HPV is the abbreviation for Human Papilloma Virus, a family of over eighty viruses which contribute to the development of wart infections anywhere on the body in both men and women. HPV is responsible for a condition known as genital warts or condyloma. In addition, five types of HPV can also cause precancerous changes in the cells of skin or mucous membranes of the reproductive organs. These changes most commonly occur on a woman’s cervix (neck of her uterus). It is currently believed that 90 percent of all cervical cancers are associated with HPV.

Symptoms

Most HPV infections are invisible. They hide in skin and mucous membranes that appear entirely normal. Carriers of HPV are often unaware of the risk this infection may pose to themselves or to a sexual partner.

The most prevalent type of growth caused by HPV is a flat wart, which cannot be seen with the naked eye. Flat warts are usually detected by a medical professional using a technique involving a solution of vinegar, which causes flat warts to turn white, or by using a special magnifying instrument called a colposcope. In women, when there are no visible warts, an abnormal Pap smear may indicate changes that identify HPV infection on her cervix.

HPV can also cause raised warts which look like small, fleshy, cauliflower-like growths. They may be soft and pliable or firm and rough to the touch. In men, they are usually first noticed on the shaft of the penis, on the scrotum or around the anus, but they may also occur inside a man’s urethra. In women, raised warts may first be seen around the opening of the vagina or the anus, but they frequently occur inside the vagina or in the cervix where they remain undetected. In both partners, infection can also occur in the mouth.

When raised warts appear around the opening to the vagina in a woman, there is frequently infection inside the vagina and on the cervix. Likewise in a man, visible warts usually indicate additional invisible infection. Raised warts that occur in visible areas are painless, but may cause itching or irritation.

Transmission

HPV is highly infectious. It is transmitted primarily by skin to skin contact with an infected partner who is shedding the virus. It is usually, but not always, spread through vaginal, anal, or oral sexual contact. But it can also occur between partners who have been exclusively faithful to one another.

It is currently estimated that one in ten college women are infected with at least one type of HPV. Studies have shown that 28-44 percent of sexually active women carry the virus on their cervix. Studies of persons carrying HPV also indicate that 60-90 percent of their partners are infected, although two-thirds of these partners will have no visible lesions.

The virus gains entrance into the body through a break in the skin. Transmission is most likely to occur in the presence of other cofactors including:

• Abrasion of the skin or weakened mucous membranes that are involved in sexual intercourse.
• Other sexually transmitted infections which have caused open sores in the skin or weakened mucous membranes of the infected area.
• Factors that compromise the strength of the immune system, including smoking, the use of alcohol, inadequate sleep or lack of healthy nutritional choices.

The time period between contraction of an infection to the appearance of lesions or cellular changes may vary greatly. It can be several months after contact before raised warts appear or an abnormal Pap smear is observed. Because of its variability, it is usually impossible to determine the source of an infection.

Once infected with a particular type of HPV, reinfection with the same type does not seem to occur. This is because the body eventually develops an immunity to that particular viral strain. However, immunity to one type of HPV does not provide immunity to other types. So, reinfection with additional viral types can easily occur.

It is unknown how long HPV remains in infected skin and mucous membranes. What is not understood at this time is how long HPV infection can remain communicable to others. We learn more and more about the HPV every year. What we believe to be true today may change in the future. What we do understand is that a healthy immune system plays a key role in suppression of this infection

Treatment

The goals of treatment are to:

• Decrease the amount of virus present to allow the immune system a fighting chance to develop immunity.
• To eliminate visible warts.
• To control symptoms, if present. In women, HPV infection of the cervix is the initiator of cellular changes in the cervix. If untreated, some of these changes may progress to cancer. Because tests are unable to determine which ones may become malignant, all lesions and abnormal cellular changes are treated and removed. Frequent visits may be needed to ensure that all lesions have been effectively treated. Do not become discouraged. Continued follow-up is extremely important.

Visible lesions may be treated with one or more of the following procedures:

• Trichloracetic Acid (TCA) - This solution is applied to lesions with a small cotton tip applicator. Burning and whitening occurs immediately at the site of application. This treatment option often requires reapplication weekly until the lesions have been completely removed. TCA need not be washed off after application, but careful cleansing of the treated area is especially important to prevent infection.
• Podophyllin - This solution is also applied to affected areas, however, it must be washed off within four hours. Weekly reapplication is frequently required. This solution may not be used during pregnancy.
• Podofilox (Codylox), Imiquimod (Adara) - These are prescriptions that are available for self-treatment. They may be used under certain circumstances, when appropriate, with the guidance of your clinician.
• Cryotherapy - A “freezing” treatment using liquid nitrogen which effectively destroys HPV lesions.
• Colposcopy - When cervical infection is suspected in a woman, she may be referred to a gynecologist who is trained in the use of colposcopy. Colposcopy is a diagnostic procedure which uses a special magnification instrument to evaluate, biopsy and treat lesions and cellular changes to ensure that all infected areas have been fully removed.

Prevention

Prevention is not always possible because HPV is transmitted by skin to skin contact. The following guidelines, however, may help you reduce your risk of sexual transmission.

• If you choose to engage in sexual intercourse, always use spermicidally lubricated condoms, even if you are taking oral contraceptives to prevent pregnancy. Spermicides are effective in helping to reduce the risk of infection from a variety of organisms. Condoms reduce the level of skin to skin contact (although they cannot be considered 100% effective because HPV may occur in areas not covered by a condom). For persons having sexual intercourse, mutual monogamy with condoms and spermicide is the most effective way to prevent transmission. It is also the most effective means of preventing reinfection with additional HPV strains or types carried by other partners.
• Make healthy decisions regarding your use of alcohol, particularly as it relates to sexual intercourse. Alcohol suppresses the immune system and makes a person more vulnerable to a wide variety of physical problems. Alcohol-free decision making may also prevent sexual intercourse with a high-risk partner.Maintain optimal levels of immune system response to prevent recurrence through healthful, well-balanced food choices, adequate rest to avoid fatigue, regular aerobic exercise, abstinence from smoking or chewing tobacco, and the development of skills to minimize and manage stress in your life.
• Practice monthly self-examinations for early detection of new lesions. The best time to do this is after a bath or shower. Using a hand mirror may be helpful. If new growths appear, seek medical evaluation.
• Clinical evaluation and Pap smears scheduled on a yearly basis are also important for women. Women who have experienced HPV infection will need Pap smears more frequently to detect the presence of recurrent infection or precancerous changes on the cervix.