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Genital Warts/HPV by Georgan Gregg
Human Papillomavirus (HPV)/Genital Warts
What are genital warts?
Human Papillomavirus (pap a LOW mah virus) or HPV is also known as genital warts, acuminate warts, condyloma acuminata, verruca acuminata, or venereal warts. HPV is a large family of viruses containing over 60 types. Half produce warts on fingers, hands & face that are only a nuisance. The other half causes genital warts, a few of which increase risk of cancer of the cervix (the mouth of the womb/uterus).
The virus that causes genital warts is not the same as the ones that cause common warts. You can’t get genital warts from the virus that causes common warts. HPV cause genital warts on mucous membrane of the cervix, vulva (outer female genitals), in or around the vagina or penis, on the scrotum (testicles/balls), in or around the anus/rectum, groin (where genitals meet the inner thigh), or in the eye or eyelid, nose, mouth or throat (from oral sex transmission).
Infection with HPV is the most common sexually transmitted disease (STD) in the United States. Perhaps 50% of sexually active adults have this virus. Most infected with the HPV have no symptoms. There is no cure.
How are genital warts transmitted?
There are many things we do not know about the HPV viruses & how it gets passed around, but we do know that HVP causing common warts is not sexually transmitted. Inanimate objects, like massage tables, locker room floors & maybe even toilet seats, can pass on some types of this virus. HPV can live in skin without causing a wart, for no one knows how long, & suddenly become a wart.
We also know that HPV warts can form on any skin surface, including mucous membrane, like the penis or vagina. The types of wart that grow on mucous membrane -genital warts- usually ARE transmitted by sex. In rare cases transmission can happen from soiled clothes or shared sex toys. To be passed along, the type that causes genital warts needs moisture & dies quickly outside the body, so it isn’t likely to lie around on inanimate objects like the common wart virus can.
During sexual penetration, the virus can go from one body to another by a tiny tear in the skin, or the large pores of mucous membrane (like vagina or cervix). Once HPV infects the new person, it can do nothing or grow into a genital wart. The new person can spread the virus even if it hasn’t caused a wart. Even condoms won’t necessarily help since HPV can be on the testicles of the male or the vulva (skin outside the vagina) of the female.
Genital warts are not always sexually transmitted. It’s been found that HPV is in some people prior to sexual activity. Because HVP is the most sexually transmitted virus in the USA, Americans don’t have to have many sexual partners to become infected.
How are genital warts diagnosed?
Diagnosis of HPV is not easy & varies between women & men. Most people infected with these viruses have no symptoms and may not know they are infected. Depending on the type of HPV, symptoms can be in the form of wart-like growths, or abnormal cell changes on the genital skin, usually on a female's cervix.
If genital warts develop they can vary in size. Some are so small that they aren’t visible to the naked eye (called sub-clinical), others have a cauliflower look, which is actually a group of warts. Genital warts usually don’t have symptoms, other than mild itching. However, in some the itching can be chronic (keeps coming back) or there can be pain around the genital openings. The pain around the genitals can be irritated by intercourse or touching. And while some warts are sub-clinical, others can become so large they prevent intercourse or childbirth. Genital warts that actually block the birth canal & require cesarean sections for the delivery of babies are rare.
Most women learn they have HPV after a Pap smear (a scraping from the cervix is tested) &/or colposcopy (magnifying the cervix with a special microscope called a colposcope). If the doctor finds abnormal cells they are removed & sent to a lab. The biopsy results (the tests at the lab) will determine whether the abnormal cells are dysplasia (dis PLAYS yea). Dysplasia are changes that –not stopped- will result in cancer of the cervix.
Without symptoms, males are difficult to test for HPV. It’s impossible to prove that a male has HPV unless he has visible genital warts or a positive Digene Hybrid Capture® HPV DNA Test from a swab a urologist (doctor specializing in genitals) can take from the urethra (hole in penis where urine & cum escape). Even if warts aren’t present & the Digene Test is negative, it does not prove that he does NOT have HPV.
The most accurate method of detecting an HPV virus infection is DNA testing. DNA is the genetic material present in all living cells. Each HPV viral type has its own unique DNA. Samples of genital skin cells can be collected & tested for the viral DNA. However, not all infections can be found even with these sophisticated tests, nor can DNA testing find all the viral types. That means it is impossible to be 100% sure if or which HPV infection is present.
What is the treatment?
There are several ways to treat genital warts, but there is no cure. Treatment is determined by considering the size, location & number of warts, changes in the warts, the patient’s preference, cost of treatment, convenience, adverse effects & the doctor’s experience with the treatments. The goal of treatment is to remove warts, reduce the amount of virus & strengthen the immune system. Some decide to get a 2nd medical opinion from a dermatologist (skin doctor). When you have a genital wart that is visible, it can be treated with freezing, TCA (an acid compound), or the old standby called podophyllin (pod eh FILL em). A form of podophyllin is even available to apply at home so you can treat yourself once the diagnosis is made.
Getting rid of the warts does not destroy the virus. In the past, laser & chemicals were used to remove warts in the vagina & vulva but 90% had warts return in a year. Many developed chronic problems from the treatment that were worse than the infection. Those treatments are now rarely used. Current treatments try to remove visible warts & treat any pre-cancerous (probably will become cancer) changes.
Interferon is medicine that strengthens the immune system against HPV. Although interferon doesn’t kill HPV, a healthy immune system keeps the virus from spreading & growing. Since a weak immune system allows the virus to growth, some doctors think it’s very important to strengthen the immune system by eating right, proper vitamins, enough sleep & reducing stress.
How do I prevent genital warts?
The only way to prevent genital warts is to avoid sex with an infected person. Unfortunately, there is no reliable way to be sure that your sexual partner is not infected with HPV. The risk for getting genital warts increases in proportion to the number of sexual partners you have. Women should have yearly PAP smears & gynecological (female organ) exams to detect any pre-cancerous stages of HPV infection.
The use of latex condoms lowers the chance of cervical cancer, which is linked to HPV. Most cervical cancer is in women who have either never had a Pap smear, or have not had one in 5 years or longer. Cervical cancer can be prevented by yearly Pap smears because any abnormal cell changes can be treated before cervical cancer develops.
What are possible complications from HPV/Genital Warts?
Certain types of HPV can cause abnormal PAP smears & cervical cancer. Pre-cancerous changes on the skin of the penis is rare compared to the large number of women with pre-cancerous changes of the cervix. HPV infection is believed to be responsible for chronic pain & itching around genital openings, even without warts. HPV can also cause pre-cancerous changes in the vaginal & the skin of the vulva.
HPV can cause ugly genital warts that are hard to destroy, especially in those under stress or with a weak immune system. Even with treatment, warts can persist for years & cause both physically & emotionally problems.
HPV can be passed from mother to infant during childbirth. Around 5% of the babies born to women with HPV are born with the virus on their vocal cords. An unknown number of babies will become carriers of HPV on their genital skin & can develop genital warts later in life, even before they are sexually active. It is not recommended that cesarean delivery be used to avoid possible infection of newborns.
Three medicines (imiquimod, podophyllin & podofilox) should not be used during pregnancy. Because genital warts can multiply & be easily rubbed off during pregnancy, many specialists recommend their removal during pregnancy. Two types of HPV (6 & 11) can cause respiratory papillomatosis (many warty growths in the larynx on the vocal cords) in infants & children.
Persons with weakened immune systems from HIV-infection or other reasons may not respond as well to therapy for genital warts & they may have more frequent recurrences after treatment. A kind of cancer called squamous (SQUA mus) cell carcinoma (kar sin O meh) can grow in genital warts or look like a genital wart & also seems to happen more often in those with weak immune systems. Biopsy (cutting out a section for testing) is needed to know for sure. Because of the increase of anal cancer in HIV-infected homosexual men, some specialists do screening for SIL (squamous intraepithelial lesion) by cell study. However the US Centers for Disease Control & Prevention (CDC) does not recommend this test.
When squamous cell carcinoma begins in the genitals, a specialist should be consulted for treatment. A woman is at high risk for cervical abnormalities if her male sex partner has squamous cell carcinoma that began in his genitals.
Who should I contact?
Talk all this over with your sexual partner(s) if you are diagnosed with genital warts. You may want to use condoms, although they cannot provide 100% protection. Being upset is normal & understandable when a doctor tells you that you may have a STD that can possibly result in cancer. Discuss your options with your doctor, seek a second opinion, or both. In addition to information, emotional support can help greatly. Any questions you or your partner(s) have can be submitted to this website or you can telephone the HPV & Cervical Cancer Prevention Resource Center's HPV Hotline at (919) 361 – 4848 [2:00 - 6:00 PM Eastern Time, M - F] for information on diagnosis, treatment, prevention, emotional support & referrals. You can check out the HPV Resource Center’s website at http://www.ashastd.org/search/index.html & email HPV-related questions to HPVnet@ashastd.org. This article appears in the following topics:
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