Like several other sexually transmitted infections, HPV usually causes an infection that does not have visible symptoms. One study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) reported that almost half of the women infected with HPV had no obvious symptoms. Because of the persistent nature of this viral infection, individuals may not be aware of their infection or the potential risk of transmission to others and of developing complications.

As far back as 1991, the Journal of the American Medical Association revealed that almost 50% of sexually active females seeking evaluation for unrelated conditions at a gynecological evaluation at a University Health Center environment demonstrated positive testing for HPV DNA in the vagina. Thus, a decade ago almost half of sexually active females revealed through testing that they had HPV DNA in their vaginas. This data is an astounding revelation regarding the prevalence of this infection that had never before been noticed.

Interestingly, in this study fewer than 10% of patients had actual visible, external signs of skin changes consistent with “genital warts”, the most common skin manifestation of HPV. The conclusion, therefore, was that about half of sexually active females ranging in age from 20-40 were infected with HPV, and fewer than one in ten patients were aware of it.

Genital Warts

Genital warts (condylomata acuminata or venereal warts) are caused by few of the many types of HPV. Other common types of HPV infections, such as those that cause warts on the hands, do not cause genital warts. Genital warts are spread by sexual contact with an infected partner and are highly contagious. Approximately two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within three months of contact. It is estimated that as many as 1 million new cases of genital warts are diagnosed in the United States each year.

In women, the warts can occur on both the outside and inside of the vagina, on the cervix (the opening to the uterus), or around the anus. In men, they are likely to be found on the tip or shaft of the penis, on the scrotum, or around the anus. Genital warts often occur in clusters and can be very tiny or can spread into large masses on genital tissues. Left untreated, genital warts often disappear. In other cases, they eventually may develop a fleshy, small raised growth with a cauliflower-like appearance. Because there is no way to predict whether the warts will grow or disappear, people who suspect that they have genital warts should be examined and treated, if necessary.

Diagnosis

A medical care provider can often diagnose genital warts by visual examination. Women with genital warts should also be examined for possible HPV infection of the cervix. The doctor may be able to identify some otherwise invisible changes in the tissue by applying vinegar (acetic acid) to areas of suspected infection. This solution causes infected areas to whiten, which makes them more visible, particularly if a procedure called colposcopy is performed. During colposcopy, a magnifying instrument is used to view the vagina and cervix. In some cases, it may be necessary to biopsy cervical tissue. This involves taking a small sample of tissue from the cervix and examining it microscopically.

A Pap smear test may indicate the possible presence of cervical HPV infection. A Pap smear is a microscopic examination of cells scraped from the uterine cervix in order to detect cervical cancer. Abnormal Pap test results are often associated with HPV infection. Women with abnormal Pap smears should be examined further to detect and treat cervical problems. Prevention The only way to prevent HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact. If warts are visible in the genital area, sexual contact should be avoided until the warts are treated. Using latex condoms during sexual intercourse may provide some protection but not always. Researchers are working to develop two types of HPV vaccines. One type would be used to prevent infection or disease (warts or pre-cancerous tissue changes); another type would be used to treat cervical cancers. Clinical trials are in progress for both types of vaccines.

Complications

Low-risk papilloma viruses cause warts but not cervical cancer. High-risk viruses are known to cause cervical cancer and have been associated with vulvar cancer, anal cancer, and cancer of the penis (a rare cancer). Although most HPV infections do not progress to cancer, it is particularly important for women who have cervical dysplasia to have regular Pap smears. Pre-cancerous cervical disease is readily treatable.

Genital warts may cause a number of problems during pregnancy. Sometimes they enlarge during pregnancy, making urination difficult. If the warts are on the vaginal wall, they can make the vagina less elastic and cause obstruction during delivery.

Rarely, infants born to women with genital warts develop laryngeal papillomatosis (warts in the throat). Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent obstruction of the airways. Research on the use of interferon therapy in combination with laser surgery indicates that this drug may show promise in slowing the course of the disease.

Oral HPV

In a statement from ASHA (The American Social Health Association), HPV is transmitted through direct skin to skin contact when an infected area comes into direct contact with mucous membranes or the delicate skin of the genital area. This can occur through genital to genital contact, vaginal and anal sex.