Human Papilloma Virus

Sexually transmitted diseases (STD) can be caused by infection with bacteria or viruses. The bacterial infections (gonorrhea, chlamydia and syphilis) can be cured with antibiotics. However those caused by viruses are not so easily cured. Human papilloma virus (HPV) is a very common but not well known virus that can cause problems in both men and women.

HPV are a group of about 100 different viruses. Infection with different strains of the virus will cause different symptoms. Some of the subtypes cause warts on the hands or feet. Others cause symptoms in the genital area. Genital infections with HPV can cause visible warts on the external genitalia and anus or be present inside the vagina or cervix.

Genital warts appear as fleshy, painless, irregularly shaped bumps on the vulva, vagina or anus. In men they appear on the penis or scrotum. They may occur singly or in groups, be raised or flat, be large or small. They are usually painless, but some people will feel itching or an irritation in the affected area.

Genital HPV is spread during sexual contact. Because the virus can be present over the entire genital region, condom use does not provide complete protection against catching the virus. Symptoms of the virus may appear several weeks, months or years after the exposure. Some people never have any symptoms of the virus. For these reasons it is usually impossible to determine when or from whom the virus was contracted.

In women HPV infection may first be detected by an abnormal Pap smear. The abnormality on the pap smear may reflect an infection with the virus that will resolve with time or may represent cervical dysplasia. Cervical dysplasia is a change in cells on the cervix that may progress to a cervical cancer if not treated. There are types of HPV that have been strongly linked to the development of cervical cancer in infected women. These are called high-risk subtypes. Other types of HPV will cause abnormalities on Pap smears but are not likely to progress to a cancer. Approximately ¾ lesions on the cervix caused by HPV will go back to normal with no treatment. This is because the immune system will take care of the infection. It is especially important that all women who are exposed to the HPV virus have regular Pap smears to detect cervical abnormalities.

HPV is quite prevalent in sexually active people. A study published several years ago in the New England Journal of Medicine found that 43% of sexually active college women became infected with the virus. Most of these infections were undetectable after about eight months but some persisted. Those women infected with the high-risk subtypes of HPV had a higher chance of an abnormal Pap smear and greater persistence of the virus. Another study from Sweden found that 92% of HPV infections had cleared after 5 years. Again the high-risk subtypes were the ones that persisted.

The majority of HPV infections will resolve with time. However some infections will remain hidden and show up months or years after exposure. There is no medication or treatment that can guarantee complete eradication of the virus. Thus the goal of treatment is to remove visible warts and alleviate irritating symptoms. There are two treatments that can be used at home, podofilox (Condylox) or imiquimod (Aldara). Both are available by prescription only. Some warts can be removed in the doctor’s office by using an acid solution or cutting them off. Laser can be used to remove extensive warts but is quite painful and usually reserved for cases unresponsive to other methods.

HPV infection can certainly be annoying and many women are embarrassed to have contracted it because of its association with sexual activity. However the visible lesions can usually be removed and serious complications are rare. The most important thing for women with an HPV infection is to get regular Pap smears. This will assure that any cervical lesions with a high propensity to become cancer can be treated long before they become invasive. Cervical cancer is usually very slow to develop and grow thus there is ample opportunity to treat lesions long before they become cancerous.