The human papilloma virus (HPV, or genital wart virus) is a very common infection of the genital area.
About HPV
HPV is transmitted from person to person through physical contact. Because the most common contact in the genital area is sexual, HPV has been labeled a sexually-transmitted disease. It can also be viewed as a germ that is passed from person to person by physical contact.
In most cases, HPV infection causes no symptoms and usually has no lasting effects. HPV infection can lead to genital warts, cervical precancer, and sometimes to cervical cancer.
Types of HPV
More than 100 subtypes of HPV have been discovered. Many of these subtypes cause no symptoms, while others may cause foot and hand warts.
Forty of these subtypes can affect the genital area. These 40 subtypes have been numbered, and are divided into low-risk and high-risk strains. A person has an 80 percent chance of contracting one of these subtypes by the time he or she is 50 years old. For most people, the virus is at undetectable levels within two years.
Low-risk subtypes
- Less likely to cause cervical cancer than high-risk subtypes.
- May cause genital warts. Two common low-risk subtypes (6 and 11) cause 90 percent of all genital warts.
High-risk subtypes
- More often associated with precancerous tissue changes of the cervix that may lead to cervical cancer, if left untreated over many years. About 70 percent of cervical precancer and cancer are caused by HPV subtype 16 and 18.
Symptoms of HPV
Most people who contact HPV experience no symptoms. The infection will often pass without the person ever knowing that he or she had an HPV virus.
Some subtypes do cause symptoms including genital warts and precancerous tissue changes of the cervix, also known as cervical dysplasia or CIN (cervical intraepithelial neoplasia). Such changes can lead to cervical cancer in women if not treated. CIN is 100 percent curable with treatment.
About mild cervical dysplasia (mild precancer, or CIN I)
Mild cervical dysplasia is often a temporary condition, especially in adolescents and young women. It is no longer considered a precancerous condition. It is now only viewed as HPV infection. In about 70 percent of such mild cases, the condition clears without any treatment.
Moderate to severe cases of cervical displasia or precancer (CIN II or CIN III) are usually treated to prevent the development of cervical cancer.
How does my doctor tell if I have HPV
An abnormal pap smear may suggest HPV or precancerous tissue changes of the cervix. Your doctor or care provider may recommend a procedure called colposcopy, which uses a microscope to carefully examine the cervix for abnormal cellular patterns.
A cervical biopsy is often performed to make a diagnosis of HPV. A cervical biopsy is a simple office procedure. Most women tolerate the procedure well with only minimal cramping.
Because HPV has been called a sexually-transmitted disease, there is a tendency for people diagnosed with HPV to feel they have been contaminated, or are dirty. We try to encourage our patients to think of it as just another germ, like bacteria on the skin. Such germs are considered a part of our normal biology.
If you have been diagnosed with a strain of HPV, your doctor will want to make sure that you do not have any precancerous conditions.
Genital warts can be diagnosed by physical examination and usually do not require a biopsy for diagnosis.
Treatment
Genital warts can be treated with a chemical to destroy the warts, with cautery, or with a laser. There are topical medications available by prescription that can be used at home to treat warts.
Cervical dysplasia in the moderate or severe category (precancerous tissue changes of the cervix) is treated most frequnetly with a Loop Elctrosurgical Excision Procedure (LEEP) procedure which uses cautery to remove the affected cells. A LEEP procedure begins in the same way as a standard pelvic exam. You will receive some local anesthesic and a mild iodine or vinegar solution to show any abnormal cells. your doctor or nurse will look at the cells through a magnifying device called a colpocscope. A think wire loop running very high frequency electrical currents will allow your provider to remove the abnormal cells very precisely. The tissue is then sent to the lab to look for cancerous cells.
Equally effective office treatment includes cyrotherapy, or freezing, which destroys the precancerous cells.
Preventing transmission
Condoms can reduce the transmission of HPV by more than 50 percent. However, they do not offer complete protection as the virus is also prsent on the outer skin of the genital area.
Smoking can affect a woman's ability to fight the virus, so we encourage women to quit smoking to help their immune system better clear the virus from their system.
The HPV vaccine
HPV (GARDASIL) is an effective and safe vaccine which protects against four sub-types:
- The "low-risk" subtypes 6 and 11. These subtypes do not generally cause precancerous conditions. They are responsible for 90 percent of genital warts.
- HPV subtypes 16 and 18. These high-risk subtypes cause 70 percent of precancerous tissue changes of the cervix and cervical cancers.
The vaccine does not protect against the other subtypes.
The vaccine is a series of three shots. You will receive the second shot two months after the first shot. The third shot is given six months after the first shot. The vaccine has been approved by the FDA for treatment of girls and women ages 9 to 26. Many insurance plans will cover the cost of the vaccine for these age groups.