HPV Infection'Genital Warts'
Written by : Dr.M.D.Mazumdar, MD
The Human Papilloma Virus is a sexually transmitted virus which can cause various symptoms, including the formation of genital warts. It is also closely associated with development of cervical cancers.
Also called condyloma acuminata or venereal warts, genital warts are soft, flesh colored bumps or growths that occur mainly in the genital regions - the vagina, cervix and urethra in females and the penis and scrotum in males.
They can also occur in the mouth after oral sex or in the rectum and anus after anal sex.
About two-thirds of all persons who have sex with an infected person will have warts after 3 months of sexual contact. It is estimated that about 20 million people are infected with the HPV virus in the USA.
Signs and Symptoms of HPV Infection
No SymptomsAbout one third of all infected people will show no symptoms at any time. Others may remain without symptoms for long durations with symptoms showing up from time to time.
Genital WartsGenital Warts start as pinkish or flesh coloured small bumps in the genital, oral or anal region. They may occur singly or in groups. Left untreated, they grow larger until they form clusters of finely branched structures with a narrow stalk hanging from the vulva, inside and outside the vagina or around the anus.
Sometimes the warts may be coarse and broad-based - small cauliflower-like growths around the genital organs. Occasionally,the warts may be flat, or very slightly raised above the skin surface. When they grow inside the vagina, they may blend with the mucus membrane and may be very difficult to identify without special techniques.
Other symptoms of HPV infection that may be present are:
Diagnosis of HPV Infection (Genital Warts)
Visual InspectionGenital warts can be diagnosed by visual inspection. The flat moist flesh colored growths are easily identifiable.
Special ExaminationGenital warts that are inside the vagina may be flat and not easily identified by direct vision. Vinegar (acetic acid) has to be applied inside the vagina which turns the affected part (warts) of the mucosa white.
BiopsySometimes a biopsy of the whitish tissue may be taken to be examined under the microscope and checked for changes in the cells.
Genetic testsThe HPV DNA can be identified inside cervical and vaginal cells in infected women. This is a definitive test for HPV infection. Regular pap smears should be done in all women in the reproductive age group to identify HPV infection and cervical cellular changes.
Pap SmearA Pap Smear checks for changes in cervical cells (cervical dysplasia) that may lead to cervical cancer. Since more than 90% of all women with cervical dysplasia are infected by HPV, it has often been reasoned that all women with cervical dysplasia needs to be evaluated for HPV infection.
HPV Tests for Men
Currently, no specific HPV tests are available for men. But HPV DNA sampling can be done in scrapings of cells taken from the tip of the penis.
Treatment of HPV Infection
Unfortunately, there is no permanent cure of HPV infection. Once infected, the virus remains in the man or woman for life. But genital warts can be treated and removed. Occasionally though, warts tend to recur.
Treatment of Genital Warts
Genital warts can be treated by application of medicines or by surgery.
Medical TreatmentVarious medicines are available that can cause the warts to shrivel and drop off. Some of them are:
- Podophyllin or Podofilox solution.
- Imidoquimod cream
- Trichloroacetic Acid
- 5-fluorouracil cream.
Surgical TreatmentWarts that resist medical treatment are best removed by surgical methods:
- Cryosurgery (freezing)
- Electrocautery or thermocautery (burning)
- Laser therapy
Complication of HPV Infection
The biggest and most well known complication of HPV infection is the development of cervical cancer. It has been seen that more than 90% of women with cervical dysplasia are also infected with the HPV virus.
Other complications that can occur are infection of the baby in pregnant woman and the development of warts in the baby's throat. Warts in the vagina can also cause difficulty in normal delivery.
Prevention of HPV Infection There are a large number of strains of HPV virus. Of these strains, HPV types 6, 11, 16 and 18 can be prevented by a vaccine known as Gardasil. Since HPV type 16 and 18 are responsible for 95% of all cervical cancers and HPV types 6 and 11 causes most of the cases ogf genital warts, these can be prevented by Gardasil.
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