Human Papillomavirus (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 as 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, an HPV infection causes no symptoms, and has no lasting effects. However, HPV infection can also lead to genital warts, cervical precancer, and sometimes to cervical cancer.
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 contacting one of these subtypes by the time he or she is 50 years old. Most people clear the virus to undetectable levels within two years.
Low-risk HPV subtypes:
- Are 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 HPV subtypes:
- Are 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 subtypes 16 and 18.
Most people who contact HPV experience no symptoms. The infection will often pass without the person ever knowing that he or she had a HPV virus.
Some subtypes of HPV do cause symptoms. Depending on the subtype, symptoms may include:
- Genital warts
- 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.
Mild cervical dysplasia is often a temporary condition, especially in adolescents and young women. It is no longer considered a precancerous condition and is now viewed to be just an HPV infection. In about 70 percent of such mild cases, the condition clears without any treatment.
Moderate and severe cases of cervical dysplasia or precancer (CIN II or CIN III) are usually treated to prevent the development of cervical cancer.
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. This is a simple office procedure, and most women tolerate it 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 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.
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 as well to treat warts.
Cervical dysplasia in the moderate or severe category (precancerous tissue changes of the cervix) is treated most commonly with a LEEP procedure, which uses cautery to remove the affected cells. This is an office procedure.
Another equally effective office treatment is cryotherapy, or freezing to destroy the precancerous cells.
Condoms can reduce the transmission of HPV by more than 50 percent. However, they do not offer complete protection, as the virus is also present 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 to better clear the virus.
A very effective and safe vaccine for HPV (GARDASIL) protects against four HPV subtypes:
- The "low-risk" subtypes 6 and 11. These subtypes of HPV 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 13 high-risk subtypes.
The vaccine is a three-shot series. The second shot is given two months after the first, and the third is given six months after the first shot. The vaccine is FDA-approved for girls and women aged 9-26. Many insurance plans will cover the cost of the vaccine for these age groups.
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