Human papillomavirus (HPV)

Alternative names

Human papillomavirus, HPV, genital warts, condylomata acuminata, penile warts, venereal warts, condyloma.

Definition

Human papillomaviruses (HPVs) are a group of about 120 viruses. Over 30 types of HPV can be passed from one person to another through sexual contact. Other types cause the typical warts that occur on the hands of many children.

Some types of HPV cause genital warts – single or multiple bumps that appear in the genital areas of men and women including the vagina, cervix, vulva, penis, and rectum. These are considered low-risk types of HPV (specifically types 6 and 11).

High-risk types of HPV may cause cancer of the cervix, vulva, vagina, anus, or penis (specifically types 16 and 18).

Cause

HPV is a sexually transmitted infection (STI) and is contagious. The most common way to get HPV is by skin-to-skin contact during oral, vaginal or anal sex with someone who has HPV.

Any sexually active person can acquire HPV. Whether you become infected with HPV is largely dependant on your immune system and the presence of certain co-factors that might put you at an increased risk for getting genital warts and other complications of HPV. These factors include:

• Multiple sexual partners
• Not knowing if someone you had sex with had STIs
• Early age when you start being sexually active
• Tobacco and alcohol use
• Stress and other viral infections (such as HIV or herpes) at the same time

Symptoms

In women, genital warts occur on the outside and inside of the vagina, on the opening to the uterus (known as the cervix), or around the anus.

In men, genital warts are less common. If present, they usually are seen on the tip of the penis. They may also appear on the shaft of the penis, on the scrotum, or around the anus.

Rarely, genital warts can also develop in your mouth or throat if you have oral sex with an infected person.

Like many STIs, genital HPV infections often do not have signs and symptoms that you can see or feel. One study reported that almost half of women infected with HPV had no obvious symptoms.

Diagnosis

In the majority of cases HPV is not diagnosed as the infection is not clinically apparent. Only once warts develop or a woman develops an abnormal Pap smear is the diagnosis of HPV infection made. This is why HPV infection is so common, because the majority of people with the infection don't ever know that they are infected and therefore do not take special precautions to prevent transmission.

Can transmission be prevented?

There have been no good studies assessing the role of condoms in preventing transmission of HPV, but recent analyses suggest that condoms may be up to 70% effective in prevention transmission of the virus. Remember, that while HIV is transmitted through semen and cervical and vaginal secretions, HPV is transmitted through skin-to-skin contact. So while the shaft of the penis may be protected by the condom, the skin of the scrotum and vulva is not.

The most effective method of preventing infection with HPV is to vaccinate against the virus. There are currently two vaccines against HPV infection licensed in South Africa. The one vaccine, Gardasil protects against genital warts and cancers associated with HPV and the other, Cervarix, protects only against cancers associated with HPV. These vaccines should be given to young people prior to the onset of sexual activity, ideally to young women and men over the age of 9 years. You should consult your doctor about the vaccination.

Treatment

There is no medication that directly kills the HPV virus. It can however be destroyed by using various topical agents or ointments.

There are treatments for genital warts, though the warts often disappear without treatment.

Depending on factors such as the size and location of the genital warts, there are various ways of treatment. Laser ablation or cauterisation is used for large genital warts, usually performed under general anaesthetic.

Your health care provider could prescribe a cream or solution to apply to the warts. If the warts are small, they can also be removed with one of the following methods:

• Freezing
• Burning
• Or topical agents such as podophyllin or trichloracetic acid
• Laser treatment

Large warts that are not respondent to other treatment may have to be removed surgically.

Although treatments can get rid of the warts, none get rid of the virus. Because the virus is still present in your body, warts often return after treatment.

Prognosis

With proper treatment, genital wart outbreaks can be controlled. However, the warts frequently reappear after treatment. Even after you have been treated for HPV, you may still infect others.

When to call your doctor

• When a current of past sexual partner is found to have genital warts.
• When you have visible warts on your external genitals, itching, discharge, or abnormal vaginal bleeding.

Reviewed by Professor Lynette Denny, Gynaecology Oncology Unit, Department Obstetrics & Gynaecology, University of Cape Town/Groote Schuur Hospital, 2010