Χάρης Χ. Χηνιάδης

How common is HPV?
In the United States, HPV is considered to be the most common sexually transmitted disease (STD). Some studies estimate that the majority of the sexually active population is exposed to at least one or more types of HPV - although most do not develop detectable symptoms. Because HPV is so common and prevalent, a person does not need have to have a lot of sexual partners to come into contact with this virus.

What about HPV and cervical cancer?

• There are many different types of genital HPV.
• Only certain types of HPV are linked with cervical cancer. These are usually called "high-risk" types.
• The types of HPV that cause raised external genital warts are not linked with cancer. These are called "low-risk" types.
• These wart-types of HPV usually are not usually found on a female's cervix, and therefore, are not going to carry any risk of cancer.
• It is common for a person to be exposed and have more than one type of HPV, including several "high-risk" types. Yet, most women do not develop cervical cancer.
• Cervical cancer usually takes years to develop.
• The majority of cases of cervical cancer are in women who have either never had a Pap smear, or have not had one in five years or more.
• Cervical cancer can be prevented if a female gets a Pap smear at regular intervals. This way, if cell changes are found, it can be monitored and / or treated before progressing to cervical cancer.
• Most of the time, men will not have any symptoms or health risks such as cancer with the "high-risk" types of HPV. It is the female's cervix that needs to be monitored.

What are the symptoms of genital warts?
Only certain types of HPV cause genital warts. Other types, not related to genital warts, can cause abnormal cell changes on the genital skin, usually on a female's cervix.

What do warts look like?

Genital warts appear as growths or bumps. Warts may be raised or flat, single or multiple, small or large. They tend to be flesh-colored or whitish in appearance. Warts usually do not cause itching, burning, or pain.

Often, genital warts are so small that they can not be seen with the naked eye. This is sometimes called "subclinical warts." Therefore, a person may not even know he or she has the type or types of HPV that cause genital warts. The types of HPV that cause raised external genital warts are not linked with cancer, and these types are usually harmless.

Where can genital warts appear?

How often can episodes of genital warts occur?

• Some people only have one episode, while others have recurrences
• When warts are present, the virus is considered active
• When warts are gone, the virus is latent (sleeping) in the skin cells - it may or may not be contagious at this time
• Genital warts may or may not return after the first episode
• A healthy immune system is usually able to clear the virus, or suppress it, over time.
• Warts may appear within several weeks after sex with someone who has the wart-types of HPV, or it may take several months or years to appear. Or, warts may never appear. This makes it hard to know exactly when or from whom someone got the virus.

How can a person get genital warts?

Any person who is sexually active can get genital warts.

• The types of HPV that cause genital warts are usually spread by direct skin-to-skin contact during vaginal, anal, or possibly oral sex with someone who has this infection.
• Very little is known about passing subclinical HPV to sex partners. HPV may be more likely transmitted when warts are present, but the virus can be transmitted even when ther are no visible symptoms.
• The types of HPV that cause genital warts are usually different from those causing warts on other body parts, such as the hands. People do not get genital warts by touching warts on their hands or feet.
• Warts on other parts of the body, such as the hands, are caused by different types of HPV.
• Warts are not commonly found in the mouth, so some experts believe that transmission through oral sex is not as likely as with genital-to-genital or genital-to-anal contact.

How can a person find out if they have genital warts?

Sometimes, warts can be very hard to see. Also, it can be hard to tell the difference between a wart and normal bumps on the genital area. If someone thinks he or she has warts or have been exposed to HPV, they should go to a doctor or clinic.
A biopsy is not necessary for diagnosing genital warts. This is only done if the bump is unusual looking or discolored.

There are no blood tests clinically available to diagnose a person for HPV.

How can someone reduce the risk of getting genital warts?

Any person who is sexually active can come across this common virus. Ways to reduce the risk are:

• Not having sex with anyone.
• Having sex only with one partner who has sex only with you. People who have many sex partners are at higher risk of getting other STDs.
• If someone has visible symptoms of genital warts, he or she should not have sexual activity until the warts are removed. This may help to lower the risk of giving the virus.
• Condoms (rubbers), used the right way from start to finish each time of having sex may help provide protection - but only for the skin that is covered by the condom. Condoms do not cover all genital skin, so they don't protect 100%.
• Spermicidal foams, creams, jellies (and condoms coated with spermicide) are not proven to be effective in preventing HPV and may cause microscopic abrasions that make it easier to contract STDs. Spermicides are not recommended for routine use.
• When someone has HPV, they are not likely to be reinfected if exposed again to the same type. This is probably due to the immune system's response to the virus. However, it is possible to be infected with a different type of HPV from a new partner.

How are genital warts treated?

• While there is no medical cure for HPV, there are several treatment options available for genital warts.
• The goal of any treatment should be to remove visible genital warts to get rid of annoying symptoms. No one treatment is best for all cases.
• Some treatments are done in a clinic or doctor's office; others are prescription creams that can be used at home for many weeks.

• Podophyllin (a chemical compound that must be applied by a doctor or nurse). This is an older treatment and is not as widely used today.
• Electrocautery (burning off warts with an electrical current)
• Laser therapy (using an intense light to destroy warts).This is used for larger or extensive warts, especially those that have not responded well to other treatments. Laser can also cost a lot of money. Most doctors do not have lasers in their office and the doctor must be well-trained with this method.

What about pregnancy and genital warts?

• Most pregnant women who have had genital warts previously but no longer do would be unlikely to have any complications or problems during pregnancy or birth.
• Most children are born healthy to women with a history of genital warts.
• Because of hormone changes in the body during pregnancy, warts can grow in size and number, bleed, or, in extremely rare cases, make delivery harder.
• Very rarely, babies exposed to the wart-types of HPV during birth may develop growths in the throat.

Is it normal to feel upset about genital warts?

Yes, it is normal. Some people feel very upset. They may feel ashamed, fearful, confused, less attractive or less interested in sex. They feel angry at their sex partner(s), even though it is usually not possible to know exactly when or from whom the virus was spread.
Some people are afraid that the genital warts could lead to cancer or that they will never be able to find a sexual partner again.

Among both patients and clinicians there is confusion over the "low-risk" HPV types that cause genital warts and the "high-risk" types associated with cervical cancers, leading many to worry needlessly about health complications with warts.