HUMAN PAPILLOMAVIRUS (HPV)

Symptoms

In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer. Genital warts usually appear as a small bump or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area. Cervical cancer usually does not have symptoms until it is quite advanced, very serious and hard to treat. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.

 Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat. These include cancers of the vulva, vagina, penis, anus, and oropharynx (cancers of the back of the throat, including the base of the tongue and tonsils).

Causes

HPV infection occurs when the virus enters your body, usually through a cut, abrasion or small tear in your skin. The virus is transferred primarily by skin-to-skin contact.Genital HPV infections are contracted through sexual intercourse, anal sex and other skin-to-skin contact in the genital region. Some HPV infections that result in oral or upper respiratory lesions are contracted through oral sex. If you're pregnant and have an HPV infection with genital warts, the warts might enlarge and multiply during pregnancy. Treatment might have to wait until after delivery. Large genital warts can block the birth canal, complicating vaginal delivery. The infection might be linked to a rare, noncancerous growth in the baby's voice box (larynx).Warts are contagious. They spread by contact with a wart or with something that touched the wart.

Diagnosis

Your doctor might be able to diagnose HPV infection by looking at your warts.If genital warts aren't visible, you'll need one or more of the following tests:

• Vinegar (acetic acid) solution test. A vinegar solution applied to HPV-infected genital areas turns them white. This may help in identifying difficult-to-see flat lesions.
• Pap test. Your doctor collects a sample of cells from your cervix or vagina to send for laboratory analysis. Pap tests can reveal abnormalities that can lead to cancer.
• DNA test. This test, conducted on cells from your cervix, can recognize the DNA of the high-risk varieties of HPV that have been linked to genital cancers. It's recommended for women 30 and older in addition to the Pap test.

Preventions

Common warts: It's difficult to prevent HPV infections that cause common warts. If you have a common wart, you can prevent the spread of the infection and formation of new warts by not picking at a wart and not biting your nails.

Plantar warts: To reduce the risk of contracting HPV infections that cause plantar warts, wear shoes or sandals in public pools and locker rooms.

Genital warts: You can reduce your risk of developing genital warts and other HPV-related genital lesions by:

• Being in a mutually monogamous sexual relationship
• Reducing your number of sex partners
• Using a latex condom, which can reduce your risk of HPV transmission

HPV vaccines

Three vaccines, which vary in the number of HPV types they protect against, have been developed. Gardasil, Gardasil 9 and Cervarix have been shown to protect against cervical cancer. Gardasil and Gardasil 9 also protect against genital warts. The Centers for Disease Control and Prevention (CDC) recommends routine HPV vaccination for girls and boys ages 11 and 12. The vaccines are to be administered in three doses over six months. If children are not fully vaccinated at ages 11 and 12, the CDC recommends that girls and women through age 26 and boys and men through age 21 receive the vaccine. The CDC also recommends the vaccine through age 26 for men who have sex with men and for both men and women who are immune compromised if they didn't get the vaccine when younger. However, these vaccines are most effective if given before being exposed to HPV, so it's best to get them before becoming sexually active. Researchers are working on newer vaccines, some designed to treat HPV lesions, but they're not yet available.

Risk Factors

HPV infections are common. Risk factors for HPV infection include:

• Number of sexual partners. The more sexual partners you have, the more likely you are to contract a genital HPV infection. Having sex with a partner who has had multiple sex partners also increases your risk.
• Age. Common warts occur mostly in children. Genital warts occur most often in adolescents and young adults.
• Weakened immune systems. People who have weakened immune systems are at greater risk of HPV infections. Immune systems can be weakened by HIV/AIDS or by immune system-suppressing drugs used after organ transplants.
• Damaged skin. Areas of skin that have been punctured or opened are more prone to develop common warts.
• Personal contact. Touching someone's warts or not wearing protection before contacting surfaces that have been exposed to HPV — such as public showers or swimming pools — might increase your risk of HPV infection.

Complications

• Oral and upper respiratory lesions. Some HPV infections cause lesions on your tongue, tonsils, soft palate, or within your larynx and nose.
• Cancer. Certain strains of HPV can cause cervical cancer. These strains might also contribute to cancers of the genitals, anus, mouth and upper respiratory tract.

Treatment