Human Papilloma Virus

What Is It & Who Gets It?

Genital warts are the result of infection with Human Papillomavirus (HPV), possibly the most common of all sexually transmittable infections. However, a person may have an HPV infection and have no visible warts on the genitals (outside or inside).

How Do You Get It, & How Serious Is It?

HPV/Genital Warts are generally spread by means of skin-to-skin and sexual contact, although HPV can also be spread from mother to child during birth. A person may also self-infect by having an area of infected skin or tissue touch another area on the person's own body.

The virus also can be spread by contact with contaminated objects, clothing, or towels where the virus has been kept warm and moist for short periods of time between contacts.

HPV affects both sexes and all races equally, though it is most commonly found in those aged 15 to 40 years old. Anyone who is sexually active, especially anyone with multiple sexual partners, is at risk of exposure to HPV. Persons whose immune systems are not working well are more likely to become infected and to have a more serious infection. Although the appearance of genital warts may be what most people dislike, the truly serious issue related to HPV infection is the strong association between certain types of HPV and conditions of dysplasia (a pre-cancerous cell growth) and squamous cell cancer - especially of the cervix in women.

How Long Until Symptoms Occur?

It may take from three weeks to eight months from the time of exposure to HPV for an infected person to develop visible warts.

What Are The Symptoms?

Most HPV infections do not show any visible symptoms, or may be small and on interior tissue such as inside a woman's vagina. Visible warts outside the vagina or on the penis are the most common symptoms that a person may notice. Typical genital warts have a characteristic "cauliflower" appearance, raised and roughened texture, and may range in color from white to pink to gray. However, genital warts may vary from this appearance and can range in size from 1 millimeter to several centimeters in diameter.

Genital warts may cause itching, burning, tenderness and pain. In the U.S., external genital warts in women most commonly occur at the lower rim of the vagina, followed in frequency by those on the labia (genital "lips") and clitoris. In men, the penile shaft is the most common site. However, all areas of the genitals can be involved.

How Is It Diagnosed & Treated?

Most often, diagnosis of genital warts is made by visual inspection. As HPV can cause microscopic changes to the cells of the cervix, a pap smear may be the first indication that a woman might have HPV. However, a colposcopic exam is usually necessary to confirm this, as there are other causes for abnormal pap smears. Colposcopy is an examination with a special binocular microscope that illuminates and magnifies the cervix for evaluation.

Several treatments are available to eliminate visible genital warts, but no therapy is guaranteed to completely eradicate HPV infection or eliminate the risks of recurrence, transmission, or development of pre-cancerous or cancerous tumors. Treatment methods include:

  • Cryotherapy using liquid nitrogen or cryoprobe to "freeze off" the warts, repeated weekly;
  • Podophyllin solution which must be washed off after 4-6 hours, repeated weekly;
  • Trichloracetic or bichloracetic acid, repeated weekly;
  • Podofilox applications - available as a self-treatment by prescription;
  • Imiquimod cream - available as a self-treatment by prescription;
  • Surgical methods - excision, laser, electrodessication, electrocautery (to cut off or "burn" off the warts);
  • Interferon injections - when warts have been previously treated and persist, an injection of interferon may aid the body's immune system in fighting HPV. Usually injected twice a week for up to eight weeks or until warts are gone.

Except for surgical methods, all treatments require several applications, and warts still recur in at least 25% of patients following any therapy. The goal of treatment is to eliminate all visible warts to lessen the symptoms of irritation and to reduce the amount of transmittable virus.

If dysplasias (abnormal cell growths) or cancerous growths occur on the genitals later, these need to be evaluated and treated promptly based on their severity.

Can It Return?

Even though warts may appear to be gone after treatment, the virus can be dormant in normal-appearing skin surrounding the original wart. Activation of this virus at a later date can cause future outbreaks.

Similarly, the virus acquired from an infected partner can lie dormant for a long period before later activation.

What About My Partner?

Partners who notice visible warts definitely should seek treatment. We suggest that partners without symptoms also be examined - if one person appears to be infected, his or her partner probably also harbors HPV regardless of whether or not there are visible warts or other symptoms.

How Is It Prevented?

There are a number of ways to prevent the spread of HPV and genital warts. The one guaranteed method is the practice of sexual abstinence, most particularly not having skin-to-skin contact with the genitals.

If you are sexually active, the consistent use of safer sex methods (latex barriers such as male or female condoms, dams, and spermicide among others) are critical. Further, limiting intimate sexual activity to one, mutually monogamous partner will further reduce your risks - especially if that partnership is lifelong. As the lifetime total number of sexual partners increases, so do the risks of acquiring this or other sexually transmitted diseases.

You can get the HPV vaccine at Student Health Service - Nurses Clinic. No appointment is needed. For more information, call (858) 534-3300.

Helpful Links

"The HPV Test - Is it For Me?" by The Amer ican Society for Colposcopy and Cervical Pathology
The CDC Vaccine Q&A
Merck & Co. Patient Information