What is HPV?

HPV is the virus that causes genital and anal warts, also sometimes called condyloma. It also causes cervical and anal cancer. There are over 100 types of HPV. The virus may cause wart-like bumps to form on the penis, in and around the vagina, on the cervix (opening to the uterus), and/or around the rectum. The virus is passed via skin-to-skin contact from one person to another during anal or vaginal sex. Warts caused by HPV are not the same warts commonly found on hands and feet, and one type of wart can not be passed from one body part (hands and feet) to another (genital area).

HPV is considered to be the most common STD in the U.S. People who have had unprotected sex with more than two partners in their lifetime have probably been exposed to the virus. It’s possible to have been exposed to the wart virus months or years before warts appear, or for symptoms never to appear at all after exposure.

How many people have it?

As mentioned above, HPV is considered the most common STD in the U.S. among both men and women. One study estimated that approximately 95 percent of HIV-positive gay men have been infected with HPV. That same study estimated that 65 percent of HIV-negative gay men have been infected with HPV. Those infections were usually in the anal canal or surrounding skin. As HPV is determined via clinical diagnosis without a confirmatory lab test, it is almost impossible to determine the exact number of people in San Francisco who have the virus.

Why worry about HPV?

There are many different types of HPV. Most are harmless – especially the ones which cause the external warts you can see. There are a few types, classified as high risk, which can cause changes in the cells of the cervix (opening to the uterus) or the cells of the anus and could lead to cancer. For this reason, it is recommended that all women should have a pap smear test every year. Federal health officials are currently considering recommending yearly anal pap smears for sexually active gay and bisexual men.

What are the symptoms?

Not everyone who has the wart virus will have visible warts. Warts may appear as wart-like growths or may be flat and only slightly raised from the skin. They may be single or multiple, small or large. They tend to be flesh-colored or whitish in appearance. Warts usually do not cause itching or burning.

Sometimes genital warts are so small that they cannot be seen with the naked eye. This is sometimes called “subclinical HPV.” This means that a person may not even know he or she has the type or types of HPV that cause genital warts.

What is an HPV test like?

A complete examination for HPV includes taking a sexual history and examining any symptoms you might be having. It can include an examination for genital warts, and in women, an evaluation for changes in the cells of the cervix caused by HPV.

Sometimes, warts can be very hard to see, even for a trained clinician. Also it can be hard to tell the difference between a wart and normal bumps on the genital area. Your medical provider may use a magnifying lens called a colposcope to see smaller warts. A biopsy is not necessary for diagnosing genital warts. This would only be done if the bump is unusual-looking or discolored.

Some medical providers put acetic acid (vinegar) on your genital area to check for warts. This would cause any warts present to turn white, making them easier to see, especially if they are viewed through a colposcope. However, the vinegar can sometimes cause normal bumps to be highlighted, so this method of diagnosis is no longer recommended or used at City Clinic.

The Pap test uses a small brush and spatula to sample cells from the cervix and place them in a small container with liquid. The specimen is then evaluated in the lab for early changes in the cells that could lead to cancer.

Blood tests are not used to diagnose HPV.

How is HPV treated?

Currently, there is no treatment to cure HPV. If you have it, it may live in your body forever. Treating the warts may possibly help reduce the risk of transmission to a partner who has never been exposed to the types of HPV you might be carrying.

There are several treatment options available for removing warts. The goal of any treatment should be to get rid of annoying symptoms. No particular treatment is best for all cases. When choosing what treatment to use, your health care provider will consider the size, location and number of warts, changes in the warts, your preference, cost of treatment, convenience, adverse effects, and their own experience with the treatments. Some treatments are done in a clinic or doctor’s office; others are prescription creams that can be used at home.

Treatments done in the doctor’s office include:

  • Cryotherapy: This is freezing off the wart with liquid nitrogen.
  • Podophyllin: A chemical compound to get rid of the warts. This is an older treatment and is not widely used today.
  • TCA (trichloracetic acid): Another chemical compound applied to the surface of the wart.
  • Cutting off warts: This has the advantage of getting rid of warts in a single office visit.
  • 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 be very expensive and is not available in all provider’s offices.

At-home creams available by doctor’s prescription:

  • Imiquimod cream (Aldara®): A self-applied treatment for external genital warts. Although expensive, it is safe, effective and easy to use. Aldara boosts the immune system to fight HPV.
  • Podofilox cream or gel (Condylox®): A self-applied treatment that destroys the tissue of external genital warts. It is inexpensive, easy to use and safe. The treatment period is about four weeks.

IMPORTANT: Over-the-counter wart treatments should not be used in the genital area. They will not be effective.

If a woman has an abnormal Pap test, there are also multiple evaluation and treatments that can be done, depending on the extent of the changes. This may involve repeating the test more frequently for close monitoring, colposcopy (looking carefully at the cervix with a magnifying lens) or carefully freezing or removing the abnormal area. If you have an abnormal Pap test your clinician will be able to discuss with you the best options in your particular case.

What can I do if I have HPV?

Some people have only one outbreak of warts, others have recurrences over time. Genital warts are most likely to be transmitted to your sex partners when the warts are actually present, but sometimes warts are too small to see with the naked eye. Very little is known about passing HPV to sex partners if the virus is present but no warts can be seen.

How do I avoid getting HPV?

Abstinence is the only way to completely avoid getting HPV and other STDs. If you’re sexually active, using condoms consistently and correctly for anal and vaginal sex is your best bet for staying sexually healthy. However, using condoms will only reduce your risk of getting warts from an infected partner because the wart virus can be on the skin near the vagina, rectum or penis – areas not always protected by a latexcondom. Some data suggest condoms reduce the risk of cervical cancer in women who have certain types of HPV. Also, condoms can reduce the risk of recurrent HPV in those who already have the virus. The HPV vaccine (Gardasil®) is approved for women and prevents infection with four types of HPV (see below).

What about the HPV vaccine?

There is an HPV vaccine (Gardasil®) that is very effective at preventing cervical cancer and genital warts. It is approved for use by men and women age 9-26 and is given as a series of three shots. If you are a woman age 18 or younger, you can get free HPV vaccine at City Clinic.