Human Papilloma Virus (HPV)

There are more than 60 viruses lumped together as Human Papilloma Virus (HPV). These viruses can cause warts anywhere on the human body. The HPV types that attack the genital tract are sexually transmitted. HPV is currently the most common sexually transmitted virus in our country with a 1,000 percent increase in HPV patients since 1987. Because it is a non-reportable disease, the actual number of patients infected with HPV is unknown. It is believed more than 50 million Americans are currently infected with the virus, with the number growing by almost a million every year.

Venereal warts (also known as genital warts or condylomata) are the "clinical" form of this infection because they can be easily seen and diagnosed. Venereal warts look like a fleshy bump of tissue on the labia, clitoris, or around the anus. The "sub-clinical" version is more common. The infection resides under the skin and cannot be seen. The sub-clinical varieties have been linked to cancers of the genital tract so it is important for sexually active women to have yearly Pap tests to detect pre-cancerous changes.

Risk Factors
You are at risk for HPV if you have had sex with more than one partner, or have had sex with a person who has had more than one partner.

Symptoms
Whether there are symptoms depends on the strain of HPV present. If there are warts, you will notice a raised, fleshy area. If left untreated, the wart may disappear or it may grow and merge with other warts to take on a cauliflower-like appearance. Some people complain of burning or itching and occasionally a wart may bleed if irritated. You may see warts from one to eight months from exposure, or they may appear many months or years later. It may be difficult or impossible for you to determine when you were exposed.

Evidence of a sub-clinical infection may first show up on a Pap test. Your test may show HPV changes or dysplasia (pre-cancerous cells). HPV infection on the cervix usually has no symptoms at all.

Diagnosis
HPV cannot be grown in a lab and there is no blood test for it. Diagnosis of warts is usually made by sight. If a suspected wart is flat and difficult to see, your doctor may look at the area with a Colposcope (a binocular-like instrument). Warts or HPV infection on the cervix is suggested on a Pap test. Definitive diagnosis is usually made with a colposcopic exam and biopsies.

There is a test available that can identify HPV DNA called the Virapap. This test will only tell us if you are shedding the HPV virus when the test is performed, a negative result does not necessarily mean you hae not come into contact with the virus.

Treatment for Venereal Warts
Like with other viruses, there is no cure for HPV. Warts can be treated as they appear so you may have to return to your doctor or midwife for repeat treatment. Over time though, the warts usually stop developing on their own.

• Trichloroacetic Acid (TCA) - This is a strong chemical painted on the warts to destroy them. The application may cause some burning and should be applied by an experienced practitioner.
• Podophyllin - This is a drug that has been long used in the treatment of venereal warts. It is painted on the warts to destroy them. Because it must be carefully washed off a few hours after it is applied, and cannot be used in pregnancy, Podophyllin is rarely used any more.
• Interferon - This is a new drug that can be injected directly into the wart itself.
• Prescription Drugs for Home Use - There are two medications (Condylox and Aldara) your doctor can prescribe for home use as treatment for venereal warts. Your doctor will show you how to apply them. They can cause burning and inflammation.

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