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GENERAL INFORMATION
DIAGNOSIS
TREATMENT
PREVENTION
GENERAL INFORMATION
Human Papillomavirus (HPV) is the most common viral sexually
transmitted disease (STD). HPV can cause genital and oral warts and cancers of
the cervix, penis, rectum, and oral cavity. There are over 80 different types of
HPV. Half of these can cause warts that grow on the hands and feet; these are
low-risk types. Others are high-risk types which have been attributed to various
cancers.
In women, the virus can infect the skin of the vulva
(external genitalia), the skin around the anus, vagina and cervix. Men may
develop warts around the entrance to the urethra, on and under the foreskin, on
the shaft of the penis and around the anus. It is important to know that not
everyone infected with HPV will develop warts.
There are over 30 types of HPV that have been found to grow
in the genital region; some of them can cause genital warts, and others may
cause changes in the cells of the cervix. These changes are what clinicians look
for when they perform a Pap smear. Therefore, HPV can be detected by a Pap
smear, and about 1/3 of women who have abnormal pap smears have HPV. The primary
reason for studying HPV is because of its link to cervical cancer. Almost all
women who have cervical cancer have HPV. However, most women who have HPV never
actually develop cervical cancer, so testing positive for HPV doesn’t mean one
will get cancer. Of the 30 different types of genital HPV, only a few ever lead
to cancer.
People who have visible genital warts can spread the virus
through intercourse. Once a person has had visible genital warts, it is thought
that s/he will probably carry the virus the rest of his/her life. The longer it
has been since a person has had genital warts, the lower the risk of spreading
the virus. A person with no visible warts, but a history of warts in the past
may still be able to transmit the virus to others. There are probably some
people who get and spread the virus without having visible genital warts. We
also suspect that the lag time between exposure and development of warts may be
as long as several years.
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DIAGNOSIS
Visible genital warts can be assumed to be due to HPV. For the less obvious changes, a number of tests, including colposcopy (looking at areas with specific changes with a magnifying instrument similar to binoculars), virus typing and biopsy have been used. None of the tests are completely reliable and some can be confusing.
There are some variations in normal anatomy that may resemble HPV-associated changes. It is often difficult, or even impossible to make an accurate diagnosis without DNA testing. A number of people have probably been told they had HPV, when in fact they did not.
In our studies, HPV DNA is tested using Hybrid Capture II, which helps in those women with borderline abnormal Pap smears (called ASCUS) to determine which changes are normal (HPV negative) or are precancerous changes (HPV positive). Our lab also uses the Roche line-blot assay to determine specific genotypes.
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TREATMENT
Whether or not someone exposed to HPV actually develops warts probably depends on that person's immune system. Likewise, the body's immune system will cause most warts to disappear without treatment; this usually takes 3-6 months. Recent studies have shown that the rate of recurrence of genital warts is the same with or without treatment. While there is some controversy among researchers, most now believe that only large visible warts should be treated. The treatments listed below are not cures for HPV, since the virus may remain in the body for an indefinite amount of time. The treatments may include:
*Topical Medications (Podophyllin, Bichloroacetic acid, Trichloroacetic acid) are medications applied to individual warts on the vulva or at the opening of the vagina. They are painted onto each individual wart and may need to be applied weekly until the warts go away. The medication can cause burning and irritation. It should be washed off in 6-8 hours after application. These are all applied by the doctor or nurse.
*Laser Treatment (using an intense light to destroy warts), Cryotherapy (freezing off warts with liquid nitrogen), or surgery (cutting off warts) can be used as other forms of treatment.
*Self-applied treatments such as Podofilox or Imiquimod cream may be used on warts. No pregnant women should use these.
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PREVENTION
Unfortunately, there is no totally reliable way for sexually active people to prevent exposure to HPV. By not having sex, or by having sex with only one uninfected person who is faithful, you can reduce your risk. The use of condoms during intercourse can do a great deal towards preventing the transmission not only of HPV but of all sexually transmitted diseases. It is important to know that since condoms do not cover all exposed areas of the skin, and since HPV is spread by skin-to-skin contact, condoms aren't completely effective. If used properly, they still will help. Spermicides and creams have not been proven to reduce HPV transmition but do work against some STDs. It is best to use them with condoms.
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