virus types, it’s possible that you could have precancerous changes in cells in the tissue without any symptoms.
Can I Be Tested?
If you’re healthy, doctors don’t routinely test for HPV.
For women, the Pap test doesn’t check for HPV. It looks for changes in cells in your cervix. If you have certain changes in those cells, your doctor may ask the lab to check for the virus. If you’re over age 30 and your pap is normal, your doctor may still test you for HPV. This is called “co-testing.”
If you have HPV and abnormal cervical cells, your doctor might order more tests right away. If you have HPV but your Pap results are normal, you may also need to get checked again in a year.
Many people have HPV (human papillomavirus), and the infection often clears up on its own, without treatment. And it often doesn’t make people sick.
But if it doesn’t go away by itself, and if it causes problems, your doctor can treat the symptoms of the infection. These may include genital warts linked to low-risk HPV types (which don’t generally lead to cancers) and the precancerous changes sometimes linked to certain types of HPV.
If You Have HPV and No Symptoms
You might not need any treatment, at least not immediately. If you have HPV, your doctor will want to make sure you don’t develop any problems from it.
If you’re a woman, your doctor may swab cells from your cervix, just like when you get a Pap test, and send them to a lab for testing. This analysis looks for genetic material, or DNA, of HPV within the body’s cells. It can find the HPV types that can cause problems. There’s no similar test for the strains of HPV that cause cancer in men.
If your doctor finds that you have a type of HPV that can lead to cancer, she may suggest you get Pap tests more often to watch for signs of abnormal cell changes in the genital area. Abnormal cell changes in the cervix may be a warning sign cervical cancer. Your doctor may also do a test called a colposcopy, in which she uses a special magnifying device called a colposcope to look closely at your cervix, vagina, and vulva.
If you’re pregnant or trying to conceive, tell your doctor before you start HPV treatment, which could affect your pregnancy. Your doctor may want to delay treatment until after you have your baby.
What If There Are Changes?
If the HPV infection has caused abnormal cell changes that could lead to cervical cancer, your doctor might want to take wait-and-see approach. Sometimes the cell changes — called cervical dysplasia, precancerous cell changes, or cervical intraepithelial neoplasia — will heal on their own.
If your doctor decides to treat the abnormal cells, she may use one of these methods:
- Cryotherapy. This involves freezing the abnormal cells with liquid nitrogen.
- Conization . This procedure, also known as a cone biopsy, removes the abnormal areas.
- Laser therapy. This uses light to burn away abnormal cells.
- Loop electrosurgical excision procedure (LEEP). The abnormal cells are removed with an electrical current. The goal is to remove all the abnormal cells, including most or all of the cells with HPV.
If You Have Genital Warts
These growths, which are caused by HPV infection, can be raised or flat. They can be small or large. They may be pink or the color of your skin. Genital warts can appear on the cervix, scrotum, groin, thigh, anus, or penis.
Treating the warts aggressively right after they appear actually isn’t a good idea. More could grow, and you’ll have to treat them again later on.
HPV types 6 and 11, which are linked to genital warts, tend to grow for about 6 months, then stabilize. Sometimes, visible genital warts go away without treatment.
If you need treatment, your doctor can prescribe a cream that you can use at home. There are two options:
- Podofilox (Condylox)
- Imiquimod (Aldara)
You’d use podofilox for about 4 weeks. It destroys the wart tissue. Research shows that about 45% to 90% of warts clear up, but sometimes the warts come back.
Imiquimod boosts the immune system so it fights off the virus. It often clears the warts, but not always permanently.
Your doctor can also prescribe other types of wart-removal treatments. Among the options:
- Cryotherapy freezes off of the wart with liquid nitrogen.
- Trichloracetic acid is a chemical that’s put on the surface of the wart.
- She can remove the cells surgically, with a scalpel.
- She can burn off warts using an electric current (electrocautery).
- A laser can vaporize the warts.
- Having the warts surgically removed may cure the problem in just one visit. Other techniques work about 80% to 90% of the time.
Generally, smaller warts are easier to treat than larger ones. Warts on moist surfaces respond better to treatments that go right on them, compared with warts on drier surfaces.
If your warts don’t go away after several treatments, your doctor might have more tests done to see if something else is going on.
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