Human Papillomavirus (HPV)

HPV stands for human papilloma virus, a virus group that includes over 100 different strains. It is transmitted to humans through sexual activity and affects over 75% of the sexually active population. In most cases, it is self-resolving but can also lead to more serious consequences if left untreated and infection persists.

WHO’S AT RISK

HPV is extremely common, especially in young, sexually active people. Risk increases in those with multiple sexual partners or those with sexual partners who have had multiple partners themselves. In the United States, about 20 million people are currently infected with HPV, many of them unknowingly.

SYMPTOMS

The noticeable symptoms of HPV infection vary greatly, primarily depending on type of HPV strain and the patient’s gender. Often, men with HPV present no signs of the disease at all, even though they are infected and can spread HPV to sexual partners. Symptoms and signs of the virus include:

Genital warts: The virus only infects the epithelial cells (surface of the skin and genitals), meaning that most symptoms appear superficially. Genital warts come in many different shapes and sizes but are most commonly seen as:

  • Bumps: tiny, raised, often skin colored
  • Distinct growths: visibly compared to cauliflower. These spots are generally localized to the anogenital region, which includes the vagina and anus in females and the penis and anus for males. Although rare, they can also occasionally be found in other mucous membranes, such as the mouth, tongue, or throat.

Pap smear abnormalities: There are strains of the virus known as high-risk HPV. These strains are more dangerous as they can cause pre-cancerous or cancerous lesions of the cervix, vagina, and/or vulva.  Fortunately, in the vast majority of cases, the problem is identified and treated before invasive cancer develops.

DIAGNOSIS

Doctors might test for HPV in response to noticeable signs and symptoms, such as genital warts or abnormal pap smears.

HPV testing can be completed when collecting a pap smear (co-testing) during a routine exam.

TREATMENT

If diagnosed, there are several different options available:

  • Observation: About 90% of cases clear up within 2 years of initial infection without any medical assistance or lifestyle changes. Given the prevalence of self-resolving cases, many times, the best prescription is just to “wait it out” with close follow up.
  • Cryosurgery: In the case of warts, extreme cold can be used to freeze off the abnormalities. These surgeries usually use liquid nitrogen.  Cryosurgery can also be used to treat cervical pre-malignant abnormalities caused by HPV, but the practice is declining in use and popularity.
  • Chemical destruction: A 75% Trichloroacetic acid (TCA) solution or the chemical resin, Podofilox, is topically applied to destroy the warts.
  • Imiquimod: Imiquimod bolsters the immune system, so it can better fight off the warts and safely be applied to the lesions.
  • Laser destruction of genital warts: This treatment is typically reserved for extensive infections.
  • LEEP: The Loop Electrosurgical Excision Procedure is the most utilized method to treat high-grade cellular abnormalities (pre-cancerous) of the cervix.  A wire loop attached to an electrosurgical generator is used to remove the lesion form the cervix.

SUMMARY

If a patient is diagnosed with HPV, it is highly recommended to notify past sexual partners. Even if safe sex practices were used, the virus can still be acquired. Abstinence is the only surefire way to avoid HPV, but continuous check-ups and smart sexual lifestyle decisions can make a huge difference as well. In addition, prevention of infection through vaccination against the Human Papilloma Virus can be undertaken.

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