Human Papilloma Virus
(pap-ill-LOW-mah)
Human Papilloma Virus (HPV) causes genital warts. It is the most common sexually transmitted virus in the United States (5.5 million cases per year) and is incurable. HPV is also highly contagious (the risk is 1 per 2 sexual encounters, or 50% per encounter).
Human papilloma virus disease is manifested by wart-like growths (Condylomata acuminata) around the cervix, vulva, rectum or penis, or more recently, in the throat. These warts may be as small as a pinhead, or as large as a fist (this is not common, but has been reported in medical reports).
A recent report of a National Cancer Institute-sponsored, 11-year long longitudinal study [JAMA, 20June01] found that:
- over 36 months, 55% of sexually active young women who had not had HPV previously, became infected.
- each new sexual partner per month increased a woman’s risk of HPV infection by 10 fold.
- daily cigarette smoking increased the chances that HPV infection would lead to LSIL (low-grade squamous intraepithelial lesions — precancerous)
Vaginal and cervical infection may result in abnormal pap smear cells (premalignant) which are very difficult to eliminate once diagnosed and which can become cancerous. Between 60 and 100 strains of HPV exist; at least five strains are known to cause cervical cancer, two other strains can cause invasive cancer within one year of infection, and men can experience cancer of the penis.
Topical chemotheraphy, surgical removal, cryotherapy and laser treatment are utilized to control the warts. However, oftentimes, the warts reappear within a few months and re-treatment is necessary.
Both males and females can infect others with the papilloma virus and yet have no apparent warts. At least 38 to 46 percent (and, up to 60 percent) of sexually active women contract HPV (NEJM, 2/98). Over 24 million Americans (one of every 11persons) were reportedly infected with HPV in 1996 (CDC, 11/96), and as mentioned above, 5.5 million more Americans are infected each year. In 1999, an estimated 12,800 cases of invasive cervical cancer were expected to occur, with about 4,800 – 5000 U.S. women dying from this disease (Landis, et al., 1999). One study of 796,337 women found that almost 25 percent of the abnormal pap smears evaluated were from 15- to 19-year-old women.
About 5,000 American women die from HPV-associated genital cancers each year (CDC, 11/96). "Certain [strains] of sexually acquired HPV are also now considered to be a cause of most cancers of the vagina, vulva, anus, and penis. Although each of these cancers occurs less frequently than does cervical cancer, taken together they equal nearly half the number of cases of cervical cancer in the United States (Eng & Butler, 1997). HPV can lead to cancer of the penis, and to cancer of the anus in men as well as women (Eng & Butler, 1997).
*****Condoms provide no protection from HPV**** (CDC, 2001).
Common symptoms of HPV, if symptoms occur:
- warts on the genitals, in the urethra, in the anus, and in the throat
- genital warts are soft to the touch, may look like miniature cauliflower florets, and often itch
- untreated genital warts can grow to block the openings of the vagina, anus, or throat and become quite uncomfortable. It usually takes two to three weeks after infection for warts to develop. In women, genital warts grow more rapidly during pregnancy or when other infections are present.
How genital HPVs are spread:
- vaginal and/or anal intercourse
- very rarely, genital warts spread to the fetus during childbirth
- oral sex
Pap tests may reveal precancerous conditions caused by genital HPVs – regular checkups and early treatment prevents cancer of the cervix.
Treatment: No cure for HPV. Though they may recur, genital warts can be removed by carefully applying, and often reapplying, a prescription medication podofilox or imiquimod – to the warts. Clinicians offer other treatments, including:
- application of podophyllin or acid
- standard surgery
- laser surgery (vaporizing the wart with a beam of high-powered light)
- cryosurgery (freezing the wart with liquid nitrogen)
- injection of interferon
Infected people who must endure these treatments may experience emotional trauma, lowered self-esteem, and/or humiliation.
The risk of developing cancer of the cervix is directly related to two factors: age of the woman at first sexual intercourse (the younger her age, the greater the risk); and the number of sexual partners (the greater the number of different partners, the greater the risk) [D. Higby, MD,Baystate Medical Center, MA; CDC].
Pap smears should be obtained yearly by sexually active women to screen for pre-cancerous cervical cells at the onset of sexual activity no matter how young the patient.
For more information regarding HPV, go to http://www.ncfpc.org/PolicyPapers/Findings%200307%20HPV.pdf, a policy paper dealing with HPV and its relation to adolescent health and education.