HUMAN PAPILLOMA VIRUS ( Genital Warts )

           Human papillomavirus (HPV) is one of the most common causes of sexually transmitted
     disease (STD) in this country. As many as 27 million Americans are infected with HPV, and the
     incidence of the diseases it causes appears to be increasing. More than 70 types of HPV have been 
     identified by scientists. Some types of the virus cause common skin warts. About one-third of the HPV
     types can be spread through sexual contact. Several types of HPV can lead to genital warts, the
     most recognizable sign of genital HPV infection. HPV Types 6 and 11 cause 90% of genital wart
     cases.  Certain other types of HPV have been closely associated with the development of cervical
     cancer and other genital cancers. HPV types 16 and 18 cause 70% of cervical cancers.

            Like many STDs, HPV infection often does not cause visible symptoms. Over half of the women
      infected with HPV had no obvious symptoms. Because the virus can remain latent in the skin,
      infected persons may not be aware of their infection and the potential risk of transmission to others
      and of developing complications.  Some studies have shown that many HPV types are found on our
      skin and most do not cause any health problems.

       Genital Warts

       Genital warts (condylomata acuminata or venereal warts) are caused by only a few of the many types
     of HPV. Other common types of HPV infections, such as those that cause warts on the hands and soles
     of the feet, do not cause genital warts. Genital warts are spread by sexual contact with an infected
     partner and are very contagious. Approximately two-thirds of people who have sexual contact with a
     partner with genital warts will develop this disease, usually within 3 months of contact. Scientists estimate
     that as many as 1 million new cases of genital warts are diagnosed in the United States each year.

              In women, the warts occur on the vulva, labia, inside the vagina, on the cervix, or around the
     anus. In men, genital warts usually appear on the tip of the penis; however, they also may be found
     on the shaft of the penis, on the scrotum, or around the anus. Rarely, genital warts also can develop in 
     the mouth or throat of a person who has had oral sexual contact with an infected person. Genital warts
     often occur in groups and can be very tiny or can accumulate into large masses on genital tissues. Left
     untreated, genital warts often grow into larger warts. 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, however, people who suspect that they have genital warts
     should be examined and treated, if necessary.      

     Diagnosis

       It is important for a person who thinks he or she may have genital warts to see a doctor.
      Genital warts are usually diagnosed by direct visual examination.Women with genital warts should be
      examined for possible HPV infection of the cervix. The doctor may be able to identify some otherwise
      invisible lesions 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 uterine 
      cervix. In some cases, it is necessary to do a biopsy of cervical tissue. This involves taking a small
      sample of tissue from the cervix and examining it under the microscope.

        A Pap smear test also may indicate the possible presence of cervical HPV infection. A Pap smear is
      a microscopic examination of cells taken from the uterine cervix in order to detect cervical cancer.
      Abnormal Pap smear results can indicate possible HPV infection. Women with abnormal Pap smears
      should be examined further to detect and treat cervical problems.

      Several new laboratory tests can identify specific types of HPV. Such tests may help a doctor determine
      whether the infection is likely to progress to precancerous lesions or be transmitted from a pregnant
      woman to her newborn.

     Treatment

      Depending on factors such as their size and location, genital warts are treated in several ways.
      Although treatments can eliminate the warts, none eradicate the virus, and warts often reappear after
      treatment. Patients should consult their doctors to determine the best treatment for them.

      Small warts can be removed by cryosurgery (freezing) or electrocautery (burning). Occasionally, surgery
      is needed to remove large warts that have not responded to other treatment. Doctors at some medical
      centers also use laser surgery to remove genital warts.

       Complications

              As mentioned above, scientists have found an association between several types of HPV and
      the development of cervical cancer, vulvar cancer, anal cancer, and cancer of the penis (a rare cancer).
      Much more research needs to be done to clarify the role of HPV in such cancers and to explore the
      possible role of other factors such as cigarette smoking, the use of oral contraceptives, and the
      presence of other STDs in increasing a person’s risk of developing genital cancers. Although most HPV
      infections do not progress to cancer, it is particularly important for women who have had evidence of HPV
      infection or genital warts to have regular Pap smears. Potentially precancerous 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.

       Infants born to women with genital warts can develop laryngeal papillomatosis (warts in the throat).
      Although a relatively rare occurrence, it is a potentially life-threatening condition for the child, requiring
      frequent laser surgery to prevent obstruction of the airways.

      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 a latex condom (rubber) during sexual intercourse may provide some protection.

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                               KENNETH GOODRICH, M.D.  -  OBSTETRICIAN- GYNECOLOGIST  
     
                                           Certified by the American Board of Obstetrics and Gynecology

           Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies
              and Uterine Fibroids, HPV treatment for Women and Men, Surgery on Obese Women,  Chronic Vaginal
              Discharges, Sexually Transmiited Diseases, Menopause, Abnormal Bleeding ,Cellulite Reduction and
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