HPV QUESTIONS AND ANSWERS

HPV QUESTIONS AND ANSWERS

What Is HPV?

Human papilloma virus (HPV) is the name of a group of viruses that

includes more than 70 different types. Certain types of HPV cause warts

on the hands or feet, while others can cause visible genital warts.

However, sometimes HPV infection causes no warts, and many people with

genital HPV do not know they have it.

What Do Genital Warts Look Like?

Genital warts are growths or bumps that appear on the vulva, in or

around the vagina or anus, on the cervix, and on the penis, scrotum,

groin or thigh. They may be raised or flat, single or multiple, small or

large. Some cluster together forming a cauliflower-like shape.

What About HPV That Causes No Visible Warts?

Sometimes HPV causes very subtle changes on the skin that can't be seen

with the naked eye. Health care providers can find these "microscopic

warts" only with the help of special instruments. In other cases, HPV

can live in the skin without causing any warts at all. This is called

"subclinical" HPV infection.

Who Gets HPV Or Genital Warts?

HPV infection, including genital warts, can occur in sexually active men

and women of all ages, races, and social classes, and can affect

homosexuals and heterosexuals alike. Infants can be infected by their

mothers during birth, but this is very rare.

How Do You Get HPV Or Genital Warts?

HPV and genital warts are usually spread by direct, skin-to-skin contact

during vaginal, anal, or oral sex with someone who has this infection.

Warts on other parts of the body, such as the hands, are caused by

different types of HPV. Contact with these warts does not seem to cause

genital warts.

Warts may appear within several weeks after sexual relations with an

infected person; or they may take months to appear; or they may never

appear. This makes it hard to know exactly when or from whom you got the

virus.

Very little is known about the transmission of subclinical HPV

infection, although some researchers believe it's less contagious than

genital warts.

How Would I Know If I Had HPV Or Genital Warts?

In some cases, it's difficult to know. Sometimes people do not notice

warts because they are inside the vagina, or on the cervix, or in the

anus. In addition, they are often flesh-colored and painless. Only

rarely do they cause symptoms such as itching, pain, or bleeding.

Sometimes warts will be found during a physical exam in men or a pelvic

exam in women. For women, an abnormal Pap smear may be the first warning

sign that HPV is present, though a Pap smear is not an accurate test for

HPV.

You should go to a doctor or clinic if:

•you notice any unusual growths, bumps, or skin changes on or near your

penis, vagina, vulva, or anus; or

•you notice any unusual itching, pain, or bleeding; or

•your sex partner(s) tells you that he or she has genital HPV or genital

warts.

How Are Genital Warts Diagnosed?

You can check yourself and your partner(s) for warts, but remember:

warts sometimes can be very difficult to see. Also, sometimes it's hard

to tell the difference between a wart and other bumps or pimples. If you

think you have warts or have been exposed to HPV, go to a doctor or

clinic. The health care provider will check more closely and may use a

magnifying lens to find small warts.

To detect warts or other abnormal tissue, health care providers

sometimes put a solution of acetic acid (like vinegar) on the genitals.

This causes abnormal tissue to turn white and makes it easier to see,

especially if it is viewed through a magnifying lens such as a

colposcope. This is not a specific test for HPV but is commonly used in

detecting cervical HPV infection.

How Is Subclinical HPV Infection Detected?

A Pap smear is a test designed to detect precancerous cervical

changes--not HPV. However, an abnormal Pap smear often shows changes

that could be caused by HPV infection. Women with abnormal Pap smears

should be examined further for cervical problems (usually through a

colposcope) or followed closely by a doctor.

There are several new tests that can detect the genetic material of HPV.

These are used to find cervical HPV infection in a small number of

cases.

How Are Genital Warts Treated?

There are many different opinions about how to treat genital warts. The

guidelines of the U.S. Centers for Disease Control and Prevention (CDC)

include the following treatment information:

•The goal of treatment should be to remove visible genital warts and get

rid of annoying symptoms. None of the available treatments is better

than another, and no single treatment is ideal for all cases.

•Podofilox solution or gel is a patient-applied treatment for external

genital warts. It is relatively cheap, easy to use, and safe.

•Imiquimod cream is a patient-applied treatment for external genital

warts and perianal warts. It is safe, effective, easy to use, and offers

an alternative to tissue-destructive therapies.

•Cryotherapy (freezing off the wart with liquid nitrogen) is relatively

inexpensive, but must be performed by a trained health care provider.

•Podophyllin is a chemical compound that must be applied by a health

care provider.

•Trichloracetic acid (TCA) is another chemical applied to the surface of

the wart by a physician.

•Laser therapy (using an intense light to destroy the warts) or surgery

(cutting off the warts) has the advantage of getting rid of warts in a

single office visit. However, treatment can be expensive and the health

care provider must be well-trained in these methods.

•The antiviral drug interferon is sometimes used, but less expensive

therapies work just as well with less discomfort.

Factors that might influence selection of treatment include size,

location, and number of warts, changes in the warts, patient preference,

cost of treatment, convenience, adverse effects, and provider

experience.

Whatever the treatment, here are some important points to remember:

•Ask your doctor for an explanation of the treatment, including its

costs and likely benefits.

•Avoid treatments which cause bad side effects or scarring.

•Be sure you understand the follow-up instructions, such as what to do

about discomfort and when to come back to the office or clinic.

•Be patient--treatment often takes several visits and a variety of

approaches.

•If you are pregnant or think you might be, tell your doctor so he or

she can choose a treatment that won't be harmful to you or to your baby.

•Don't use drug store treatments for warts. These are not meant for

sensitive genital skin.

•Some experts suggest avoiding sexual contact with the infected area

during treatment. This is partly to protect the treated area of skin

from friction and help it heal.

How Is Subclinical HPV Infection Treated?

According to the CDC, many say there is no proven benefit to treating

subclinical HPV. It is important, however, that health care providers

watch carefully for precancerous changes on the cervix that may be found

along with HPV infection.

Can HPV And Genital Warts Be Cured?

Treatment of genital warts can be frustrating for both health care

provider and patient alike. The average patient may take a few

treatments to clear genital warts.

None of the available treatments is a cure for HPV. The virus can remain

in nearby skin after treatment. Because the virus can lie dormant in the

cells, in some cases warts can return months or even years after

treatment. In other cases, warts never recur.

What About HPV, Genital Warts And Cancer?

The types of HPV linked to cervical cancer usually are not the types

that cause genital warts. But a woman with genital warts, like any other

sexually active woman, should get yearly Pap smears.

Yearly Pap smears are the best safeguard against cervical cancer. Pap

smears detect abnormal cells present on the surface of the cervix.

Cancer almost always can be prevented through the early detection and

treatment of abnormal cervical tissue.

What About HPV, Genital Warts And Pregnancy?

Genital warts sometimes cause problems during pregnancy and delivery.

Because of hormone changes in the body during pregnancy, warts can grow

in size and number, bleed, or make delivery more difficult. Very rarely,

babies exposed to HPV during birth may develop warts in the throat.

Despite these risks, a woman with genital warts does not need to have a

cesarean-section delivery unless warts are blocking the birth canal.

It is important that a pregnant woman notify her doctor or clinic if she

or her partner(s) has had HPV or genital warts.

How Can I Avoid Getting HPV Or Genital Warts?

Certain ways to lower your risk of getting any sexually transmitted

disease also may be effective with HPV or genital warts:

•You can reduce your risk of getting HPV or genital warts by not having

sex with anyone or by having sex only with one uninfected partner who

has sex only with you. People who have many sexual partners are at

higher risk of getting sexually transmitted infections.

•Latex condoms ("rubbers"), used properly from start to finish each time

you have sex, provide some protection if they cover the area of the HPV

infection. Condoms are recommended with all new or casual sexual

partners.

•Spermicidal foams, creams, and jellies are not proven to act against

HPV and genital warts, but they are effective against some other STDs.

They are best used along with condoms, not in place of condoms.

Is It Normal To Feel Emotional Or Upset About Having HPV Or Genital

Warts?

Yes. Some people feel very upset. They feel ashamed or less attractive

or less interested in sex. They feel angry at their sexual partner(s),

even though it is usually not possible to know exactly when or from whom

the virus was spread. They're afraid that the infection could lead to

cancer. It is normal to have all, some, or none of these feelings.

If you are worried about HPV or genital warts, remember:

•Genital HPV can be managed.

•Cervical cancer, the most serious problem associated with genital HPV,

is easily prevented through regular Pap smears and treatment of

precancerous cell changes.

•Informing yourself about HPV will help you to understand and manage the

infection.

•You are not alone. It is estimated that tens of millions of Americans

have HPV infection. For most, it is a minor problem.

Where Can I Get More Information?

For more information on HPV and other STDs:

•Contact the STD clinic in your local health department.

•Check with your own health care professional.

•Call the CDC National STD Hotline (1-800-227-8922). It's toll-free and

open to calls from 8:00 a.m. to 11:00 p.m. Eastern Time, Monday through

Friday.

Thanks for their diligence!