Human Papillomavirus (HPV) & Genital Warts

Human papillomavirus (HPV) is a group of more than 200 related viruses. Some of them are spread through sexual contact. Most people have been exposed to HPV. Usually, your immune system controls HPV infections, and they go away on their own and don't cause any health problems, but some need treatment.

There are two categories of sexually transmitted HPV. They are called low-risk HPV and high-risk HPV. Sometimes high-risk HPV infections can stay at the cervix (the lower part of a woman's uterus) for many years. This can lead to cell changes. If these changes are not screened for and treated, they may get worse over time and become cancer.

Low-risk HPVM can cause warts on or around your genitals, anus, mouth, or throat.

High-risk HPV can cause various cancers:

• Cervical cancer
• Anal cancer
• Oropharyngeal cancer, a type of head and neck cancer, also called throat cancer
• Vulvar cancer
• Vaginal cancer
• Penile cancer

HPV infections are very common. Nearly all sexually active people are infected with HPV soon after they become sexually active.

Some people get warts from certain low-risk HPV infections, but the other types (including the high-risk types) have no symptoms.

If a high-risk HPV infection lasts for many years and causes cell changes, you may have symptoms. You may also have symptoms if those cell changes develop into cancer. Which symptoms you have depends on which part of your body is affected.

Health care providers can usually find out if you have warts by looking at them.

Nearly all cervical cancers are caused by a long-lasting infection with a high-risk type of HPV. Screening can prevent cancer by finding out if you need treatment for changes that might happen before cancer, called precancer.

Screening tests for HPV can include:

• For women, there are cervical cancer screening tests that can find changes in the cervix that might lead to cancer. As part of the screening, women may have Pap tests (sometimes called a Pap smear), HPV tests, or both. HPV tests use a sample of cervical cells.
• Your provider may also suggest a colposcopy to check for abnormal cells.

An HPV infection itself cannot be treated. Because HPV causes cancer at other places in the body, testing for the HPV virus can be helpful to make other treatment decisions.

• HPV infection. Talk to your provider about whether you need other tests and how often you should be checked to prevent cervical cancer.
• Warts. There are medicines that you can apply to a wart. If they don't work, your provider could freeze, burn, or surgically remove them.
• Cell changes caused by infection with high-risk HPV. Treatments may include medicines you apply to the affected area or various surgical procedures.

People who have HPV-related cancers usually get the same types of treatment as people who have cancers that HPV does not cause. An exception to this is for people who have certain oral and throat cancers. They may have different treatment options.

Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading HPV. If you or your partner is allergic to latex, you can use polyurethane condoms. The most reliable way to avoid infection is to not have anal, vaginal, or oral sex.

Vaccines can protect against several types of HPV, including genital warts and some that can cause cancer. The vaccines provide the most protection when people get them before exposure to the virus. This means that it is best for people to get them before they become sexually active.

Ask your child's provider about when to vaccinate your child against HPV. If you're over age 26 and haven't been vaccinated, talk with your provider about the possible benefits of vaccination.

Genital warts are soft growths on the skin and mucous membranes of the genitals. They may be found on the penis, vulva, urethra, vagina, cervix, and around and in the anus.

Genital warts are spread through sexual contact.

The virus that causes genital warts is called human papillomavirus (HPV). HPV infection is the most common sexually transmitted infection (STI). There are more than 180 types of HPV. Many cause no problems. Some cause warts on other parts of the body and not the genitals. Types 6 and 11 are most commonly linked to genital warts.

Certain other types of HPV can lead to precancerous changes in the cervix, or to cervical cancer. These are called high-risk types of HPV. They can also lead to vaginal or vulvar cancer, anal cancer, and throat or mouth cancer.

Important facts about HPV:

• HPV infection spreads from one person to another through sexual contact involving the anus, mouth, or vagina. The virus can be spread, even if you do not see the warts.
• You may not see warts for 6 weeks to 6 months after becoming infected. You may not notice them for years.
• Not everyone who has come into contact with the HPV virus and genital warts will develop them.

You are more likely to get genital warts and spread them more quickly if you:

• Have multiple sexual partners
• Are sexually active at an early age
• Use tobacco or alcohol
• Have a viral infection, such as herpes, and are stressed at the same time
• Are pregnant
• Have a weakened immune system due to a condition such as diabetes, HIV/AIDS, or from medicines

If a child has genital warts, sexual abuse should be suspected as a possible cause.

Genital warts can be so tiny, you cannot see them.

The warts can look like:

• Flesh-colored spots that are raised or flat
• Growths that look like the top of a cauliflower

In females, genital warts can be found:

• Inside the vagina or anus
• Outside the vagina or anus, or on nearby skin
• On the cervix inside the body

In males, genital warts can be found on the:

• Penis
• Scrotum
• Groin area
• Thighs
• Inside or around the anus

HPV can also cause warts on the:

• Lips
• Mouth
• Tongue
• Throat

Other symptoms are rare, but can include:

• Increased dampness in the genital area near the warts
• Increased vaginal discharge
• Genital itching
• Vaginal bleeding during or after sex

Your health care provider will perform a physical exam. In women, this includes a pelvic exam.

An office procedure called colposcopy is used to spot warts that cannot be seen with the naked eye. It uses a light and a low-power microscope to help your provider find and then take samples (biopsy) of abnormal areas in your cervix. Colposcopy is usually done in response to an abnormal Pap test.

HPV can cause abnormal results on a Pap test. If you have these types of changes, you may need more frequent Pap tests or a colposcopy.

An HPV DNA test can tell if you have a high-risk type of HPV known to cause cervical cancer. This test may be done:

• If you have genital warts
• As a screening test for cervical cancer women age 30 or older
• In women of any age who have a slightly abnormal Pap test result

Make sure you are screened for cervical, vaginal, vulvar, or anal cancer if you have been diagnosed with genital warts.

Genital warts must be treated by a provider. Do not use over-the-counter medicines meant for other kinds of warts.

Treatment may include:

• Medicines applied to the genital warts or injected by your provider
• Prescription medicine that you apply at home several times a week

The warts may also be removed with minor procedures, including:

• Freezing (cryosurgery)
• Burning (electrocauterization)
• Laser therapy
• Surgery

If you have genital warts, all of your sexual partners should be examined by a provider and treated if warts are found. Even if you do not have symptoms, you should be treated. This is to prevent complications and avoid spreading the condition to others.

You will need to return to your provider after treatment to make sure all the warts are gone.

Routine Pap tests are recommended if you are a woman who has had genital warts, or if your partner had them. If you had warts on your cervix, you may need to have Pap tests every 3 to 6 months for a time after the first treatment.

Women with precancerous changes caused by HPV infection may need further treatment.

Many sexually active young women become infected with HPV. In many cases, HPV goes away on its own.

Most men who become infected with HPV never develop any symptoms or problems from the infection. However, they can still pass it on to current and sometimes future sexual partners. Men are at increased risk for cancer of the penis, anus, and throat if they have a history of HPV infection.

Even after you have been treated for genital warts, you may still infect others.

Some types of HPV can cause cancer of the cervix and vulva. They are the main cause of cervical cancer.

Genital warts may become numerous and quite large. These will need further treatment.

Contact your provider if:

• A current or past sexual partner has genital warts.
• You have visible warts on your external genitals, itching, discharge, or abnormal vaginal bleeding. Keep in mind that genital warts may not appear for months to years after having sexual contact with an infected person.
• You think a young child might have genital warts.

Women should begin having Pap tests at age 21 or as recommended by their provider.

HPV can be passed from person to person even when there are no visible warts or other symptoms. Practicing safer sex can help reduce your risk for getting HPV and cervical cancer:

• Always use male and female condoms. But be aware that condoms cannot fully protect you. This is because the virus or warts can also be on the nearby skin.
• Have only one sexual partner, who you know is infection-free.
• Limit the number of sexual partners you have over time.
• Avoid partners who take part in high-risk sexual activities.

An HPV vaccine is available:

• It protects against the HPV types that cause most HPV cancers in women and men. The vaccines DO NOT treat genital warts, they prevent the infection.
• The vaccine can be given to boys and girls 9 to 12 years old. If the vaccine is given at this age, it is a series of 2 shots.
• If the vaccine is given at 15 years or older, it is a series of 3 shots.
• The vaccine can be given to adults age 27 to 45 years, after a discussion with their providers.

Ask your provider whether the HPV vaccine is right for you or your child.